‘I'm beyond caring’, a response to the Francis Report: the failure of social systems in health care to adequately support nurses and nursing in the clinical care of their patients

Lord Francis was commissioned to look at why the serious problems (between January 2005 and March 2009) at Mid Staffs Foundation Trust were not identified sooner and the appropriate action taken. Lord Francis was also asked to outline what lessons could be learned to enhance patient care. The report was delivered on 5 February 2013 and contained 290 recommendations. The key message was that the National Health Service needed to put the patient first and everything else should flow from that principle. Poor standards of care should not be tolerated and staff would be expected to speak out when they felt patient care was being compromised. Lord Francis also recommended that there should be one regulatory body and that the role of the Care Quality Commission was to be reviewed.     

Musical experts recruit action-related neural structures in harmonic anomaly detection: Evidence for embodied cognition in expertise

Humans are extremely good at detecting anomalies in sensory input. For example, while listening to a piece of Western-style music, an anomalous key change or an out-of-key pitch is readily apparent, even to the non-musician. In this paper we investigate differences between musical experts and non-experts during musical anomaly detection. Specifically, we analyzed the electroencephalograms (EEG) of five expert cello players and five non-musicians while they listened to excerpts of J.S. Bach’s Prelude from Cello Suite No. 1. All subjects were familiar with the piece, though experts also had extensive experience playing the piece. Subjects were told that anomalous musical events (AMEs) could occur at random within the excerpts of the piece and were told to report the number of AMEs after each excerpt. Furthermore, subjects were instructed to remain still while listening to the excerpts and their lack of movement was verified via visual and EEG monitoring. Experts had significantly better behavioral performance (i.e. correctly reporting AME counts) than non-experts, though both groups had mean accuracies greater than 80%. These group differences were also reflected in the EEG correlates of key-change detection post-stimulus, with experts showing more significant, greater magnitude, longer periods of, and earlier peaks in condition-discriminating EEG activity than novices. Using the timing of the maximum discriminating neural correlates, we performed source reconstruction and compared significant differences between cellists and non-musicians. We found significant differences that included a slightly right lateralized motor and frontal source distribution. The right lateralized motor activation is consistent with the cortical representation of the left hand – i.e. the hand a cellist would use, while playing, to generate the anomalous key-changes. In general, these results suggest that sensory anomalies detected by experts may in fact be partially a result of an embodied cognition, with a model of the action for generating the anomaly playing a role in its detection.     

Are You Sure There Isn't a Monster in the Closet? Regulation of Children's Worrying in Uncertain Contexts

Intolerance of uncertainty and maladaptive information seeking are linked in many models of worry and clinical anxiety. This study aimed to examine children's use of information to regulate negative arousal associated with uncertainty in an exciting or threatening pretend play context. Children were presented with a positively or negatively valenced imaginary creature in a closed box. They were then given visual, verbal, or no reminder as to the pretend status of the entity. Children in the verbal and no information conditions were significantly more likely to spontaneously check as to the presence or absence of the creature during the game. These results confirm that some children react with more intense worry in situations of uncertainty, and that the type of information provided to children is important in assisting them to regulate that emotional response. The study provides analogue experimental support for the value in clinical contexts of direct experience in order to reduce uncertainty regarding imagined possibilities, and, in turn, worrying.     

Threat-related processing supports prospective memory retrieval for people with obsessive tendencies

Obsessive-compulsive disorder can result in a variety of deficits to cognitive performance, including negative consequences for attention and memory performance. The question addressed in the current study concerned whether this disorder influenced performance in an event-based prospective memory task. The results from a subclinical population indicated that, relative to non-anxious controls and mildly depressed controls, people with obsessive-compulsive tendencies (washing compulsions) incur decrements in remembering to respond to cues related to a neutral intention (respond to animals). This deficit was ameliorated by giving the subclinical group an intention about a threat-related category (respond to bodily fluids) and cueing them with concepts that they had previously rated as particularly disturbing to them. Thus, their normal attentional bias for extended processing of threat-related information overcame their natural deficit in event-based prospective memory.     

Increasing the number of contacts generated during contact tracing interviews

ABSTRACT

To stem the spread of infectious diseases (e.g., Ebola), epidemiologists conduct contact tracing interviews (CTIs) with infected individuals regarding their contacts who may also be infected. These contact tracing interviews, however, may be vulnerable to deadly errors of omission. A promising technique to maximise recall is the Cognitive Interview (CI), which is grounded in psychological theory. In the present study, participants imagined they were infected with meningococcal meningitis and reported their contacts over the previous three days during either a control interview or a CI. To model the cognitive impairment associated with being sick, half of the participants were interviewed while simultaneously completing a cognitive impairment task. The CI generated more contacts than the control interview. However, when the cognitive impairment task was completed, the CI and the control interview performed similarly. We recommend the CI be considered as an alternative to the control interview, particularly if the interviewee is not temporarily impaired due to distraction or illness.     

