How to bridge the nurse innovation-diffusion gap? An in-depth case study of Create4Care

Introduction

Nurses frequently innovate in response to operational failures, regulations, procedures, and/or other workflow barriers that prevent them from delivering high-quality patient care. Unfortunately, most nurse innovations do not diffuse to a broader audience, depriving other nurses from taking advantage of solutions that have already been developed elsewhere. This under-diffusion is problematic from a societal and welfare point of view. The goal of this paper is to understand how diffusion shortage of nurse innovations can be reduced.

Methods

We develop a qualitative case study of a medical makerspace at the largest academic hospital in the Netherlands. This medical makerspace reported unusually high rates of nurse innovation diffusion. Our data collection includes on-site observations, archival data, secondary data, and fifteen in-depth interviews with key informants. Qualitative coding procedures and a combination of deductive and inductive reasoning are used to analyze the data.

Results

Our data show that personal, organizational, regulatory, and market barriers prevent nurses from further developing and diffusion their innovations in an anticipatory manner. That is, because nurses expect that transforming an initial solution into an innovation that can be shared with others will be too time consuming and difficult they do not proceed with the further development. The medical makerspace that we investigated adequately addresses this problem by developing an innovation ecosystem that largely takes over the innovation and diffusion process.

Discussion

We provide a concrete example of how a medical makerspace, and innovation support systems in a broader sense, can be designed to more adequately address the nurse innovation-diffusion gap. The two main elements of the practical solution that we identified are: (1) Support systems should facilitate that others may lead the development and diffusion of innovations and (2) The support system should promote that actors integrate their functional specializations within an innovation ecosystem. We make two theoretical contributions. First, we contribute to understanding barriers in the nurse innovation-diffusion process from a psychological point. Second, we identified that an ecosystem perspective is beneficial to develop innovation support systems in which diffusion occurs more often.

From a Symptom-Based to a Person-Centered Approach in Treating Depressive Disorders in Adolescence: A Clinical Case Formulation Using the Psychodynamic Diagnostic Manual (PDM-2)'s Framework

BACKGROUND

Depressive disorders in adolescence are among the most challenging clinical syndromes to diagnostically identify and treat in psychotherapy. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2) proposes an integration between nomothetic knowledge and an idiographic understanding of adolescent patients suffering from depression to promote a person-centered approach. This single-case study was aimed at describing and discussing the clinical value of an accurate diagnostic assessment within the PDM-2 framework.

METHOD

Albert, a 16-year-old adolescent with a DSM-5 diagnosis of major depressive disorder, was assessed using instruments from various perspectives: the Structured Clinical Interview for DSM-5; the Psychodynamic Chart-Adolescent of the PDM-2, and other clinician-report instruments; and the Shedler-Westen Assessment Procedure for Adolescents and Defense Mechanisms Rating Scale Q-sort, coded by external observers.

RESULTS

Albert's assessment revealed impairments in various mental capacities, especially in regulating self-esteem. He presented a borderline personality organization at a high level and an emerging narcissistic personality syndrome.

CONCLUSIONS

The case discussion showed the importance of providing clinically meaningful assessments to plan for effective treatments in youth populations. Especially, it is necessary to understand the adolescent's unique characteristics in terms of mental and personality functioning and consider the developmental trajectories and adaptation processes that characterize this specific developmental period.

How Speakers Orient to the Notable Absence of Talk: A Conversation Analytic Perspective on Silence in Psychodynamic Therapy

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence (1) can retroactively become part of a topic closure sequence, (2) can become shaped as an intra-topic silence, and (3) can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels.

