Is parenting the mediator of change in behavioral parent training for externalizing problems of youth?

Change in parenting behavior is theorized to be the mediator accounting for change in child and adolescent externalizing problems in behavioral parent training (BPT). The purpose of this review is to examine this assumption in BPT prevention and intervention programs. Eight intervention and 17 prevention studies were identified as meeting all criteria or all but one criterion for testing mediation. Parenting behaviors were classified as positive, negative, discipline, monitoring/supervision, or a composite measure. Forty-five percent of the tests performed across studies to test mediation supported parenting as a mediator. A composite measure of parenting and discipline received the most support, whereas monitoring/supervision was rarely examined. More support for the mediating role of parenting emerged for prevention than intervention studies and when meeting all criteria for testing mediation was not required. Although the findings do not call BPT into question as an efficacious treatment, they do suggest more attention should be focused on examining parenting as a putative mediator in BPT.     

Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study

Background

GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation.

Objective

The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation.

Methods

The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation.

Results

Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%).

Conclusions

The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context.     

Influence of Exercise on the Metabolic Profile Caused by 28 days of Bed Rest with Energy Deficit and Amino Acid Supplementation in Healthy Men

Objective Muscle loss and metabolic changes occur with disuse [i.e. bed rest (BR)]. We hypothesized that BR would lead to a metabolically unhealthy profile defined by: increased circulating tumor necrosis factor (TNF)-α, decreased circulating insulin-like-growth-factor (IGF)-1, decreased HDL-cholesterol, and decreased muscle density (MD; measured by mid-thigh computerized tomography).Methods We investigated the metabolic profile after 28 days of BR with 8±6% energy deficit in male individuals (30-55 years) randomized to resistance exercise with amino acid supplementation (RT, n=24) or amino acid supplementation alone (EAA, n=7). Upper and lower body exercises were performed in the horizontal position. Blood samples were taken at baseline, after 28 days of BR and 14 days of recovery.Results We found a shift toward a metabolically unfavourable profile after BR [compared to baseline (BLN)] in both groups as shown by decreased HDL-cholesterol levels (EAA: BLN: 39±4 vs. BR: 32±2 mg/dL, RT: BLN: 39±1 vs. BR: 32±1 mg/dL; p<0.001) and Low MD (EAA: BLN: 27±4 vs. BR: 22±3 cm², RT: BLN: 28±2 vs. BR: 23±2 cm²; p<0.001). A healthier metabolic profile was maintained with exercise, including NormalMD (EAA: BLN: 124±6 vs. BR: 110±5 cm², RT: BLN: 132±3 vs. BR: 131±4 cm²; p<0.001, time-by-group); although, exercise did not completely alleviate the unfavourable metabolic changes seen with BR. Interestingly, both groups had increased plasma IGF-1 levels (EAA: BLN:168±22 vs. BR 213±20 ng/mL, RT: BLN:180±10 vs. BR: 219±13 ng/mL; p<0.001) and neither group showed TNFα changes (p>0.05).Conclusions We conclude that RT can be incorporated to potentially offset the metabolic complications of BR.     

The impact of cognitive training and mental stimulation on cognitive and everyday functioning of healthy older adults: A systematic review and meta-analysis

This systematic review and meta-analysis investigates the impact of cognitive training and general mental stimulation on the cognitive and everyday functioning of older adults without known cognitive impairment. We examine transfer and maintenance of intervention effects, and the impact of training in group versus individual settings. Thirty-one randomised controlled trials were included, with 1806 participants in cognitive training groups and 386 in general mental stimulation groups. Meta-analysis results revealed that compared to active controls, cognitive training improved performance on measures of executive function (working memory, p = 0.04; processing speed, p < 0.0001) and composite measures of cognitive function (p = 0.001). Compared to no intervention, cognitive training improved performance on measures of memory (face-name recall, p = 0.02; immediate recall, p = 0.02; paired associates, p = 0.001) and subjective cognitive function (p = 0.01). The impact of cognitive training on everyday functioning is largely under investigated. More research is required to determine if general mental stimulation can benefit cognitive and everyday functioning. Transfer and maintenance of intervention effects are most commonly reported when training is adaptive, with at least ten intervention sessions and a long-term follow-up. Memory and subjective cognitive performance might be improved by training in group versus individual settings.     

