Pre-screening education in multiple marker screening programs: The effect on patient anxiety and knowledge

Previous studies have shown that unexplained deviations in maternal serum multiple marker screening (MMS) generate considerable anxiety during the remainder of pregnancy. While the role of education in decreasing anxiety is documented, to date there has been no prospective evaluation of which educational practices might minimize this emotional stress. In a pilot study, we prospectively examined the effects on anxiety and knowledge by providing information about MMS (1) by genetic counselor, (2) by pamphlet, and (3) by primary physician. Women randomized to one of these three modalities were administered the Spielberger State- Trait Anxiety Inventory [STAI] and knowledge questionnaires at their initial obstetrics visit, at their second visit after educational intervention and 1–2 weeks after MMS results were provided to patients. Education resulted in an increase in knowledge and post-education knowledge was different between educational modalities. Anxiety declined in patients educated through genetic counseling or a pamphlet.     

A case-based approach to the development of practice-based competencies for accreditation of and training in graduate programs in genetic counseling

The American Board of Genetic Counseling (ABGC) sponsored a consensus development conference with participation from directors of graduate programs in genetic counseling, board members, and expert consultants. Using a collective, narrative, and case-based approach, 27 competencies were identified as embedded in the practice of genetic counseling. These competencies were organized into four domains of skills: Communication; Critical Thinking; Interpersonal, Counseling, and Psychosocial Assessment; and Professional Ethics and Values. The adoption of a competency framework for accreditation has a variety of implications for curriculum design and implementation. We report here the process by which a set of practice-based genetic counseling competencies have been derived; and in an accompanying article, the competencies themselves are provided. We also discuss the application of the competencies to graduate program accreditation as well as some of the implications competency-based standards may have for education and the genetic counseling profession. These guidelines may also serve as a basis for the continuing education of practicing genetic counselors and a performance evaluation tool in the workplace.The Consortium includes Directors of established graduate programs in genetic counseling and members of the ABGC Board of Directors who participated in the Consensus Development Conference held in January 1994: Diane Baker (University of Michigan/ABGC); Bonnie Baty (ABGC); Joan Burns (University of Wisconsin); Debra Collins (ABGC); Virginia Corson (ABGC); Beth Fine (Northwestern University/ABGC); Elizabeth Gettig (University of Pittsburgh); Verle Headings (Howard University); Jacqueline Hecht (University of Texas); Carl Huether (University of Cincinnati); Bonnie LeRoy (University of Minnesota); Joan Marks (Sarah Lawrence College); Anne Matthews (University of Colorado); Roberta Palmour (McGill University); Lorna Phelps (Medical College of Virginia); Kimberly Quaid (Indiana University); Joan Scott (ABGC); Ann Smith (ABGC); Helen Travers (ABGC); Judith Tsipis (Brandeis University); Ann Walker (University of California-Irvine/ABGC); Jon Weil (University of California-Berkeley); S. Robert Young (University of South Carolina); Randi Zinberg (Mount Sinai School of Medicine, New York).     

Death of a Salesman: A clinical look at the Willy Loman family

A separation-individuation model is used to explore the dynamics of the Willy Loman family as depicted in the play,Death of a Salesman. The concept of differentiation is discussed, with examples from the play used to magnify the applicability of this construct. The family is viewed in three-generational context, using Erickson's definition of identity as it relates to the continuity between the past, present and future. The low level of differentiation inexorably leads to a void of intimacy, reflected in the form of emotional isolation, inability to tolerate differences and lack of problem solving skills. Finally, the discussion accents the difficulties experienced by the Loman children to separate and in individuation.     

Semantic specificity in cued recall

In three cued recall experiments, extralist retrieval cues that were congruous in meaning to an encoded target pair of words produced better recall of the targets than wh6n the cuetarget relation was incongruous. However, this result, which differs from that of other experiments, depended in some cases on scoring recall of a target pair when either member of the pair was recalled. It is argued that (1) pairs of words are typically stored as higher order units, (2) the best test procedure is to request recall of both members of the pair when an extralist cue is presented, and (3) semantic features provide an important dimension in the mnemonic representation of word events.     

