Measuring the social interactions of people with traumatic brain injury and their communication partners: The adapted Kagan scales

Background: Considerable attention has been given to the nature of communication impairments of individuals with TBI (Coelho, 2007 Coelho, C. A. 2007. Management of discourse deficits following traumatic brain injury: Progress, caveats, and needs. Seminars in Speech & Language, 28(2): 122–135.  [Google Scholar]; Ylvisaker, Turkstra, & Coelho, 2005 Ylvisaker, M., Turkstra, L. S. and Coelho, C. 2005. Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research with clinical implications. Seminars in Speech & Language, 26: 256–267. [Crossref], [PubMed] , [Google Scholar]). However, there have been few data focusing on the way communication partners deal with the often distressing sequelae of TBI.

Aims: This study reports inter- and intra-rater reliability of the Adapted Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) for TBI interactions.

Method & Procedures: The MSC and MPC were adapted to reflect theoretical models of cognitive-communication support for people with TBI. A total of 10 casual and 10 purposeful TBI interactions were independently rated by two raters to establish inter-rater reliability and by one rater on two separate occasions to determine intra-rater reliability.

Outcomes & Results: Excellent inter-rater agreement was established on the MSC (ICC?=?0.85–0.97) and the MPC (ICC?=?0.84–0.89). Intra-rater agreement was also strong (MSC: ICC?=?0.80–0.90; MPC: ICC?=?0.81–0.92). Over 90% of all ratings scored within 0.5 on a 9-point scale.

Conclusions: This is the first scale to measure the communication partner during TBI interactions. It shows promise in evaluating communication partner training programmes.     

Evaluating the causes of impaired irony comprehension following traumatic brain injury

Background : Individuals with traumatic brain injury (TBI) are known to have difficulty in understanding non-literal language devices such as irony. There are at least two possible explanations for poor irony comprehension following TBI; first, deficits might be caused by a specific impairment to theory of mind (ToM) and, second, deficits could be attributed to more general impairment in executive functioning (EF). Aims : This study aimed to evaluate the role of ToM and EF in the ability to comprehend non-literal ironic jokes. Methods & Procedures. Participants were 16 individuals who had sustained a TBI and 16 age- and demographic-matched controls. The ability to make inferences about mental states was compared to inferential reasoning capacity more generally. Participants were also assessed on other aspects of EF thought to contribute to inference making (working memory, concept formation, and fluency). The extent to which scores on these tasks were associated with participants' ability to comprehend ironic jokes was assessed using correlational and regression analyses. Outcomes & Results : Participants with TBI were significantly impaired on tasks measuring both ToM and EF. ToM was not significantly associated with irony comprehension. Instead, inferential reasoning, more broadly defined, demonstrated the strongest association. None of the component EF tasks were associated with irony comprehension. Conclusions : The results of this study do not support the theory that a specific impairment to ToM causes poor irony comprehension in TBI. In contrast, general inferential reasoning was a strong and significant predictor.     

Can a health coaching intervention delivered during pregnancy help prevent excessive gestational weight gain?

This study evaluated: (1) the efficacy of a health coaching (HC) intervention designed to prevent excessive gestational weight gain (GWG); and (2) whether there were improved psychological, motivational, and behavioural outcomes for women in the HC intervention compared to a “usual care” control group. In this quasi-experimental study, 267 pregnant women ≤18 weeks gestation were recruited between August 2011 and June 2013 from two hospital antenatal clinics in Melbourne, Australia. Intervention women received four individual HC and two group HC/educational sessions informed by theories of behaviour change. Women completed questionnaires assessing psychological, motivational and behavioural outcomes at 16–18 (baseline) and 33 (post-intervention) weeks gestation. Weight measures were collected. Compared to usual care, the intervention did not limit GWG or prevent excessive GWG. However, HC women reported greater use of active coping skills post-intervention. Despite lack of success of the HC intervention, given the risks associated with excessive weight gain in pregnancy, health professionals should continue to recommend appropriate GWG.     

Identifying Change Targets for Posttraumatic Stress Disorder Among Suicidal and Self-Injuring Women With Borderline Personality Disorder

Research on psychotherapies for posttraumatic stress disorder (PTSD) is increasingly focused on understanding not only which treatments work but why and for whom they work. The present pilot study evaluated the temporal relations between five hypothesized change targets—posttraumatic cognitions, guilt, shame, general emotion dysregulation, and experiential avoidance—and PTSD severity among women with PTSD, borderline personality disorder, and recent suicidal and/or self-injurious behaviors. Participants (N = 26) were randomized to receive 1 year of dialectical behavior therapy (DBT) with or without the DBT prolonged exposure (DBT PE) protocol for PTSD. Potential change targets and PTSD were assessed at 4-month intervals during treatment and at 3-month posttreatment follow-up. Time-lagged mixed-effects models indicated that between-person differences in all change targets except guilt were associated with more severe PTSD, η²s = .32–.55, and, except for general emotion dysregulation, slowed the rate of change in PTSD severity over time, η²s = .20–.39. In DBT but not in DBT + DBT PE, individuals with higher levels of guilt and experiential avoidance relative to their own average had more severe PTSD at the next assessment point, η²s = .12–.25. The associations between the proposed change targets and PTSD severity were not bidirectional, except for general emotion dysregulation, η² = .50; and posttraumatic cognitions, η² = .06. These preliminary findings suggest that trauma-related cognitions, shame, and guilt, as well as problems regulating them, may be important change targets for improving PTSD in this patient population.     

