语境与阅读语用能力的培养

语境是语用学研究最主要的课题之一 ,它的内涵主要包括上下文、社交及文化等语境知识。在阅读理解时 ,读者必须依赖语境 ,综合有效地运用各种语境知识 ,排除歧义 ,消除模糊 ,合理推断 ,达到全面且准确的理解。为此 ,阅读教学中应着力培养学生的语用能力 ,以文化导入为手段 ,不断提高学生运用文化等语境知识推断语用意义的能力     

Self-selected intensity exercise in the treatment of major depression: A pragmatic RCT

Objective. The purpose of the study was to determine the therapeutic effect of physical exercise for patients with unipolar depression. Participants took part in an 8-week walking/running aerobic exercise program at a local sports club. Methods. Forty-six outpatients aged 18–65 years and diagnosed with mild to severe depression (ICD-10 criteria) were randomly assigned to an intervention group or wait list. Treatment as usual was continued. The Hamilton Rating Scale for Depression (HRSD-17) served as the main outcome measure. Secondary outcome measures were Beck Depression Inventory (BDI-II), Fitness Index (FI), and VO₂ max as estimated by Urho Kaleka Kekkonen or UKK 2-km Walk Test. Results. Out of forty-six participants, 24% dropped out. Participants attended 58% of exercise sessions. All randomized participants were included in intention-to-treat (ITT) analysis. Analysis of covariance or ANCOVA showed a large reduction of depressive symptoms in HRSD-17 scores (Cohen's d: 1.8; mean change 8.2, p < .0001). BDI-II (Cohen's d: 0.50; mean change: 4.7, p = 0.09), FI scores (Cohen's d: 0.27; mean change: 5.3, p = 0.08), and VO₂ max did not change significantly. Conclusions. We observed a large and clinically significant change in HRSD-17 scores. Moderate changes in BDI-II scores without clinical significance and small changes in physical fitness assessments were observed.     

NT-proBNP to exclude heart failure in primary care – a pragmatic,cluster-randomized study

Abstract

Heart failure (HF) is difficult to recognize in primary care. N-terminal pro B-type natriuretic peptide (NT-proBNP) can be used as a rule-out test in HF due to its high negative predictive value. We aim to determine whether the number per 1000 patients of HF diagnoses increase among patients referred from primary care to an outpatient HF clinic, if general practitioners (GPs) were offered NT-proBNP in a real-life setting. All GP practices covered by Randers Regional Hospital were randomized to an intervention group (34 GP practices) and a control group (35 GP practices) in this pragmatic, cluster-randomized controlled trial. The main outcome was the number of patients referred to echocardiography and diagnosed with HF in each group. The number of patients per 1000 diagnosed with HF in the two groups was the same (0.09 (0.02–0.16) vs. 0.14 (0.07–0.21), p?=?.3541). A total of 700?NT-proBNP analyses, of which 611 were unique, were requested from 31 GP practices in 17.5?months. A total of 184 patients were referred to echocardiography on suspicion of HF. The number of patients per 1000 referred in the intervention group was significantly higher (p?p?=?.019). Hence, increased diagnostic effectiveness could not be shown in this real-life setting.     

Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities

Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.     

Describing Self‐Care Self‐Efficacy: Definition,Measurement, Outcomes,and Implications

PURPOSE

The pragmatic utility method of concept analysis was used to explore the usefulness of the concept self‐care self‐efficacy.

DATA SOURCES

Empirical studies across disciplines published between 1996 and 2015 were used as data.

DATA SYNTHESIS

A data matrix was developed. Analytical questions and responses were derived from the data to understand patterns, develop new knowledge and achieve synthesis.

CONCLUSION

Usefulness of the concept is contingent on how it is defined and measured. Self‐care self‐efficacy is associated with performance of self‐care activities and positive health outcomes in diverse populations.

IMPLICATIONS

Research can guide development of targeted interventions to increase patients' self‐care self‐efficacy, thus reducing costs, and assisting people to achieve optimal health.     

Medical Rehabilitation: Guidelines to Advance the Field With High-Impact Clinical Trials

The purpose of this Special Communication is to summarize guidelines and recommendations stemming from an expert panel convened by the National Institutes of Health, National Center for Medical Rehabilitation Research (NCMRR) for a workshop entitled The Future of Medical Rehabilitation Clinical Trials, held September 29-30, 2016, at the NCMRR offices in Bethesda, Maryland. The ultimate goal of both the workshop and this summary is to offer guidance on clinical trials design and operations to the medical rehabilitation research community, with the intent of maximizing the effect of future trials.