Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility

Objectiveto implement use of Roberts’ Coping with Labor Algorithm^© (CWLA) with laboring women in a large tertiary care facility.Designthis was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation.Settingthe project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year.Participantsfull, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change.Findingsa majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice.Implications for practicethis work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.     

马加爵仇恨杀友的行为及心理过程研究

目的为了探讨和预防类似马加爵仇恨杀友的行为和心理规律,加强对大学生的心理和思想政治教育．使他们健康成长为社会主义事业的接班人和建设者。方法通过社会、学校调查,依据相关的理论,借鉴相关的文献、资料以及定性、定量分析等方法研究马加爵仇恨杀友的行为和心理过程。结果马加爵仇恨杀友的行为过程：预谋策划阶段,周密实施阶段,精心逃跑阶段。马加爵仇恨杀友的心理过程：萌发阶段——自卑心理,发展阶段——压抑心理,爆发阶段——绝望心理。从马加爵残酷杀害学友中得到的启示。结论只要大学生的心理健康和思想政治教育等工作到位,马加爵杀人犯罪的行为是完全可以预防和避免的。     

Single-trial event-related potentials and autonomic measures of the orienting reflex

We aimed to clarify the event-related potentials (ERPs) associated with elicitation and habituation of the basic Orienting Reflex (OR). Participants were presented with 16 innocuous tones, alternating in intensity, at long variable inter-stimulus intervals, with no task. This allowed us to examine stimulus novelty and intensity effects in the absence of stimulus-related task demands. Single-trial ERPs were extracted to obtain estimates of the early N1 and the late positive complex (LPC) to each stimulus. Electrodermal responses showed substantial main effects of trials and intensity, supporting their functionality as an OR index. Cardiac deceleration showed no systematic change with intensity or trials, suggesting that it marks the transient onset of each stimulus, early in the stimulus-processing sequence. Respiratory pause showed a substantial main effect of trials but no intensity effect, suggesting that it reflects an intermediate processing stage. A main effect of intensity, but no simple trial effect, was apparent in the N1, suggesting that it reflects a different intermediate processing stage. The subsequent LPC showed only a topographic interaction with trials and intensity, failing to support any substantive role in OR processing. These different stimulus-response profiles are discussed in the context of a sequential processing model of the OR.     

多层迷走神经理论及其临床价值

目的介绍Porges的多层迷走神经理论及其临床应用价值,为临床心理干预提供借鉴。方法利用文献法,查阅Porges理论相关文献,综述其理论的核心思想。结果多层迷走神经理论具有坚实的研究基础,能够解释大量临床心理现象。结论Porges多层迷走神经理论给我们提供了一个新的理解人类心理的视角,具有较广阔的应用价值。     

A theoretical framework for measuring knowledge in screening decision aid trials

Objective

To describe a theoretical framework for assessing knowledge about the possible outcomes of participating in bowel cancer screening for the faecal occult blood test.

Methods

The content of the knowledge measure was based on the UK General Medical Council's screening guidelines and a theory-based approach to assessing gist knowledge (Fuzzy Trace Theory). It comprised conceptual and numeric questions to assess knowledge of the underlying construct (e.g. false positive concept) and the approximate numbers affected (e.g. likelihood of a false positive). The measure was used in a randomised controlled trial involving 530 adults with low education, to compare the impact of a bowel screening decision aid with a screening information booklet developed for the Australian Government National Bowel Cancer Screening Program.

Results

The numeric knowledge scale was particularly responsive to the effects of the decision aid; at follow-up decision aid participants’ numeric knowledge was significantly greater than the controls (P < 0.001). This contrasts with the conceptual knowledge scale which improved significantly in both groups from baseline to follow-up (P < 0.001).

Conclusion

Our theory-based knowledge measure was responsive to change in conceptual knowledge and to the effect on numeric knowledge of a decision aid.

Practice implications

This theoretical framework has the potential to guide the development of knowledge measures in other screening settings.     

基于计划行为理论及学习倦怠感的考试作弊行为

目的探讨计划行为理论模型及学习倦怠感对作弊意向与行为的预测。方法采用基于计划行为理论的考试作弊意向量表和学习倦怠感量表对四川省6所高校的228名大二～大四学生做调查,并自我报告大学期间的考试作弊行为频数。结果①有60.1%的被试报告自己有过作弊行为;②学习倦怠感与计划行为理论模型呈显著的正相关;③作弊行为的意向及实际发生情况与计划理论模型(t=4.603,8.061;P<0.001)及学习倦怠感(t=4.142,4.753;P<0.001)的得分均存在显著差异。结论学习作弊是大学校园较为普遍的问题;计划行为理论模型及学习倦怠感能有效评估考试作弊意向及预测作弊行为。     

Learning in Psychotherapy Group Supervision: Transcending Complementarity and the Generative Potential of Group Conflict

At the site of interpersonal conflict resides the potential for learning. This paper presents psychodynamic theories, empirical research and a fictional case study of psychotherapy group supervision. Supervision is discussed in terms of teaching and learning, triangular relations, and group and organizational perspectives. We examine the interconnectedness of patterns of distress that emerge within dynamic relational systems at the levels of the macro‐social, organizational, group and individual. The concepts of equivalence, parallel process and reflection process provide frameworks for this discussion. We explore the constraints and dynamic influence of the organization upon the supervision relationship and the ethical tensions that construct im/possible positions for the supervisor. The case study tells a fictional story of a supervision group situated in an organizational context – a university psychotherapy education programme. A collapse of the group into complementarity, that is into polarized conflicted positions, proffers a vitalizing opportunity for learning. Through the clinical discussion, we reveal how this is contingent on the group's capacity to think together about the meaning of their struggle and to transcend a binary conflict and achieve ‘the third’.     

大学生考试作弊行为意向问卷初步编制

目的编制大学生考试作弊行为意向问卷。方法根据计划行为理论的假设构建大学生考试作弊行为意向问卷结构,通过开放式问卷调查获得作弊行为的突显信念编制问卷;检验问卷的信度和效度。结果问卷的内部一致性系数为0.88,各维度的内部一致性系数在0.71~0.88之间;验证性因素分析显示,问卷各拟合指数（RM SEA=0.059,NF I=0.95,CF I=0.97）均达到可接受的水平。结论编制的大学生考试作弊行为意向问卷具有较好的信度和效度;对作弊行为的态度、主体规范以及知觉行为控制对改变作弊行为具有指向性。     

Toward a new methodological paradigm for testing theories of health behavior and health behavior change

Objective

Traditional theory testing commonly applies cross-sectional (and occasionally longitudinal) survey research to test health behavior theory. Since such correlational research cannot demonstrate causality, a number of researchers have called for the increased use of experimental methods for theory testing.

Methods

We introduce the multi-methodological theory-testing (MMTT) framework for testing health behavior theory.

Results

The MMTT framework introduces a set of principles that broaden the perspective of how we view evidence for health behavior theory. It suggests that while correlational survey research designs represent one method of testing theory, the weaknesses of this approach demand that complementary approaches be applied. Such approaches include randomized lab and field experiments, mediation analysis of theory-based interventions, and meta-analysis.

Conclusion

These alternative approaches to theory testing can demonstrate causality in a much more robust way than is possible with correlational survey research methods. Such approaches should thus be increasingly applied in order to more completely and rigorously test health behavior theory.

Practice implications

Greater application of research derived from the MMTT may lead researchers to refine and modify theory and ultimately make theory more valuable to practitioners.     

The psychophysiology of medical communication. Linking two worlds of research

Objective

Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports.The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior.

Methods

In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication.

Conclusion

This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system.

Practice implications

When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.