A randomized trial of a DWI intervention program for first offenders: intervention outcomes and interactions with antisocial personality disorder among a primarily American-Indian sample

BACKGROUND: Randomized trial evidence on the effectiveness of incarceration and treatment of first-time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI. METHODS: A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first-time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self-reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis. RESULTS: Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non-ASPD participants. CONCLUSIONS: Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American-Indian sample.     

Fieldwork in nursing research: positionality, practicalities and predicaments

AIMS: This paper draws on the literature to explore some of the issues of concern to nurses undertaking fieldwork in contemporary healthcare settings. BACKGROUND: The emergence of poststructuralist and postmodern perspectives has raised questions about ethnographic approaches, and problematized the role of researchers in the construction of plausible and credible ethnographic accounts. As a practice discipline, nursing needs to negotiate a thorny path between methodological purity and practical application, with nurse researchers required to take account of both philosophical and pragmatic concerns. DISCUSSION: There is general agreement that researching with an individual or group rather than researching on an individual or group is the more effective way to approach fieldwork. Feminist writers appear to have dealt with this issue best, advocating intimacy, self-disclosure, and reciprocity in encounters with research participants. The duality of the nurse researcher role; power and politics and the moral implications of fieldwork are acknowledged as factors influencing nurses in the planning and conduct of fieldwork. Nurses as researchers may be better equipped than other social researchers to deal with contingencies in the field. CONCLUSIONS: Laying the epistemological ground for the participant observer role during fieldwork and understanding its impact on the resultant ethnographic account is essential to methodological rigour in field research. Consideration of some of the practicalities and predicaments experienced by nurses as researchers when conducting fieldwork prior to going out into the field is an important research strategy and will facilitate methodological potency.     

Race and family history assessment for breast cancer

OBJECTIVE: Studies have demonstrated disparities in breast cancer screening between racial and ethnic groups. Knowledge of a woman's family history of breast cancer is important for initiating early screening interventions. The purpose of this study was to determine whether differences exist in the collection of family history information based on patient race. DESIGN: Cross-sectional patient telephone interview and medical record review. SETTING: Eleven primary care practices in the Greater Boston area, all associated with Harvard Medical School teaching hospitals. PARTICIPANTS: One thousand seven hundred fifty-nine women without a prior history of breast cancer who had been seen at least once by their primary care provider during the prior year. MEASUREMENTS AND MAIN RESULTS: Data were collected on patients regarding self-reported race, family breast cancer history information, and breast cancer screening interventions. Twenty-six percent (462/1,759) of the sample had documentation within their medical record of a family history for breast cancer. On multivariate analysis, after adjusting for patient age, education, number of continuous years in the provider's practice, language, and presentation with a breast complaint, white women were more likely to be asked about a breast cancer family history when compared to nonwhite women (odds ratio, 1.68; 95% confidence interval, 1.21 to 2.35). CONCLUSIONS: The majority of women seen by primary care providers do not have documentation of a family breast cancer history assessment within their medical record. White women were more likely to have family breast cancer information documented than nonwhites.     

Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users

Aim To test the effectiveness of motivational interviewing (MI) in comparison with drug information and advice in opportunistically securing reductions in drug‐related risk among young cannabis users not seeking help. Design Randomized controlled trial. Setting Eleven London Further Education colleges. Participants A total of 326 students aged 16–19 years who smoked cannabis weekly or more frequently. Interventions Participants were randomized to a single‐session intervention of MI or drug information and advice‐giving. Measurements Cannabis use, cigarette smoking and alcohol consumption and harm outcomes were assessed after both 3 and 6 months. Findings No differences were found between MI and drug information and advice, although MI fidelity was not high. There were wide‐ranging individual practitioner effects on observed outcomes and a practitioner–intervention interaction was detected in relation to cannabis cessation after 3 months. Change over time was more pronounced for cannabis use than for other drug use. Conclusions Further study of the nature and consequences of MI fidelity, and individual practitioner effects more generally, is needed. Advice may be an effective brief intervention with young cannabis users in its own right and should be evaluated further in trials.     

Clinician stance in the treatment of chronic eating disorders

Long‐term outcome studies of anorexia nervosa have shown that a significant number of individuals do not fully recover from their eating disorder symptoms. Individuals who develop chronic eating disorders may express either strong ambivalence about symptom reduction or a complete lack of interest in change. As a result, clinicians can find this group particularly challenging. This report expands upon a treatment stance based on principles of Motivational Interviewing that addresses difficulties typically encountered in working with this population. The stance outlines a mission statement and specific clinician behaviours that promote engagement and alliance with this group, including the communication of beliefs that foster client self‐acceptance, not making assumptions, being curious, active, and on the same side, and maximizing client responsibility for change. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.     

Enhancing brief cognitive-behavioral therapy with motivational enhancement techniques in cocaine users

Background

We investigated the impact of enhancing brief cognitive-behavioral therapy with motivational interviewing techniques for cocaine abuse or dependence, using a focused intervention paradigm.

Methods

Participants (n = 74) who met current criteria for cocaine abuse or dependence were randomized to three-session cognitive-behavioral therapy (CBT) or three-session enhanced CBT (MET + CBT), which included an initial session of motivational enhancement therapy (MET). Outcome measures included treatment retention, process measures (e.g., commitment to abstinence, satisfaction with treatment), and cocaine use.

Results

Participants who received the MET + CBT intervention attended more drug treatment sessions following the study interventions, reported significantly greater desire for abstinence and expectation of success, and they expected greater difficulty in maintaining abstinence compared to the CBT condition. There were no differences across treatment conditions on cocaine use.

Conclusions

These findings offer mixed support for the addition of MET as an adjunctive approach to CBT for cocaine users. In addition, the study provides evidence for the feasibility of using short-term studies to test the effects of specific treatment components or refinements on measures of therapy process and outcome.     

A Change Will Do You Good

The primary care physician is described as many things—generalist, information manager, chronic care coordinator, and specialist in disease prevention. But midlevel clinicians, the Internet, and self-motivated patients can provide most of these services quite ably on their own. Why, then, are we here? One indispensable role for the family doctor is to be an agent of change for our patients and our communities. Through the groundbreaking work of Michael Balint, William Miller, and Stephen Rollnick, we have a solid framework for understanding our role in the change process. It is through working with patients, however, that we learn of their extraordinary capacity for change—and by extension, ours.     

动机性访谈应用于种植义齿患者的护理效果

目的 观察动机性访谈应用于种植义齿患者的护理效果。方法 选择2022年3月-2023年3月合肥市口腔医院滨湖门诊部种植义齿患者120例,采用随机数字表法将其分为对照组和试验组,各60例。对照组采用常规安全教育,试验组采用动机性访谈,比较两组牙菌斑指数、牙龈指数合格率、口腔异味指数、修复体状况、满意度。结果 试验组牙菌斑指数为（1.37±0.36）分,低于对照组的（2.04±0.62）分（P＜0.05）;试验组牙龈指数合格率高于对照组（P＜0.05）;试验组口腔异味指数为（87.54±2.32）分,高于对照组的（78.02±2.49）分（P＜0.05）;试验组修复体完好率高于对照组（P＜0.05）;试验组满意率高于对照组（P ＜0.05）。结论 动机性访谈应用于种植义齿患者能有效减少牙菌斑指数,减轻口腔异味,提高牙龈指数合格率,提升修复体完好率与患者满意度。