Effects of ASL Rhyme and Rhythm on Deaf Children's Engagement Behavior and Accuracy in Recitation: Evidence from a Single Case Design

Early language acquisition is critical for lifelong success in language, literacy, and academic studies. There is much to explore about the specific techniques used to foster deaf children’s language development. The use of rhyme and rhythm in American Sign Language (ASL) remains understudied. This single-subject study compared the effects of rhyming and non-rhyming ASL stories on the engagement behavior and accuracy in recitation of five deaf children between three and six years old in an ASL/English bilingual early childhood classroom. With the application of alternating treatment design with initial baseline, it is the first experimental research of its kind on ASL rhyme and rhythm. Baseline data revealed the lack of rhyme awareness in children and informed the decision to provide intervention as a condition to examine the effects of explicit handshape rhyme awareness instruction on increasing engagement behavior and accuracy in recitation. There were four phases in this study: baseline, handshape rhyme awareness intervention, alternating treatments, and preference. Visual analysis and total mean and mean difference procedures were employed to analyze results. The findings indicate that recitation skills in young deaf children can be supported through interventions utilizing ASL rhyme and rhythm supplemented with ASL phonological awareness activities. A potential case of sign language impairment was identified in a native signer, creating a new line of inquiry in using ASL rhyme, rhythm, and phonological awareness to detect atypical language patterns.

The Influence of Interpersonal Patterns on the Therapy Process in a Case of Childhood Trauma

Research concerning the influence of core interpersonal patterns related to childhood trauma on the therapeutic process is scarce. We investigated interpersonal patterns at the start of treatment, changes in interpersonal patterns as treatment progressed, and the change process in a mixed-methods single case study of a supportive-expressive psychodynamic psychotherapy with a 33-year-old female with a history of childhood trauma. The patient showed a pervasive inability to open up towards others throughout the entire treatment, which is closely associated with others' actual or anticipated rejection, disrespect and disinterest. Excessive use of expressive interventions, which target interpersonal change, initially led to a worsening of the patient's condition. Via supportive and general interventions, symptom stabilization was achieved. The findings of this study suggest a thorough understanding of dominant interpersonal patterns is necessary to recognize their influence on the therapy process.

Capturing the Spatial Relatedness of Long-Distance Caregiving: A Mixed-Methods Approach

Long-distance caregiving (LDC) is an issue of growing importance in the context of assessing the future of elder care and the maintenance of health and well-being of both the cared-for persons and the long-distance caregivers. Uncertainty in the international discussion relates to the relevance of spatially related aspects referring to the burdens of the long-distance caregiver and their (longer-term) willingness and ability to provide care for their elderly relatives. This paper is the result of a first attempt to operationalize and comprehensively analyze the spatial relatedness of long-distance caregiving against the background of the international literature by combining a longitudinal single case study of long-distance caregiving person and semantic hierarchies. In the cooperation of spatial sciences and geoinformatics an analysis grid based on a graph-theoretical model was developed. The elaborated conceptual framework should stimulate a more detailed and precise interdisciplinary discussion on the spatial relatedness of long-distance caregiving and, thus, is open for further refinement in order to become a decision-support tool for policy-makers responsible for social and elder care and health promotion. Moreover, it may serve as a starting point for the development of a method for the numerical determination of the long-distance caregivers on different spatial reference scales.

Bilayer Mucoadhesive Buccal Film for Mucosal Ulcers Treatment: Development, Characterization, and Single Study Case

The formation of mucosal ulcers is an end result of epithelial damage, and it occurs due to some specific causes, such as trauma, aphthous stomatitis, lichen planus and lichenoid reactions, cytotoxic effects of chemotherapy and radiation, and drug-induced hypersensitivity reactions and malignant settings. This study focused on films for target drug delivery with respect to the treatment of the diseases of the oral mucosa, specifically mucositis. The results of a single clinical study as a pre-experimental design was performed and followed up to the outcome until 30 days. The polymeric film was prepared in a mucoadhesive bilayer structure: the basal layer with lidocaine HCl had a faster release than the apical layer with benzydamine HCl and N-acetyl-cysteine. Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), and SEM characterized the physical–chemical and morphological properties. The cell viability and cytotoxicity were evaluated in cell line MCF7. The transport mechanism of the solvent (swelling) and the drugs in the basal or apical layer (drug release) was explained with mathematical models. To evaluate the effect of movement inside the mouth, the folding endurance was determined. The mucoadhesive bilayer film is biologically safe and stimulates cellular proliferation. A single study in vivo demonstrated the therapeutic effect of the mucoadhesive bilayer film in buccal mucositis.

