Stress management training in health psychology practice: Critical clinical issues.

Stress management training interventions have become one of the most popular treatment programs in health psychology practice. Although numerous clinical approaches are available, limited attention is given to the matching of intervention with the clinical needs of individuals. As a result, stress management programs are more frequently marketed in clinical and community settings as palliative techniques without sufficient exploration of the causes of stress. We review these concerns and highlight critical assessment and treatment variables that moderate the efficacy of specific stress management interventions. Suggestions for further research and guidelines for clinical practice are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unified Modeling Methodology for Construction Simulation

This paper discusses a new approach that will facilitate the use of simulation in the construction industry. Previous attempts in this regard have been hampered by the gap between the user and the simulation software, the power and flexibility of available tools, and the readiness of industry. A comprehensive new approach (referred to as the Unified Modeling Methodology), which addresses the complete needs of the construction simulationist, is detailed. It is based on several state-of-the-art concepts in addition to newly developed ones. This methodology also describes how all of these concepts can be combined together using object oriented principles. The methodology was used in the development of a complete simulation tool development and utilization environment called Simphony. Several case studies were performed to illustrate the advantages of the new approach.     

The study of intoxicant use and misuse in psychological and medical education: A basic curriculum.

Discusses factors responsible for the previous neglect of substance abuse by health care professions and describes changes that have made it possible to include this field in clinical education and training. Various factors contributed to the neglect of substance abuse, including the social, psychological, and political distance between clinicians and those with intoxicant problems; the disruptive impact of early psychoanalytic thinking; and clinicians' lack of faith in the efficacy of treatment. As a more treatment-oriented group developed intoxicant problems, treatment facilities and techniques improved, leading to a greater optimism about outcome among clinicians. These and other changes make further education in this field feasible and desirable. A sample curriculum is presented for a full year's course of 26 2-hr seminars on this topic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opening the Window of Sustainable Development to Future Civil Engineers

A recent survey by ASCE showed a major need for rebuilding the critical components of the nation’s aging infrastructure, such as roads and water-supply systems. To accomplish this major task, in addition to knowledge of basic civil engineering principles and techniques, future civil engineers need to be aware of the effects of planning, design, and construction on our environment. Specifically, a course needs to be developed for educating future civil engineers on concepts and techniques of protecting our natural resources, and planning for sustainable development and construction in an environmentally friendly manner. Specific topics can include modules on water resources and recycling in construction. The focus should be on teaching applications of new environmentally friendly concepts and techniques through case histories and real-world problems. Continuous evaluation of course content and methods of presentation should be made. The course should instill environmental awareness in the students’ minds such that in the future, the environment is considered as much a part of any decision-making process in the practice of civil engineering, as are mathematics or the physical sciences.     

Measuring the therapist's impact on the patient's therapeutic progress.

Describes methods and concepts developed by the Mount Zion Psychotherapy Research Group for empirically evaluating the pertinence or suitability of a therapist's interventions (behaviors) to a patient's particular problems, needs, and treatment goals. Intensive studies of 2 brief pychotherapy cases are presented. In these studies, patient-initiated critical incidents (tests) were identified, the case-specific accuracy of the therapist's responses to these incidents was rated, and the impact of these interventions on subsequent patient behavior was measured. The findings indicated that these patients tended to show improvement in the therapeutic process when the therapist's interventions were in accord with their particular problems and treatment goals. The application of this method to clinically relevant studies of psychotherapy is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The increase in angiotensin type-2 receptor mRNA level by glutamate stimulation in cultured rat cortical cells

Advanced practice nurses are challenged to assess comprehensively the value of their role and the impact of their practice. Value is defined as quality divided by cost. The correlations among the structure, strategies of care (process), and their objectives (outcome) are key to the assessment of the quality of care and the impact of the advanced practice nurse's role. Advanced practice nurses are challenged to provide high quality care for a competitive or decreased cost. For the profession of nursing, outcomes are the result of interventions based on the nurse's clinical judgment and theoretical, practical, or scientific knowledge. An evaluation model is presented that comprehensively measures the impact of advanced practice nurses on patients and families, and an example is presented. Using the model will give credibility and validity to the APNs' positive impact on the quality and financial outcomes of care for each patient and for entire patient populations.     