89例儿童孤独症语训练效果分析

目的：本文主要是探讨言语对孤独症儿童训练的效果。方法：对89例随机抽样的孤独症儿童,采用应用行为分析法（Applied Behavior Analysis,ABA）进行语言训练,比较孤独症儿童训练前后言语沟通的康复效果,包括发音吐词、词语表达、情感交流。结果：孤独症患儿系统接受综合康复训练后,言语水平明显优于未接受训练者,且越早干预,效果越好,两者具有非常显著的统计学差异（P〈0.01）。结论：语言培训尤其是早期系统语言干预可明显改善孤独症儿童言语沟通、人际交往及刻板、冲动行为。     

自信心团体治疗对焦虑症患者的干预效果

目的探讨自信心团体治疗对改善焦虑症患者焦虑症状与惧怕否定评价的效果。方法将70例焦虑症患者随机分为研究组和对照组。对研究组进行为期1个月的自信心团体治疗,对照组不采取任何干预措施。分别在干预前、干预后、干预后3个月对两组进行焦虑自评量表(SAS)和惧怕否定评价量表(FNE)评定,运用独立样本t检验、重复测量方差分析对数据进行处理,分析患者焦虑症状和惧怕否定评价的改善状况。结果 1在干预后,实验组的焦虑症状、对否定评价的恐惧显著低于对照组(t=-2.89,6.06;P0.01);2在干预后3个月,实验组的焦虑症状、对否定评价的恐惧显著低于对照组(t=-10.92,6.32;P0.01);3实验组干预后的焦虑症状、对否定评价的恐惧显著低于干预前,干预3个月后的焦虑症状、对否定评价的恐惧显著低于干预前,存在显著差异(F=43.704,49.102;P0.001);4对照组在干预前、干预后、干预后3个月3个测查点之间不存在显著差异。结论自信心团体治疗对改善焦虑症患者焦虑症状及克服对否定评价的恐惧有显著效果。     

能级循环培训对精神科护士自我效能感的影响

目的探讨对精神科护士实施能级循环培训的方法及效果。方法运用提高自我效能感途径的方法,对本院98名精神科护士进行为期1年的能级循环培训,于培训前后用一般自我效能感量表和护士压力源量表进行评分比较。结果精神科护士培训后护士压力源量表各方面评分均低于培训前,自我效能感平均得分高于培训前,培训前后比较差异有显著统计学意义(t=2.53~9.93,P0.05或0.01)。结论能级循环培训能够减轻精神科护士的工作压力,提高精神科护士的自我效能感,从而提高工作能力。     

基于坐位平衡的虚拟康复训练系统软件设计

摘要：目的：为了克服脑卒中患者在坐位康复训练过程中因重复训练所产生的厌倦心理。本研究设计了一种用于坐位平衡功能训练的虚拟康复训练系统软件,旨在增加患者坐位康复训练的趣味性,激发患者主动训练的积极性,使康复训练可以取得更好的治疗效果;方法：本系统采用上下位机结构,上下位机之间通过蓝牙串口进行通信,软件基于Microsoft的Di-rectX接口进行设计,采用vc＋＋进行编程,使用纹理映射技术实现了地面场景的加载和渲染,并从．x文件中加载人物网格信息并对其渲染,根据下位机坐板上四个压力传感器的压力控制虚拟人的运动;结果：实现了患者通过调整身体重心来控制虚拟训练环境中虚拟人沿指定路径行走的功能。能同时给与病人视觉和听觉的双重刺激;结论：本系统软件可以提高病人坐位平衡康复训练的积极性,对需要进行长期康复训练的病人能起到更好的治疗效果。     

Clinical competence in developmental‐behavioural paediatrics: Raising the bar

For our specialist paediatric workforce to be suitably equipped to deal with current childhood morbidity, a high level of competence in developmental‐behavioural paediatrics (DBP) is necessary. New models of training and assessment are required to meet this challenge. An evolution of training in DBP, built around the centrepiece of competency‐based medical education, is proposed. Summative assessment based upon entrustable professional activities, and a menu of formative workplace‐based assessments specific to the DBP context are key components. A pilot project to develop and implement these changes is recommended.