Lack of awareness despite complex visual processing: Evidence from event-related potentials in a case of selective metamorphopsia

Visual awareness is thought to result from integration of low- and high-level processing; instances of integration failure provide a crucial window into the cognitive and neural bases of awareness. We present neurophysiological evidence of complex cognitive processing in the absence of awareness, raising questions about the conditions necessary for visual awareness. We describe an individual with a neurodegenerative disease who exhibits impaired visual awareness for the digits 2 to 9, and stimuli presented in close proximity to these digits, due to perceptual distortion. We identified robust event-related potential responses indicating 1) face detection with the N170 component and 2) task-dependent target-word detection with the P3b component, despite no awareness of the presence of faces or target words. These data force us to reconsider the relationship between neural processing and visual awareness; even stimuli processed by a workspace-like cognitive system can remain inaccessible to awareness. We discuss how this finding challenges and constrains theories of visual awareness.

Look at Mummy: challenges in training parents to deliver a home treatment program for childhood apraxia of speech in a rural Canadian community

INTRODUCTION

Children requiring speech pathology services in rural and remote locations face many barriers in accessing adequate services. This has particular consequences for children who need intensive treatment for therapy to be effective, such those with childhood apraxia of speech (CAS). Parent training has been used to overcome speech pathology service delivery barriers for a range of other communication disorders. However, the effectiveness of training parents to deliver a motor-based treatment for CAS within rural and remote contexts has not been evaluated. This study examined the effectiveness and feasibility of training parents in a rural community to use the treatment approach of dynamic temporal and tactile cueing (DTTC) in order to provide more intensive treatment sessions at home.

METHODS

The study used an experimental single case across behaviours design and parent interviews to evaluate outcomes both quantitatively and qualitatively. The study included four parent-child dyads from a mixed socioeconomic rural community in Canada. Child participants ranged in age from 3 years to 8 years. Child treatment outcomes were measured using an improvement rate difference (IRD) calculation based on percentage of phonemes correct. Fidelity to the treatment protocol was measured using a fidelity score.

RESULTS

All parents reported challenges in carrying out the program due to social and behavioural challenges. Parents also reported benefits such as being able to spend more time with their child and learning some useful cueing techniques. Only one of the four participants had a moderate effect size for his target words (IRD=57%).

CONCLUSION

While training parents to deliver DTTC may be effective for some parent-child dyads, clinicians are advised that parent training may not be suitable for all families, and parents in rural and remote communities may face particular social circumstances that make following through with an intensive treatment program difficult.

Challenges and solutions for N-of-1 design studies in health psychology

Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.

Superior explicit memory despite severe developmental amnesia: In-depth case study and neural correlates

The acquisition of new semantic memories is sometimes preserved in patients with hippocampal amnesia. Robust evidence for this comes from case reports of developmental amnesia suggesting that low-to-normal levels of semantic knowledge can be achieved despite compromised episodic learning. However, it is unclear whether this relative preservation of semantic memory results from normal acquisition and retrieval or from residual episodic memory, combined with effortful repetition. Furthermore, lesion studies have mainly focused on the hippocampus itself, and have seldom reported the state of structures in the extended hippocampal system. Preserved components of this system may therefore mediate residual episodic abilities, contributing to the apparent semantic preservation. We report an in-depth study of Patient KA, a 27-year-old man who had severe hypoxia at birth, in which we carefully explored his residual episodic learning abilities. We used novel speeded recognition paradigms to assess whether KA could explicitly acquire and retrieve new context-free memories. Despite a pattern of very severe amnesia, with a 44-point discrepancy between his intelligence and memory quotients, KA exhibited normal-to-superior levels of knowledge, even under strict time constraints. He also exhibited normal-to-superior recognition memory for new material, again under strict time constraints. Multimodal neuroimaging revealed an unusual pattern of selective atrophy within each component of the extended hippocampal system, contrasting with the preservation of anterior subhippocampal cortices. A cortical thickness analysis yielded a pattern of thinner but also thicker regional cortices, pointing toward specific temporal lobe reorganization following early injury. We thus report the first case of superior explicit learning and memory in a severe case of amnesia, raising important questions about how such knowledge can be acquired.

