Neuropsychological assessment of traumatic brain injury: Current ethical challenges and recommendations for future practice

Threats to the integrity of psychological assessment: The misuse of test raw data and materials

In the practice of psychological assessment there have been warnings for decades by the American Psychological Association (APA), the National Academy of Neuropsychology (NAN), other associations, and test vendors, against the disclosure of test raw data and test materials. Psychological assessment occurs across several different practice environments, and test raw data is a particularly sensitive aspect of practice considering what it implicitly represents about a client/patient, and this concept is further developed in this paper. Many times, test materials are intellectual property protected by copyrights and user agreements. It follows that improper management of the release of test raw data and test materials threatens the scientific integrity of psychological assessment. Here the matters of test raw data, test materials, and different practice environments are addressed to highlight the challenges involved with improper releases and to offer guidance concerning good-faith efforts to preserve the integrity of psychological assessment and legal agreements. The unique demands of forensic practice are also discussed, including attorneys' needs for cross-examination and discovery, which may place psychologists (and other duly vetted evaluators) in conflict with their commitment to professional ethical codes and legal agreements. To this end, important threats to the proper use of test raw data and test materials include uninformed professionals and compromised evaluators. In this paper, the mishandling of test raw data and materials by both psychologists and other evaluators is reviewed, representative case examples, including those from the literature, are provided, pertinent case law is discussed, and practical stepwise conflict resolutions are offered.

The power of observation. Occupational therapists' descriptions of doing observations of people with cognitive impairments in the context of community practice

BACKGROUND

Observation is an important method for occupational therapists (OTs) to gather information on people's occupational performance; yet, not much research has been conducted on OTs' descriptions of doing observations in their practices.

AIMS

This study aimed to explore community OTs descriptions of doing observations during the assessment of persons with cognitive impairments.

MATERIAL AND METHODS

Nineteen OTs participated in focus group interviews. Thematic analysis with an inductive approach was performed.

RESULTS

Three themes were revealed during analysis, the value of doing unstructured observations, the importance of doing observations in familiar contexts, and the importance of experience, structure and competence when doing observation.

CONCLUSIONS AND SIGNIFICANCE

This study showed that the participants regarded observation as one of OTs' core competencies, and they described doing observations in different ways. The results emphasised the importance of doing unstructured observations in persons' familiar contexts when assessing persons with cognitive impairments. However, the participants highlighted the need for increasing OTs structure and competence through implementing more occupation-based standardised assessment tools for OTs in community services to facilitate evidence-based practice.

Key Factors in Decision Making for ECLS: A Binational Factorial Survey

Background

Extracorporeal life support (ECLS) provides support to patients with cardiopulmonary failure refractory to conventional therapy. While ECLS is potentially life-saving, it is associated with severe complications; decision making to initiate ECLS must, therefore, carefully consider which patients ECLS potentially benefits despite its consequences.

Objective

To answer 2 questions: First, which medically relevant patient factors influence decisions to initiate ECLS? Second, what are factors relevant to decisions to withdraw a running ECLS treatment?

Methods

We conducted a factorial survey among 420 physicians from 111 hospitals in Switzerland and Germany. The study included 2 scenarios: 1 explored willingness to initiate ECLS, and 1 explored willingness to withdraw a running ECLS treatment. Each participant responded to 5 different vignettes for each scenario. Vignettes were analyzed using mixed-effects regression models with random intercepts.

Results

Factors in the vignettes such as patients’ age, treatment costs, therapeutic goal, comorbidities, and neurological outcome significantly influenced the decision to initiate ECLS. When it came to the decision to withdraw ECLS, patients’ age, days on ECLS, criteria for discontinuation, condition of the patient, comorbidities, and neurological outcome were significant factors. In both scenarios, patients’ age and neurological outcome were the most influential factors.

Conclusions

This study provided insights into physicians’ decision making processes about ECLS initiation and withdrawal. Patients’ age and neurological status were the strongest factors influencing decisions regarding initiation of ECLS as well as for ECLS withdrawal. The findings may contribute to a more refined understanding of complex decision making for ECLS.