Clinical Outcomes, Cost-Effectiveness, and the Role of Psychology in Treatments for Chronic Pain Sufferers.

Millions of people throughout the world suffer from chronic pain despite significant advances in research, technology, and treatment. Advances include the understanding of the neurobiology of nociception, the psychology of pain perception and response, and the availability of a range of pharmacological agents, operative procedures, physical modalities (e.g., ultrasound, transcutaneous electrical nerve stimulation, diathermy), regional anesthesia (e.g., nerve blocks), neuroaugmentation modalities (e.g., spinal cord stimulators, implantable drug delivery systems), comprehensive pain rehabilitation programs, and complementary and alternative medicine modalities. The authors discuss the clinical effectiveness and cost-effectiveness of these various treatment modalities. They note the roles and contributions of psychologists in the assessment of chronic pain sufferers and as treatment providers on interdisciplinary teams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Multilevel Examination of the Relationships Among Training Outcomes, Mediating Regulatory Processes, and Adaptive Performance.

This study examined whether cognitive, affective-motivational, and behavioral training outcomes relate to posttraining regulatory processes and adaptive performance similarly at the individual and team levels of analysis. Longitudinal data were collected from 156 individuals composing 78 teams who were trained on and then performed a simulated flight task. Results showed that posttraining regulation processes related similarly to adaptive performance across levels. Also, regulation processes fully mediated the influences of self- and collective efficacy beliefs on individual and team adaptive performance. Finally, knowledge and skill more strongly and directly related to adaptive performance at the individual than the team level of analysis. Implications to theory and practice, limitations, and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Career Benefits Associated With Mentoring for Proteges: A Meta-Analysis.

Meta-analysis was used to review and synthesize existing empirical research concerning the career benefits associated with mentoring for the protege. Both objective (e.g., compensation) and subjective (e.g., career satisfaction) career outcomes were examined. Comparisons of mentored versus nonmemored groups were included, along with relationships between mentoring provided and outcomes. The findings were generally supportive of the benefits associated with mentoring, but effect sizes associated with objective outcomes were small. There was also some indication that the outcomes studied differed in the magnitude of their relationship with the type of mentoring provided (i.e.. career or psychosocial). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A policy evaluation of simultaneous and sequential lineups.

Many states and communities are rewriting their eyewitness identification policies. Some of these jurisdictions are excluding simultaneous lineups altogether, and others are allowing them if double-blind administration of sequential lineups is not possible. The Innocence Project advocates the latter and puts forward blind sequential-lineup administration as the best form of lineup identification. Although sequential lineups are claimed to be superior, no explicit policy analysis has been done. In the present study, the author uses a policy-analysis model based on decision theory to examine the utility of simultaneous and sequential lineups, as well as to examine a range of values placed on identification outcomes and their probabilities. Simultaneous lineups are shown to be superior to sequential lineups under most conditions examined in this analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What makes vocational rehabilitation effective? Program characteristics versus employment outcomes nationally in VA.

With the focus on well-defined models for rehabilitation of people with mental illness, there is interest in program elements that predict successful outcomes. Data on programmatic elements from 92 Veterans Affairs Compensated Work Therapy (CWT) programs were merged with 6,891 individual records. General estimation equation analyses were used to identify correlates of 3 dependent variables representing successful outcomes. Community-based work at the individual level was positively associated with all 3 measures of success. Program emphasis on assertive outreach was positively associated with competitive employment and achievement of constructive activity. Greater amounts of assertive outreach and less integration of mental health and vocational staff were associated with a greater likelihood of constructive activity. These results suggest that the best outcomes are achieved by community-oriented programs incorporating assertive outreach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the pre-referral factors associated with differential 6-month outcomes among children receiving system-of-care services.

The authors of this study used a subset of data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program to investigate the prereferral characteristics and experiences of children with serious emotional disturbance as they relate to indicators of clinically significant improvement and deterioration during their first 6 months of service. Minority racial/ethnic background, a history of substance and out-of-home placement were identified as predictors of deterioration at 6 months, higher levels of functional impairment, higher levels of caregiver strain, and poorer academic functioning were associated with significantly lower odds of deterioration. Initial service experience was examined in an effort to explain the relationship between identified prereferral characteristics and 6-month change status. Implications are considered and discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Syndrome co-occurrence and treatment outcomes in youth mental health clinics.