Studying the Efficacy of Psychodrama With the Hermeneutic Single Case Efficacy Design: Results From a Longitudinal Study

Throughout the last decades, scientific and therapeutic communities have made common efforts to collect reliable information concerning the efficacy of psychotherapies. One of these initiatives has, recently, involved the psychodrama community and its desire to achieve progress in the validation of this therapy. Based on Robert Elliott's Hermeneutic Single Case Efficacy Design, we followed five participants (three women, two men, aged 27-48 years) of a psychodrama group over the course of their therapeutic process, which ranged from 24 months to 5 years. For the single case study, we selected the participant who had the longest data collecting record, including one follow-up. Participants generally reported improvement in their personal therapeutic goals, decrease in symptoms and life problems, and some showed a marked increase in spontaneity levels. In the single case, these results are confirmed, and following decision criteria it is possible to assert that the participant improved in all the variables assessed and that therapy is the main cause of these changes. Furthermore, the participant frequently rated psychodrama sessions as being helpful and stated they had a transformational impact on his life. This research contributes toward validating psychodrama as an efficient therapeutic method, hopefully stimulating practitioners to integrate therapy and research-which, for years, were considered independent and incompatible-and to facilitate their use in a complementary way.

Emotion-focused therapy for binge-eating disorder: A review of six cases

OBJECTIVE

This study aimed to provide preliminary evidence of the usefulness of emotion-focused therapy (EFT) for binge-eating disorder (BED).

METHODS

We used a single-subject design in which 12 weeks of individual EFT were applied nonconcurrently to six female adult participants with BED, following three weekly baseline sessions. Participants were assessed for binge-eating psychopathology and emotion regulation difficulties on a weekly basis during baseline and treatment. They were assessed on a 2-, 4-, and 8-week basis during posttreatment, and they were assessed for binge-eating episodes, eating disorder attitudes, alexithymia, and psychiatric comorbidity at pretreatment and posttreatment.

RESULTS

All cases experienced reliable recovery from binge-eating psychopathology and a significant decrease in binge-eating frequency. For all cases, there was reliable improvement or recovery on eating and shape concerns, and there was improvement on weight concern for the majority of cases. For all cases, reliable recovery or improvement occurred in overall emotion regulation. Most cases that were in the clinical range pretreatment recovered for anxiety, and reliable improvement in or recovery from depression occurred for all cases. There was reliable recovery or improvement in alexithymia for half of the cases; however, the other half experienced no change or deteriorated. There were no treatment dropouts.

CONCLUSION

Individual EFT demonstrates potential as a psychological treatment for BED. The current study provides preliminary evidence to guide the development of a more extensive trial to test the efficacy of individual EFT for BED as well as to identify possible mechanisms of change.

Enhanced Working Memory Binding by Direct Electrical Stimulation of the Parietal Cortex

Recent works evince the critical role of visual short-term memory (STM) binding deficits as a clinical and preclinical marker of Alzheimer’s disease (AD). These studies suggest a potential role of posterior brain regions in both the neurocognitive deficits of Alzheimer’s patients and STM binding in general. Thereupon, we surmised that stimulation of the posterior parietal cortex (PPC) might be a successful approach to tackle working memory deficits in this condition, especially at early stages. To date, no causal evidence exists of the role of the parietal cortex in STM binding. A unique approach to assess this issue is afforded by single-subject direct intracranial electrical stimulation of specific brain regions during a relevant cognitive task. Electrical stimulation has been used both for clinical purposes and to causally probe brain mechanisms. Previous evidence of electrical currents spreading through white matter along well defined functional circuits indicates that visual working memory mechanisms are subserved by a specific widely distributed network. Here, we stimulated the parietal cortex of a subject with intracranial electrodes as he performed the visual STM task. We compared the ensuing results to those from a non-stimulated condition and to the performance of a matched control group. In brief, direct stimulation of the parietal cortex induced a selective improvement in STM. These results, together with previous studies, provide very preliminary but promising ground to examine behavioral changes upon parietal stimulation in AD. We discuss our results regarding: (a) the usefulness of the task to target prodromal stages of AD; (b) the role of a posterior network in STM binding and in AD; and (c) the potential opportunity to improve STM binding through brain stimulation.