Changing paradigms from empirically supported treatment to evidence-based practice: A cultural perspective.

Psychotherapy research guidelines have a profound impact on research, training, and practice, and they also influence reimbursement decisions that can have ethical and legal consequences. Furthermore, research guidelines have implications for the treatment of culturally diverse groups. Unfortunately, these implications have often been overlooked. Therefore, this article contrasts the impact of two prominent research guidelines on the development of culturally sensitive psychotherapies: (a) empirically supported treatments (ESTs) developed in 1995 by the American Psychological Association’s (APA) Division 12 (Society of Clinical Psychology; Task Force on Promotion and Dissemination of Psychological Procedures, 1995), and (b) evidence-based practice in psychology (EBPP) developed by the APA (Task Force on Promotion and Dissemination of Psychological Procedures,2006) Presidential Task Force on Evidence-Based Practice. Although overall we believe that EBPP is more responsive to the needs and characteristics of culturally diverse groups, ESTs also have many strengths. As the cultural implications of research guidelines are better understood, researchers and clinicians will be able to more effectively advance the development of culturally sensitive evidenced-based psychological treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating quality and effectiveness in the promotion of health: approaches and methods of public health and social sciences

Health promotion and health education have often been limited to evaluation of the effectiveness of actions and programmes. However, since 1996 with the Third European Conference on Health Promotion and Education Effectiveness, many researchers have become interested in "quality assessment" and new ways of thinking have emerged. Quality assurance is a concept and activity developed in industry with the objective of increasing production efficiency. There are two distinct approaches: External Standard Inspection (ESI) and Continuous Quality Improvement (CQI). ESI involves establishing criteria of quality, evaluating them and improving whatever needs improvement. CQI views the activity or service as a process and includes the quality assessment as part of the process. This article attempts to answer the questions of whether these methods are sufficient and suitable for operationalising the concepts of evaluation, effectiveness and quality in health promotion and education, whether it is necessary to complement them with other methods, and whether the ESI approach is appropriate. The first section of the article explains that health promotion is based on various paradigms from epidemiology to psychology and anthropology. Many authors warn against the exclusive use of public health disciplines for understanding, implementing and evaluating health promotion. The author argues that in practice, health promotion: -integrates preventive actions with those aiming to maintain and improve health, a characteristic which widens the actions of health promotion from those of classic public health which include essentially an epidemiological or "risk" focus; -aims to replace vertical approaches to prevention with a global approach based on educational sciences; -involves a community approach which includes the individual in a "central position of power" as much in the definition of needs as in the evaluation of services; -includes the participation and socio-political actions which necessitate the use of varied and specific instruments for action and evaluation. With the choice of health promotion ideology, there exist corresponding theories, concepts of quality, and therefore methods and techniques that differ from those used until now. The educational sciences have led to a widening of the definition of process to include both "throughput and input", which has meant that the methods of needs analysis, objective and priority setting and project development in health promotion have become objects of quality assessment. Also, the modes of action and interaction among actors are included, which has led to evaluation of ethical and ideological aspects of projects. The second section of the article discusses quality assessment versus evaluation of effectiveness. Different paradigms of evaluation such as the public health approach based on the measurement of (epidemiological) effectiveness, social marketing and communication, and the anthropological approach are briefly discussed, pointing out that there are many approaches which can both complement and contradict one another. The author explains the difference between impact (the intermediate effects, direct or indirect, planned or not planned, changes in practical or theoretical knowledge, perceptions, and attitudes) and results (final effects of mid to long term changes such as changes in morbidity, mortality, or access to services or cost of health care). He argues that by being too concerned with results of programmes, we have often ignored the issue of impact. Also, by limiting ourselves to evaluating effectiveness (i.e. that the expected effects were obtained), we ignore other possible unexpected, unplanned and positive and negative secondary effects. There are therefore many reasons to: -evaluate all possible effects rather than only those lined to objectives; -evaluate the entire process rather than only the resources, procedures and costs; -evaluate the impact rather than results; -evalu     

Discharge planning for new mothers. At home everything is different

In the hope of discovering a user friendly resource applicable to the Clinical practice of all nurses, staff at Vancouver General Hospital experiment with the use of nursing protocols. Last year nurses on the neurological unit proposed that effective management of seizure patients could be further facilitated when expected standards of care were properly developed, implemented, utilized and evaluated in the form of a nursing protocol. A two phase study was conducted attempting to compare those patients admitted to the unit one year prior to the use of the protocol, with those admitted for one year following its implementation. The results of this study will be presented in relation to the effectiveness of the protocol on patient outcomes. As well, the unit nurses' response to working with the protocol will be reviewed.     

