Total quality management and the silent patient

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.     

Computer-adaptive testing: the impact of test characteristics on perceived performance and test takers' reactions

This study examined how specific features of adaptive tests are related to test takers' reactions. Participants took a computer-adaptive test in which 2 features, difficulty of the initial item and difficulty of subsequent items, were manipulated, then responded to questionnaires assessing their reactions to the test. The data show that the relationship between a test's objective difficulty, which was determined by the 2 manipulated test characteristics, and reactions was fully mediated by perceived performance. Additional analyses evaluated the impact of feedback on reactions to the adaptive test. In general, feedback that was consistent with perceptions of performance was positively related to reactions. The results suggest that minor changes to the design of an adaptive test may potentially enhance examinees' reactions.     

Experimental evidence for serial models of lexical access: a judgment task

The hypothesis that the lemma and lexeme levels of lexical access are in a feed-forward serial relation is supported. Subjects judge the degree of semantic relatedness of pairs of words. Stimuli are all functionally synonymous; they are pairs of words implicated in natural word blends. Half the stimuli are phonologically related and the other half are not. In one experiment the pairs are presented in a sentential context and in the other no context is provided. In both the experiments the phonologically unrelated pairs are judged closer in meaning than the phonologically related pairs. This is interpreted as support for serial models of lexical access.     

Underreporting of psychopathology on the MMPI-2: a meta-analytic review

Meta-analytic techniques were applied to studies of the MMPI-2 in which participants given standard instructions were compared with participants instructed or believed to have been underreporting. Traditional and supplementary indices of underreporting yielded a mean effect size of 1.25, suggesting that underreporting respondents differ from those responding honestly by a little more than 1 standard deviation, on the average, on these scales. Analyses of classification accuracy suggested that several scales are moderately effective in detecting underreporting, although accuracy decreases if participants have been coached about validity scales. Base rates of defensive responding in relevant populations are reviewed, and methodological issues, including research designs, coaching, and incremental validity of supplementary underreporting scales, are discussed.     

The Assessment of Hyperactivity and Attention (AHA): development and preliminary validation of a brief self-assessment of adult ADHD

A brief self-rating scale, the Assessment of Hyperactivity and Attention (AHA), was developed and validated using a "gold standard" DSM-based semi-structured interview. The sample consisted of 101 smokers (74% male, 73% Caucasian)-38.6% with no DSM-IV ADHD diagnosis, 10.9% with a childhood diagnosis only, and 50.5% with an adult diagnosis (requiring childhood diagnosis as well). The mean age SD was 33.7 9.7; participants smoked a mean of 19.0 5.6 cigarettes/day. Results indicate that the AHA has utility as a screening tool and as a self-report assessment of ADHD with sensitivity of .80, specificity of .60, positive predictive power of .67, negative predictive power of .75, kappa of .40, odds ratio of 6.15, and an area under the curve (receiver operating characteristic analysis) of .79. Given the high rate of ADHD among smokers, the AHA may be useful in identifying smokers who may need more in-depth clinical evaluation for attentional problems.     

Conflict resolution and peer mediation in middle schools: extending the process and outcome knowledge base

Many professional educators are implementing school-based prevention focused on conflict resolution (CR) and peer mediation (PM). The authors conducted research on CR-PM in 3 middle schools. Specifically, they surveyed teachers and students, tracked disciplinary incidents across school years, collected mediation data, and compared mediators with a matched sample to determine attitudinal change as a result of PM training and experience. The authors also surveyed peer mediators and disputants about program satisfaction, as well as peer mediators and their parents about the generalization of PM skills. The authors conclude with implications for developing future CR programs, including a focus on mediation-process evaluation as well as schoolwide outcome measures and the use of peer mediation training as an intervention for students at risk.     

The role of collaborative planning in children's source-monitoring errors and learning.

The aim of this research was to provide empirical evidence for a cognitive process that may contribute to children's learning from another person. A cornerstone of Vygotsky's sociocultural theory is that knowledge is internalized from others; however, the cognitive processes that support this transformation are underspecified. In a series of three studies, kindergarten children (mean age 5 years 8 months) participated in a categorization task with an adult in several collaborative and noncollaborative conditions and then were tested on their memory of who had performed which actions in the task. After the memory task, children were asked to recategorize the items on their own. Source-monitoring patterns and children's learning varied across conditions according to predictions. A measure of recoding was related to children's planning language that, in turn, predicted learning among the children. The results suggest that one process that contributes to children's internalization of knowledge may involve recoding of agent information and that recoding can be indexed by source-monitoring performance.     

Reducing child witnesses' false reports of misinformation from parents.

This study explored whether a source-monitoring training (SMT) procedure, in which children distinguished between events they recently witnessed versus events they only heard described, would help 3- to 8-year-olds to report only experienced events during a target interview. Children (N = 132) who witnessed science demonstrations and subsequently heard their parents describe nonexperienced events received SMT before or after a forensic-style interview. SMT reduced the number of false reports that 7- and 8-year-old children reported in response to direct questions but had no impact on the performance of younger children. Combined with earlier results, these data suggest a transition between 3 and 8 years of age in the strategic use of source-monitoring information to support verbal reports, such that only 7- and 8-year-olds generalize training to a difficult memory task that does not include mention of specific alternative sources.     

Can the Edinburgh Risk of Repetition Scale Predict Repetition of Deliberate Self‐poisoning in an Australian Clinical Setting?

This study tested the ability of the Edinburgh Risk of Repetition Scale (ERRS) to identify patients at high risk for repeat deliberate self-poisoning (DSP). Consecutive DSP patients (N= 1,317) over a 3-year period were followed-up for 12 months. A statistically significant relationship between ERRS scores and repetition was observed; however, sensitivity and specificity were low. Logistic regression analysis revealed only "previous parasuicide" contributed significantly to repetition. The ERRS had limited value in identifying patients at high risk of repeat DSP in this clinical population.