Psychotherapy with a 3-Year-Old Child: The Role of Play in the Unfolding Process

Few studies have investigated the outcomes and process of psychodynamic psychotherapies with children. Among the limited number of studies, some only paid attention to play and verbal production, as they are fundamental aspects in assessing the psychotherapy process. This paper focuses on an empirical investigation of a 3-year, once-a-week psychodynamic psychotherapy carried out with a 3-year-old girl. A process-outcome design was implemented to evaluate play and verbal discourse in in the initial, middle, and final parts of 30 psychotherapy sessions. Repeated measurements of standardized play categories (the Play Category System and the Affect in Play Scale-Preschool version) and verbal discourse (Verbal Production) were analyzed. To increase the clinical validity of the study, data from the assessment phase and vignettes from the sessions were reported to deepen the patient's picture during the unfolding therapy process. Parent reports before and after the therapy were also included. Empirically measured changes in play and verbal production were fundamental in evaluating the young patient's psychotherapy process. Verbal production and discourse ability progressively increased and took the place of play, which instead became more symbolic. Developmental issues as well as psychotherapy's influence on the patient's change, were discussed in relation to the role of play in enhancing the development of verbal dialog and the expression of the child's emotions, needs, and desires.

When the Single Matters more than the Group (II): Addressing the Problem of High False Positive Rates in Single Case Voxel Based Morphometry Using Non-parametric Statistics

In recent years, an increasing number of studies have used Voxel Based Morphometry (VBM) to compare a single patient with a psychiatric or neurological condition of interest against a group of healthy controls. However, the validity of this approach critically relies on the assumption that the single patient is drawn from a hypothetical population with a normal distribution and variance equal to that of the control group. In a previous investigation, we demonstrated that family-wise false positive error rate (i.e., the proportion of statistical comparisons yielding at least one false positive) in single case VBM are much higher than expected (Scarpazza et al., 2013). Here, we examine whether the use of non-parametric statistics, which does not rely on the assumptions of normal distribution and equal variance, would enable the investigation of single subjects with good control of false positive risk. We empirically estimated false positive rates (FPRs) in single case non-parametric VBM, by performing 400 statistical comparisons between a single disease-free individual and a group of 100 disease-free controls. The impact of smoothing (4, 8, and 12 mm) and type of pre-processing (Modulated, Unmodulated) was also examined, as these factors have been found to influence FPRs in previous investigations using parametric statistics. The 400 statistical comparisons were repeated using two independent, freely available data sets in order to maximize the generalizability of the results. We found that the family-wise error rate was 5% for increases and 3.6% for decreases in one data set; and 5.6% for increases and 6.3% for decreases in the other data set (5% nominal). Further, these results were not dependent on the level of smoothing and modulation. Therefore, the present study provides empirical evidence that single case VBM studies with non-parametric statistics are not susceptible to high false positive rates. The critical implication of this finding is that VBM can be used to characterize neuroanatomical alterations in individual subjects as long as non-parametric statistics are employed.

Theoretical pluralism in psychoanalytic case studies

The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynamic case studies (www.singlecasearchive.com) to inquire about their psychoanalytic orientation during their work with the patient. The response rate for this study was 45%. It appears that the two oldest psychoanalytic schools, Object-relations psychoanalysis and Ego psychology or "Classical psychoanalysis" dominate the literature of published case studies. However, most authors stated that they feel attached to two or more psychoanalytic schools of thought. This confirms that the theoretical pluralism in psychoanalysis stretches to the field of single case studies. The single case studies of each psychoanalytic school are described separately in terms of methodology, patient, therapist, or treatment features. We conclude that published case studies features are fairly similar across different psychoanalytic schools. The results of this study are not representative of all psychoanalytic schools, as some do not publish their work in ISI ranked journals.