Regional cerebral blood flow response to recognition memory versus semantic classification tasks

Two randomly assigned groups, N = 7 each, of neurologically normal patients were composed. One group, RM, had regional cerebral blood flow measurements during a recognition memory probe test; the other group, SC, had rCBF measurements during a semantic classification task, using the same stimulus and response features as the RM task. Thus, the groups differed only in the cognitive instruction they were executing. The RM group showed a significantly lower change from resting baseline to activation, in mean left hemisphere initial slope index, than did the SC group. The RM group, but not the SC group, showed a significant inverse correlation between occipital flow and accuracy of memory performance as indicated by d′. Correlations between age and hemispheric initial slope index, and between homologous left and right hemisphere sites, were also described. The results are considered to support an anatomical basis for the distinction between episodic and semantic memory and to suggest that occipital flow may diminish with accurate memory performance because of an upstream demand of blood in the medial temporal lobes.     

An investigation into the relationships between gender and language

The present investigation focused upon the impact of gender and various powerful and less powerful linguistic features on the communication of unfamiliar male and female college students. Same-sex and mixed-sex dyads were recorded as they engaged in discussions regarding suggestions for a bogus freshman orientation booklet. Although few gender differences were found, the result of a factor analysis yielded three factors: questions, suggestions, and process variables. These factors are consistent with a power perspective in the use of various linguistic features. However, the present findings suggest that gender and power alone cannot explain differences in communication styles. Rather, the results suggest the need to consider other aspects of the speaker to explain differences that occur in the use of language.     

Analysis of the elements of attention: A neuropsychological approach

A model for conceptualizing the components or elements of attention is presented. The model substitutes for the diffuse and global concept of attention a group of four processes and links them to a putative system of cerebral structures. Data in support of the model are presented; they are derived from neuropsychological test scores obtained from two samples, the first consisting of 203 adult neuropsychiatric patients and normal control subjects, and the second, an epidemiologically-based sample of 435 elementary school children. Principal components analyses of test scores from these two populations yielded similar results: a set of independent elements of attention that are assayed by different tests. This work presents a heuristic for clinical research in which the measurement of attention is essential.     

Factors affecting entrapment in escalating conflicts: The importance of timing

Entrapping conflicts are those in which individuals continue to invest their resources—even in seemingly losing propositions-in large part to justify previous unfilled expenditures. It has been demonstrated that individuals define their motivation for investing very differently at the various stages of an entrapping conflict. One implication of this motivational dynamic is that various factors may differentially affect degree of entrapment (i.e., amount invested), depending upon the point in time at which they are introduced. The present studies were designed to test this notion. All subjects were given an initial monetary stake and had the opportunity to win more by taking part in an entrapping investment situation. In Experiment 1, half the subjects were provided with a payoff chart that made salient the costs associated with investing (Highcost salience condition) whereas half were not (Low-cost salience condition). Moreover, for half of the subjects the payoff chart was introduced before they were asked to invest (Early condition) whereas for the other half it was introduced after they had invested a considerable portion of their resources (Late condition). Entrapment was lower in the High salience-Early than in the Low salience-Early condition. However, there was no difference between groups in the Late condition. In Experiment 2, the perceived presence of an audience interacted with personality variables related to face-saving to effect entrapment. When the audience was described as “experts in decision making,” subjects high in public self-consciousness (or social anxiety) became less entrapped than those low on these dimensions. When the audience consisted of individuals who “wished simply to observe the experimental procedure,” however, high public self-consciousness (or social anxiety) individuals were significantly more entrapped than lows. Moreover, these interaction effects occurred when the audience was introduced late, but not early, into the entrapment situation. Taken together, these (and other) findings suggest that economic factors are more influential determinants of behavior in the earlier stages of an entrapping conflict, whereas face-saving variables are more potent in the later phases. Alternative explanations are discussed.