Gene therapy

In the last years there has been much progress in our understanding of molecular mechanisms in the pathogenesis of disease. In this review we provide an overview of gene therapy, its most actualized techniques for gene delivery, and we give specific examples of laboratory and clinical achievements to date. The development of methods for delivering genes to mammalian cells has stimulated great interest in the possibility of treating human disease by gene-based therapies. As a result, concepts and methods that would have been considered purely science fiction 50 years ago are now used in the treatment of diseases. The widespread application of gene therapy technology to many diseases is already breaking down the traditional boundaries of modern medicine. However, despite its progress, several key technical drawbacks need to be overcome before gene therapy can be used safely and effectively in clinical settings. Technological developments, particularly in the areas of gene delivery and cell transplantation, will be critical for the successful practice of gene therapy.     

An analysis of unmet need for HIV services: The Houston Study

HIV/AIDS is indicative of general institutional neglect that disproportionately affects minorities, poor, and underserved populations. Among women and minorities, HIV infection is associated with preexisting economic distress. Moreover, socioeconomic resources, gender, and race/ethnicity may determine access to medical and nonmedical services that affect disease progression. An analysis of data collected for the Ryan White Care Act needs assessment in Houston, Texas, was performed to assess the effects of socioeconomic and demographic factors on unmet needs for existing medical, social, and counseling services, adjusting for the effects of illness and substance abuse. Results indicated that lower income and Hispanic ethnicity were associated with the unmet need for medical services. Higher income was positively associated and African American ethnicity was negatively associated with the unmet need for social services. Also, higher income and private insurance were negatively associated with counseling services. The authors suggest that these latter findings may result from program eligibility requirements and respondents' hierarchy of needs, respectively.     

Central nervous system metastasis in breast cancer

BACKGROUND AND PURPOSE: Central nervous system (CNS) metastasis occurs in at least 30% of patients with breast cancer. Standard treatment is the same as in other solid tumors, though clinical behavior, and sensitivity to radiation therapy (RT) and to chemotherapy may differ considerably. Most of these patients die within a few months, but a substantial subgroup may survive a year or more. The last decade has given rise to new diagnostic methods, new surgical and radiotherapeutic techniques, and the clinical evidence of a chemotherapy permissive blood-brain barrier in CNS metastases. The literature was reviewed to assess the clinical impact of early diagnosis, recognition of prognostic factors, and of the recently developed therapeutic approaches. MATERIAL AND METHODS: Review of the literature on CNS involvement in breast cancer focusing on clinical studies on early diagnosis, new modes of treatment, and factors influencing outcome. RESULTS: Although randomized studies are still awaited, systemic chemotherapy seems a valuable alternative for RT of brain metastases in selected cases. In meningeal carcinomatosis, long survival may be independent of intraventricular chemotherapy. Neurotoxicity of intensive intraventricular treatment is considerable. In epidural metastasis, early diagnosis with prompt start of treatment remains the crucial factor for outcome. Radiation therapy is the mainstay of treatment of epidural metastasis, but new surgical techniques and even systemic chemotherapy should be considered in selected cases. CONCLUSIONS: Recognition of prognostic factors combined with appropriate use of various recently developed therapeutic possibilities will improve the clinical outcome including better local tumor control and less treatment-induced neurotoxicity in a considerable number of patients with CNS metastasis from breast cancer.     