A single case study of computerised cognitive training for older persons with mild cognitive impairment

The results of a multiple baseline single case study using computerised cognitive training in older adults with Amnestic Mild Cognitive Impairment (aMCI) are reported. Two participants each completed 40 sessions of training in two phases: an initial phase that trained attention, processing speed and cognitive flexibility, followed by a mixed memory and execution functions phase. It was hypothesised that participants would improve with practice on the trained tasks, that the benefits of training would generalise to non-trained neuropsychological probe measures, and that training would result in improved perceptions of memory and mood. Results indicated that one participant showed improved performance on untrained measures of attention and reasoning. On pre/post measures both participants reported less frequent cognitive failures in everyday life and improved mood following training. The results are discussed along with suggestions for future research.

Proper name anomia after right-hemispheric lesion: a case study

This study describes the case of CH, a 68-year-old left-handed woman who suffered a right temporo-parieto-occipital infarct in the territory of the middle cerebral artery and who exhibits severe proper name anomia. During the acute stage, CH was diagnosed with severe amnestic aphasia (Aachen Aphasia Test). Her lesion mirrors those of left hemisphere impairing the processing proper names, without an aphasic language disorder in general. Seven weeks later, language improved to a mild amnestic aphasia that currently does not interfere with her daily life. However, the use of proper names in both the visual and auditory modalities was still impaired and showed no improvement after 6 months of speech therapy. While not being able to name family members or familiar persons, she was, however, still able to describe the persons' backgrounds along with some additional semantic information. Furthermore, in a simple semantic design test, CH was selectively impaired in correctly classifying proper names into their respective word classes. Conversely, she was able to correctly name and classify other word categories (e.g., common nouns). In the subsequent study, we assessed the modalities "auditory comprehension," "picture naming," and "reading comprehension" and classified her responses in the categories "correctly named," "correctly classified," "correctly described attributes" (e.g., occupation) and "falsely named." The results were compared with those of an age-matched healthy control group. In the visual task, CH correctly named 80% of the visualized objects, 3% of the familiar persons and 15% of the familiar city views.

The circle of security parenting and parental conflict: a single case study

The Circle of Security Parenting (COS-P) is an early attachment based intervention that can be used with groups, dyads, and individuals. Created in the USA and now used in many countries, COS-P is a visually based approach that demonstrates its central principles through videos of parent/child interactions. The core purpose of the COS-P is to provide an opportunity for caregivers to reflect on their child's needs and on the challenges each parent faces in meeting those needs. Even though there is a wide range of clinical settings in which child/parent attachment is an important component of assessment there is limited empirical data on when and how attachment based interventions are appropriate for specific clinical profiles and contexts. The aim of this paper is to present a clinical application of COS-P in order to explore and reflect on some specific therapeutic tasks where it works and on some clinical indicators and contexts appropriate for its application. A single case study of a father, "M." (43 years old) in conflict for the custody of his 5 years old daughter is reported. The Adult Attachment Projective Picture System (AAP), the Parenting Stress Index, the Strengths and Difficulties Questionnaire, and the Parental Alliance Measure, were administered pre- and post-intervention. The clinical significance analysis method revealed that numerous changes occurred in the father. The AAP showed improvements in the level of agency of self. M. made gains in his capacity to use internal resources and to increase his agency of self. M. was classified as recovered in his perception of the child's functioning and as improved in his parenting stress and parenting alliance with the mother. Considerations on specific contexts and clinical indicators for the application of COS-P are proposed.