Despite widespread speculation that syndrome co-occurrence undermines treatment outcomes, this hypothesis has not been fully examined within clinical care settings. To address this gap, the authors investigated the relation between syndrome co-occurrence and outcome among 325 clinically referred youths. For every syndrome, higher initial severity was predictive of greater treatment gains and higher posttreatment symptom levels; contrary to speculation in the literature, co-occurrence effects were rare and modest in size, accounting for 0.6% of outcome variance on average. The results suggest that co-occurrence, though common in youth clinical care, is not an obstacle to treatment success in most cases. In addition to its substantive findings, the study illustrates how a dimensional approach can be used to shed new light on co-occurrence in clinical care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting success in college: A longitudinal study of achievement goals and ability measures as predictors of interest and performance from freshman year through graduation.

The authors examined the role of achievement goals, ability, and high school performance in predicting academic success over students' college careers. First, the authors examined which variables predicted students' interest and performance in an introductory psychology course taken their first semester in college. Then, the authors followed students until they graduated to examine continued interest in psychology and performance in subsequent classes. Achievement goals, ability measures, and prior high school performance each contributed unique variance in predicting initial and long-term outcomes, but these predictors were linked to different educational outcomes. Mastery goals predicted continued interest, whereas performance-approach goals predicted performance. Ability measures and prior high school performance predicted academic performance but not interest. The findings support a multiple goals perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aggression and Violence Against Home Care Workers.

This article describes the development of the Violence and Aggression in Health Care Questionnaire (VAQ) and the application of the measure in the field of home care. In a 1st sample of 361 German home care workers, the scales of the VAQ reached internal consistencies from .72 to .93. A confirmatory factor analysis gave evidence to the hypothesized factor structure. Significant correlation with indicators of psychophysical strain and health resulted in a 2nd sample of 180 home care workers. In multiple regression analysis based on a 3rd sample of 180 home care workers, verbal aggression by patients was a significant predictor of negative psychological outcomes. The relationship is completely mediated by negative emotional reactions after aggressive incidents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nocturnal Hemodialysis in Australia

Background: Because home hemodialysis has long been a common Australian support modality, the advent of home‐based nocturnal hemodialysis (NHD) in Canada stimulated the extension of our existing home‐ and satellite‐based conventional hemodialysis (CHD) programs to NHD. As a result, the first government‐funded, home‐based, 6‐nights‐per‐week NHD program in Australia began in July 2001. Methods: Sixteen patients have been trained for NHD; 13 dialyzed at home 8 to 9 hr per night for 6 nights per week, whereas 3 preferred to train for NHD at home using an 8‐ to 9‐hr alternate‐night regime. Results: The program experience to March 1, 2003, was 655 patient‐weeks. Two patients had withdrawn for transplantation and 2 for social reasons, although 1 continues on alternate‐night NHD. There hade been no deaths. Ten patients had dialyzed without partners. All patients ceased phosphate binders at entry. Thirteen of 16 discontinued all antihypertensive drugs. There were no fluid or dietary restrictions. Phosphate was added to the dialysate to prevent hypophosphatemia. Pre‐ and postdialysis urea and phosphate levels were broadly within the normal ranges. All patients reported restorative sleep; similarly partners reported stable sleep patterns and noted improved mood, cognitive function, and marital relationships in their NHD partners. Preliminary cost analyses show that whereas consumables had doubled, and epoetin and iron expenditures had risen by 28.9%, other pharmaceutical costs had fallen by 47%, and nursing wage costs were 48% of the notional cost had these patients remained on CHD. Three patients on NHD were retired, 7 worked full‐time, 3 worked part‐time, and 3 drew disability support, whereas previously on CHD, 3 were retired, 3 had worked full‐time, 3 had worked part‐time, and 7 had drawn disability support. Conclusion: We believe that NHD is viable, safe, effective, and well accepted with significant lifestyle benefits and reemployment outcomes. Although initial setup costs are significant, NHD cost advantage over CHD progressively accrues as program numbers exceed 12 to 15 patients.