Periodontics in the next millennium

This article prognosticates where periodontology will be in the next millennium. The forecasting of such events is wrought with confusion because such predictions are shadowed by bias, dogmatism, prejudice, experiences, and opinions from either a closed or open mind. The results of the survey from 101 periodontists reflect opinions from varied backgrounds, years of clinical experience, and individual levels of success or failure. The responses cannot be tested for accuracy or duplicated by another survey except to wait out the test of time for the year 2025. Clinicians will be challenged to make decisions on accepting new techniques and concepts as these are brought into the therapeutic fold of periodontics. The clinician will be met with new possibilities as a paradigm shift is inevitable for periodontal practice in the next millennium. After all, who would have thought in the 1960s, the soft tissue augmentation era, that 22 years later in 1982, the regeneration of the lost attachment apparatus (alveolar bone, cementum, and periodontal ligament) would become a reality. This survey strongly suggests that by the end of the first quarter of the twenty-first century, local delivery of antimicrobials, growth and differentiation factors, and root biomodification agents will have a major impact on the practice of periodontics. One thing is certain, in the next millennium, considering the responses from this survey, a new era in periodontics will be here. By the year 2025, the research, development, and dissemination of new periodontal knowledge will be beyond the imagination from what was considered usual and customary for the twentieth century.     

The psychological dimensions of arthritis.

Reviews the literature on the psychological assessment and therapy of persons with arthritis, focusing primarily on the diagnostic category of rheumatoid arthritis. Assessment has involved attempts to define an arthritic personality using psychoanalytic concepts, but more recently it has included the identification of stressors as precursive and exacerbative of disease and the measurement of the impact of arthritis on psychosocial and functional variables. Psychological or behavioral therapy strategies for pain and stress management, psychotherapy in group settings, and attention to medical compliance are among the sparsely reported treatment techniques. It is concluded that therapies that initially address the physical condition, as opposed to mental health needs, are likely to be most acceptable to the patient and most successful in outcome. (72 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children''s spiritual response: validation of the nursing diagnosis spiritual distress

A variety of new radiopharmaceutical agents have been introduced to probe myocardial function in vivo. This review will introduce these new techniques which have recently been available in Japan. Tc-99m perfusion imaging agents provide excellent myocardial perfusion images which may enhance diagnostic accuracy in the study of coronary artery disease. In addition, greater photon flux from the tracer permits simultaneous assessment of regional perfusion and function with use of first-pass angiography or ECG-gated acquisition. Positron emission tomography enables metabolic assessment in vivo. Preserved FDG uptake indicates ischemic but viable myocardium which is likely to improve regional dysfunction after revascularization. In addition, FDG-PET seems to be valuable for selecting a high risk subgroup. Recently I-123 BMIPP, a branched fatty acid analog, has been clinically available in Japan. Less uptake of BMIPP than thallium is often observed in the ischemic myocardium. Such perfusion metabolic mismatch which seems to be similarly observed in FDG-PET is identified in the stunned or hibernating myocardium with regional dysfunction. Both of them are likely to recover afterwards. Severe ischemia is identified as reduced BMIPP uptake at rest, suggesting its role as an ischemic memory imaging. I-123 MIBG uptake in the myocardium reflects adrenergic neuronal function in vivo. In the study of coronary artery disease, neuronal denervation is often observed around the infarcted myocardium and post ischemic region as well. More importantly, reduced MIBG uptake in these patients can identify high risk for ventricular arrhythmias and assess severity of congestive heart failure. These new techniques will provide insights into new pathological states in the ischemic heart disease and enable to select optimal treatment in these patients.     

Treating prison inmates with co-occurring disorders: an integrative review of existing programs

The tremendous growth in state and federal correctional populations has focused greater attention on the needs of mentally ill and substance abusing inmates. Although an estimated 3-11% of prison inmates have co-occurring mental health (psychotic and major mood) disorders and substance abuse disorders, few treatment programs are described in the literature and there is little available information regarding effective treatment strategies for this population. The current study provides an integrative review of seven 'dual diagnosis' treatment programs that recently have been developed in state and federal prisons. Many of these have evolved from existing substance abuse treatment programs and approaches. Key program components include an extended assessment period, orientation/motivational activities, psychoeducational groups, cognitive-behavioral interventions such as restructuring of 'criminal thinking errors', self-help groups, medication monitoring, relapse prevention, and transition into institution or community-based aftercare facilities. Many programs use therapeutic community approaches that are modified to provide (a) greater individual counseling and support, (b) less confrontation, (c) smaller staff caseloads, and (d) cross-training of staff. Research is underway in three of the seven sites to examine the effectiveness of these new programs.     