Profound loss of general knowledge in retrograde amnesia: evidence from an amnesic artist

Studies of retrograde amnesia have focused on autobiographical memory, with fewer studies examining how non-autobiographical memory is affected. Those that have done so have focused primarily on memory for famous people and public events—relatively limited aspects of memory that are tied to learning during specific times of life and do not deeply tap into the rich and extensive knowledge structures that are developed over a lifetime. To assess whether retrograde amnesia can also cause impairments to other forms of general world knowledge, we explored losses across a broad range of knowledge domains in a newly-identified amnesic. LSJ is a professional artist, amateur musician and history buff with extensive bilateral medial temporal and left anterior temporal damage. We examined LSJ's knowledge across a range of everyday domains (e.g., sports) and domains for which she had premorbid expertise (e.g., famous paintings). Across all domains tested, LSJ showed losses of knowledge at a level of breadth and depth never before documented in retrograde amnesia. These results show that retrograde amnesia can involve broad and deep deficits across a range of general world knowledge domains. Thus, losses that have already been well-documented (famous people and public events) may severely underestimate the nature of human knowledge impairment that can occur in retrograde amnesia.

Analysis of cursive letters, syllables, and words handwriting in a French second-grade child with Developmental Coordination Disorder and comparison with typically developing children

Poor handwriting is a core deficit in Developmental Coordination Disorder (DCD). In a previous study, we compared the evolution of cursive letters handwriting in a girl with DCD throughout her second-grade year with that of typically developing (TD) children. We found that her handwriting evolved much less than that of TD children and remained similar to that of pre-schoolers at all stages, suggesting that her handwriting skills have reached a steady state level. We present here a continuation of this work, in which we focused on the velocity aspects of handwriting in another French child with DCD. Indeed, different velocity patterns have been observed in Chinese and English children with DCD. In the French cursive style of writing, consecutive letters are joined, a major difference with the English script style of writing. We thus analyzed the handwriting of a second-grade French girl with DCD, not only for isolated letters but also for syllables and words, in comparison to that of TD first-graders (6-7 years old; N = 85) and second-graders (7-8 years old; N = 88). Each written track was digitized, and nine kinematic parameters were measured to evaluate writing fluency. Results showed that the productions of the child with DCD were more similar to those of first-graders than to those of second-graders. In line with our previous study, the most discriminative parameters between the child with DCD and TD children were size and mean speed. Moreover, her handwriting was less fluent than that of TD children. In contrast to previous observations, we observed a higher writing velocity of the child with DCD when compared to TD children, whatever the complexity of the item, and no significant difference with TD children in the pausing time during writing. These differences may reflect linguistic specificities. For syllables and words, each letter was treated separately as a single unit, thus reflecting a problem in anticipation and automation.

Effectiveness of intensive, group therapy for teenagers who stutter

BACKGROUND

Treatment of adolescents who stutter is an under-researched area that would benefit from greater attention.

AIMS

To investigate whether an intensive treatment programme for older teenagers who stutter, aged over 16 years of age, is effective in reducing overt and covert aspects of stuttering.

METHODS & PROCEDURES

A repeated-measures, single-subject experimental design was replicated across participants. The study consisted of a 5-week baseline phase, 2-week intensive treatment phase, 5-week consolidation phase and 10-month follow-up phase. Participants were asked to make ten video recordings at home during each phase, while completing a reading and a conversation task. Recordings were analysed in terms of the percentage of stuttered syllables using a simplified time-series analysis. Participants completed self-report questionnaires at predetermined times throughout the study. Data are presented for three males aged 17;7, 17;11 and 18;10.

OUTCOMES & RESULTS

One participant completed all required recordings. Difficulties were encountered collecting follow-up data with the other two participants and data are available up to 5 months after the intensive therapy phase. A significant trend of reduced frequency of stuttering was found for all three participants during the intensive therapy phase. This trend continued throughout the consolidation phase and remained significant when available longer-term data were included in the analysis. Participants also reported increased self-efficacy about speaking and reduced overt and covert aspects of stammering.

CONCLUSIONS & IMPLICATIONS

Findings show that this therapy programme for teenagers had a significant treatment effect for the participants studied in the short- and medium-term, however longer-term data were not available for all participants. Issues in conducting research with this client group are discussed.

Metacognitive therapy in recurrent depression: a case replication series in Denmark

Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.

Being altered by the unexpected: understanding the perioperative patient's experience: a case study

The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study.