Prevalence of blood donation eligibility in Australia: A population survey

Background

Reliable estimates of the population proportion eligible to donate blood are needed by blood collection agencies to model the likely impact of changes in eligibility criteria and inform targeted population-level education, recruitment, and retention strategies. In Australia, the sole estimate was calculated 10+ years ago. With several subsequent changes to the eligibility criteria, an updated estimate is required.

Study Design and Methods

We conducted a cross-sectional national population survey to estimate eligibility for blood donation. Respondents were aged 18+ and resident in Australia. Results were weighted to obtain a representative sample of the population.

Results

Estimated population prevalence of blood donation eligibility for those aged 18–74 was 57.3% (95% CI 55.3–59.3). The remaining 42.7% (95% CI 40.7–44.7) were either temporarily (25.3%, 95% CI 23.5–27.2) or permanently ineligible (17.4%, 95% CI 16.1–18.9). Of those eligible at the time of the survey, that is, with the UK geographic deferral for variant Creutzfeldt-Jakob disease included, (52.9%, 95% CI 50.8–54.9), 14.2% (95% CI 12.3–16.3) reported donating blood within the previous 2 years. Eligibility was higher among men (62.6%, 95% CI 59.6–65.6) than women (52.8%, 95% CI 50.1–55.6). The most common exclusion factor was iron deficiency/anemia within the last 6 months; 3.8% (95% CI 3.2–4.6) of the sample were ineligible due to this factor alone.

Discussion

We estimate that approximately 10.5 million people (57.3% of 18–74-year-olds) are eligible to donate blood in Australia. Only 14.2% of those eligible at the time of survey reported donating blood within the previous 2 years, indicating a large untapped pool of potentially eligible blood donors.     

A validation study of two brief measures of depression in the cardiac population: the DMI-10 and DMI-18

The authors report on the psychometric characteristics and clinical efficacy of two versions of a recently developed screening measure of depression (the DMI-18 and DMI-10) in the cardiac population. Patients with acute coronary syndrome or heart failure (N = 322) completed the DMI measures, psychosocial questionnaires, and a semistructured clinical interview during the hospital stay. The DMI-18 and DMI-10 measures have adequate psychometric properties, demonstrating high sensitivity and specificity when evaluated against clinical judgment based on a semistructured interview. The DMI-18 and DMI-10 are appropriate for use as screening instruments in cardiac patients.     

The influence of patient-centered communication during radiotherapy education sessions on post-consultation patient outcomes

Objective

To adapt an observational tool for assessing patient-centeredness of radiotherapy consultations and to assess whether scores for this tool and an existing tool assessing patient-perceived patient-centeredness predict patient outcomes.

Methods

The Measure of Patient-Centered Communication (MPCC), an observational coding system that assesses depth of discussion during a consultation, was adapted to the radiotherapy context. Fifty-six radiotherapy patients (from 10 radiation therapists) had their psycho-education sessions recorded and coded using the MPCC. Patients also completed instruments assessing their perception of patient-centeredness, trust in the radiation therapist, satisfaction with the consultation, authentic self-representation (ASR) and state anxiety.

Results

The MPCC correlated weakly with patient-perceived patient-centeredness. The Feelings subcomponent of the MPCC predicted one aspect of ASR and trust, and interacted with level of therapist experience to predict trust. Patient-perceived patient-centeredness, which exhibited a ceiling effect, predicted satisfaction.

Conclusion

Patient-centered communication is an important predictor of patient outcomes in radiotherapy and obviates some negative aspects of radiation therapists’ experience on patient trust. As in other studies, there is a weak association between self-reported and observational coding of PCC.

Practice implications

Radiation therapists have both technical and supportive roles to play in patient care, and may benefit from training in their supportive role.     

Effectiveness of general practice-based health checks: a systematic review and meta-analysis

Background

A recent review concluded that general health checks fail to reduce mortality in adults.

Aim

This review focuses on general practice-based health checks and their effects on both surrogate and final outcomes.

Design and setting

Systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials.

Method

Relevant data were extracted from randomised trials comparing the health outcomes of general practice-based health checks versus usual care in middle-aged populations.

Results

Six trials were included. The end-point differences between the intervention and control arms in total cholesterol (TC), systolic and diastolic blood pressure (SBP, DBP), and body mass index (BMI) were −0.13 mmol/l (95% confidence interval [CI] = −0.19 to −0.07), −3.65 mmHg (95% CI = −6.50 to −0.81), −1.79 mmHg (95% CI = −2.93 to −0.64), and −0.45 kg/m² (95% CI = −0.66 to −0.24), respectively. The odds of a patient remaining at ‘high risk’ with elevated TC, SBP, DBP, BMI or continuing smoking were 0.63 (95% CI = 0.50 to 0.79), 0.59 (95% CI = 0.28 to 1.23), 0.63 (95% CI = 0.53 to 0.74), 0.89 (95% CI = 0.81 to 0.98), and 0.91 (95% CI = 0.82 to 1.02), respectively. There was little evidence of a difference in total mortality (OR 1.03, 95% CI = 0.90 to 1.18). Higher CVD mortality was observed in the intervention group (OR 1.30, 95% CI = 1.02 to 1.66).

Conclusion

General practice-based health checks are associated with statistically significant, albeit clinically small, improvements in surrogate outcome control, especially among high-risk patients. Most studies were not originally designed to assess mortality.