Lean Construction: From Theory to Implementation

This article compares the techniques developed for lean construction with those developed for lean manufacturing. Lean manufacturing and lean construction techniques share many common elements despite the obvious differences in their assembly environments and processes. Manufacturing plants and construction sites are different in many ways that might explain why lean production theories and practices do not fully fit the construction industry. Though many lean construction tools and elements are still in an embryonic state, lean construction techniques are gaining popularity because they can affect the bottom line of projects. Additionally, this paper presents a study of a construction project in which specific lean construction elements were tested. Each technique was evaluated in terms of its impact on the performance of the project. Based on the findings of the study, a new “lean assessment tool” is proposed to quantify the results of lean implementations. The assessment tool evaluates six lean construction elements: last planner, increased visualization, huddle meetings, first-run studies, five S’s, and fail safe for quality. This paper provides a simple and comprehensive approach that is transferable to any construction project.     

Medical risk report: improving patient management and record keeping through a problem-oriented approach

The problem-oriented record satisfies the needs of the contemporary practitioner by addressing the transition from diagnosis to treatment. The technique organizes collected data, identifies all patient problems (medical and dental), defines solutions and/or management of those problems, and documents treatment rendered. Predictably, the problem-oriented record will avoid problems associated with malpractice litigation, conform to regulations of third-party payers, and facilitate practice analyses and quality assessment, i.e., through computer-assisted tracking of patient care based on problems and not just treatment rendered. As many practices today focus on a "patient-centered" approach to practice, the problem-oriented record clearly supports such a philosophy in its completeness of managing patient care information. The dentist, in consultation with other health care providers, can and should feel confident treating patients from the growing population of patients with medical risk. By integrating the problem-oriented approach into patient management and record keeping, dentists can more easily develop a plan for the complexities that accompany patients. Whether these complexities are of a medical, dental, or combined nature, the problem-oriented record helps the practitioner organize information, plan for treatment, and document patient care in a complete and concise manner.     

Practicing clinical psychologists’ provision of sexual health care services.

Practicing clinical psychologists are likely to work with sexual health concerns as part of their clinical practice because of high prevalence rates and sexual problems as symptoms of mental or physical health problems and their pharmacological treatment. However, the majority of clinicians do not receive didactic or supervised clinical training. This survey of 188 practicing clinical psychologists in one Canadian city confirmed that, despite lack of training, many clinicians discussed sexual health concerns with their clients and used a variety of sex therapy techniques. This survey also revealed, however, that 60% of clinicians did not ask, or very infrequently asked, clients about sexual health. In general, lack of training affected level of comfort, and both may result in inadequate application of sex therapy techniques and treatment. The results of this survey indicate an ethical imperative to included sexuality training in current graduate curricula to adequately prepare psychologists to assess, refer, and treat sexual health concerns. The inclusion of sexuality-related topics in existing clinical graduate courses, an increase in sexuality-specific courses focused on assessment and intervention in graduate curricula, and broader options for continuing education for practicing clinical psychologists are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing anxiety and depression in alcohol and drug dependence

Previous research has highlighted the high prevalence (30-60%) of comorbid anxiety and mood disorders in clients with substance misuse disorders and, equivalently, a third of those with affective disorder report a history of substance use disorder (Kessler et al., 1994; Regier et al., 1990; Robins & Regier, 1991). This article reviews the management of such cases and identifies key issues in the assessment process, as well as potential avenues for treatment. Other articles have highlighted the increased service utilisation and the cost of care and treatment of comorbidity. This article will primarily focus on the management of individual cases and will briefly refer to issues of service organisation. Although antidepressant or anxiolytic pharmacotherapy may have a role in the treatment of severe disorders, the benefits of using these medications must be balanced against the increased risk of side-effects or adverse reactions in individuals who continue to engage in substance misuse or who have medical complications associated with drug or alcohol dependency. Effective psychosocial approaches largely focus on brief, empirically tested manualised therapies such as cognitive therapy (Carroll, 1998a). However, modifications are required to such approaches to ensure that the interventions are tailored to the needs of clients exhibiting comorbidity. The data available demonstrate some evidence for the benefits of structured psychological approaches, but more sophisticated randomized controlled trials are required to evaluate the efficacy of both psychological and pharmacological approaches.