Directed remembering: Subliminal cues alter nonconscious memory strategies

Much research on memory function has focused on changes in recognition performance brought about by differences in the processes engaged during encoding. In most of this work, participants either receive explicit instructions to remember particular items or they perform orienting (i.e., encoding) tasks that support different levels of memory performance. In daily life, however, the retention or dismissal of information often occurs without conscious intent, thereby suggesting an alternative, nonconscious route through which purposive remembering and forgetting can occur. Based on this line of reasoning, we speculated that recognition performance in a standard item-based forgetting paradigm may be moderated by subliminal cues that trigger the automatic activation of different mnemonic strategies. We report the results of two experiments that supported this prediction. In each experiment, the basic item-based forgetting effect was replicated, but via the subliminal presentation of “remember” and “forget” cues. In addition, cue-dependent differences in memory performance were traced to the operation of a covert rehearsal mechanism during encoding. We consider the implications of these findings for the non-conscious operation of memory processes in everyday life.     

An examination of two-process theories of false recognition

Contemporary theories of false memory suggest there are two processes that combine to produce false memory: one that increases false memory (error-inflating processes) and one that counteracts false memory (error-editing processes). Two experiments using the DRM paradigm (Deese, 1959; Roediger & McDermott, 1995) explored the influence of manipulating the number of associates studied, study item presentation frequency, backward associative strength, and study time on error-inflating and error-editing processes separately by examining speeded and unspeeded recognition decisions. The results of these studies indicate that (1) increasing the number of associates studied primarily influenced error-inflating processes; (2) increasing backward associative strength increased error-inflating processes and impaired error-editing processes; (3) increasing study item presentation frequency increased both error-inflating and error-editing processes; and (4) increasing study time had a weak effect on error-editing processes. Further, the results of these studies suggest that comprehensive theories of false memory phenomena must propose the existence of two different factors: one that increases false memory and is available early in memory retrieval, and one that usually, but not always, decreases false memory and is available later in retrieval.     

Naming without knowing and appearance without associations: Evidence for constructive processes in semantic memory?

Abstract

This study describes a patient (SE) with temporal lobe injury resulting from Herpes Simplex Encephalitis, who displayed a previously unreported impairment in which his knowledge of associative and functional attributes of animals was disproportionately impaired by comparison with his knowledge of their sensory attributes (including their visual properties and characteristic sounds). His knowledge of man-made objects was preserved. A striking aspect of the present case was that the patient remained able to name many animals from their pictures, despite making gross errors in generating associative information about these same animals. This suggests that a semantic representation incorporating stored sensory knowledge may be sufficient for naming (at least for biological categories) and associative information may be unnecessary. Semantic knowledge may normally incorporate more information than is necessary for identification. SE's errors were found to be confabulatory and reconstructive in nature and it is argued that this aspect of his performance challenges passive conceptions of semantic memory couched in terms of a catalogue of stored representations. It is proposed that the patient's disorder affects a dynamic, constructive, and inferential component of his knowledge base, and that this component is sensitive to semantic category.     

On the nature of the delayed “inhibitory” Cueing effects generated by uninformative arrows at fixation

When the interval between a spatially uninformative arrow and a visual target is short (<500 ms), response times (RTs) are fastest when the arrow points to the target. When this interval exceeds 500 ms, there is a near-universal absence of an effect of the arrow on RTs. Contrary to this expected pattern of results, Taylor and Klein (J Exp Psychol Hum Percept Perform 26:1639–1656, 2000) observed that RTs were slowest when a to-be-localized visual target occurred in the direction of a fixated arrow presented 1 s earlier (i.e., an “inhibitory” Cueing effect; ICE). Here we examined which factor(s) may have allowed the arrow to generate an ICE. Our experiments indicated that the ICE was a side effect of subthreshold response activation attributable to a task-induced association between the arrow and a keypress response. Because the cause of this ICE was more closely related to subthreshold keypress activation than to oculomotor activation, we considered that the effect might be more similar to the negative compatibility effect (NCE) than to inhibition of return (IOR). This similarity raises the possibility that classical IOR, when caused by a spatially uninformative peripheral onset event and measured by a keypress response to a subsequent onset, might represent, in part, another instance of an NCE. Serendipitously, we discovered that context (i.e., whether an uninformative peripheral onset could occur at the time of an uninformative central arrow) ultimately determined whether the “inhibitory” aftermath of automatic response activation would affect output or input pathways.     

Gist perception requires attention

Four experiments (240 subjects) explored gist perception without attention using the Mack and Rock (1998) cross task. Twelve scenes were flashed under conditions of inattention, divided, and full attention. Subjects described what they saw on critical trials in which a scene was flashed with the cross. In Experiments 3 and 4 subjects also chose the scene from a four scene array. In Experiment 4 the critical scenes were shown twice in the inattention condition. Overall, only 17% reported gist in the inattention condition, 65% did so with divided, and 82% did so with full attention. In Experiment 4 most subjects remained inattentionally blind to the scenes even though they were shown twice, conditions which fostered repetition priming, and we found a suggestion of negative priming. The results of all 4 experiments indicate that gist requires attention.