Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership.     

Effectiveness of an Educational and Support Program for Family Members of a Substance Abuser

Abstract

This paper investigates the relationship between marital adjustment and congruency of couple preference regarding wife employment. Implications for marriage and family therapists are emphasized. Husband, wife, and couple scores were obtained on the Marital Status Inventory and Dyadic Adjustment Scale for eight work pattern categories. The first four (Dual-Career, Dual-Work, Pre-Dual-Career, Traditional Single-Career) were current couple work patterns perceived as desirable by both spouses. The last four categories (Incongruent Dual-Career, Incongruent Dual-Work, Incongruent Pre-Dual-Career, Incongruent Traditional Single-Career) were current couple work patterns that one spouse, in conflict with the other spouse, perceived as undesirable. In addition, number and ages of children and number of wife work hours were analyzed for their effects on marital adjustment in these couples. The results of this study indicate that marital adjustment is negatively influenced only when the wife wants to work in her career, is not employed, and her husband does not want her to be employed now or in the future. Possible reasons for these findings and suggestions for further research are included.     

Does calling it “Morgan's way” reduce student learning? Evaluating the effect of person-presentation during comparison and discussion of worked examples in mathematics classrooms

Mathematics textbooks sometimes present worked examples as being generated by particular fictitious students (i.e., person-presentation). However, there are indicators that person-presentation of worked examples may harm generalization of the presented strategies to new problems. In the context of comparing and discussing worked examples during extended classroom instruction, the current study compared the impact of person-presentation to strategy labels on students' posttest accuracy and ratings of strategy generalizability. Five algebra teachers and their 168 students used worked examples either presented using fictitious students or with a strategy label during a multiweek unit on equation solving, with teachers randomly assigned to condition. All students compared and discussed the worked examples. In this context, we found no effect of condition on student accuracy at posttest, nor on their ratings of the generalizability of the presented strategies. We discuss why previously found negative effects of person-presentation may not have extended to this context.     

Can Children with Autism Recover? If So, How?

Although Autism Spectrum Disorders (ASD) are generally assumed to be lifelong, we review evidence that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome. Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and attention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial.     

Advancing the assessment of parent-child interactions: development of the Parent Instruction-Giving Game with Youngsters

This study investigates the validity of the Parent Instruction–Giving Game with Youngsters (PIGGY), a newly developed direct-observation system. The PIGGY is a derivative of the Dyadic Parent-Child Interaction Coding System II [DPICS-II; Eyberg, S. M., Bessmer, J., Newcomb, K., Edwards, D., Robinson, E. (1994). Manual for the Dyadic Parent-Child Interaction Coding System-II. Social and Behavioral Sciences Documents (Ms. No. 2897)] and the Behavior Coding System [BCS; Forehand, R. L., McMahon, R. J. (1981). Helping the noncompliant child. New York: Guilford Press] and utilizes a format similar to the more structured Compliance Test [Roberts, M. W., Powers, S. W. (1988). The Compliance Test. Behavioral Assessment, 10, 375–398]. Using the PIGGY, parents provide standardized commands to their child (e.g., “Put the book on the table”). The parenting skills used to gain compliance (e.g., instruction giving, praise, discipline techniques) as well as child behavior (e.g., noncompliance) are coded on an observation form. In Study 1, 14 “noncompliant” and 14 “compliant” children and their mothers were selected based on parent report of child behavior. The PIGGY differentiated between the two groups on repeat commands, defiant child behavior, and overreactive parenting. Other forms of validity are also reported. In Study 2, the PIGGY was used to monitor the effectiveness of behavioral parent training with a mother and her 3-year-old daughter with oppositional-defiant disorder. Changes in both child and parent behavior were reflected in PIGGY scores. Overall, these studies suggest that the PIGGY may be valuable as both a screening tool and a measure of response to treatment.