Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of ??listening?? to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome. 相似文献
The Go/No Go Association Task (GNAT; Nosek & Banaji, 2001) is an implicit measure with broad application in social psychology. It has several conceptual strengths to recommend it over other implicit methods, but the belief that it has poor reliability coupled with the absence of a method for calculating this important psychometric property has hindered its wider acceptance and use. Using data obtained from six GNAT studies covering a wide range of content areas, Study 1 compares the properties of different methods for estimating reliability of the GNAT. Study 2 demonstrates a resampling procedure to investigate how reliability varies as a function of block length. Study 1 shows that with appropriately chosen stimuli the GNAT can be a very reliable measure, while Study 2 indicates that as an empirical rule of thumb 50 to 80 trials per block should yield adequate to very good reliability. However, researchers are urged to calculate their own reliability coefficients, to this end we discuss GNAT design issues and provide procedures for calculating GNAT reliability which we hope will enhance the utility of the GNAT as a measure and promote its use in studying implicit cognition. 相似文献
Noninvasive prenatal testing (NIPT) allows for highly sensitive detection of Down syndrome early in pregnancy with no risk of miscarriage, therefore potentially increasing the number of pregnancies identified with Down syndrome. This study assesses how mothers of children with Down syndrome perceive NIPT, especially the impact they think it will have on their families and other families with children who have Down syndrome. Seventy-three self-reported mothers of children with Down syndrome responded to an anonymous online survey emailed to, and posted on, message boards of various Down syndrome support groups and networks. Data analysis included chi-square tests and thematic analysis. Fifty-nine percent of respondents indicated they would use NIPT in the future; respondents who had not used prenatal testing in the past were significantly less likely to report interest in using NIPT in the future than those who had prenatal testing previously (p?.001). Many respondents felt NIPT could lead to increased terminations (88 %), increased social stigma (57 %), and decreased availability of services for individuals with Down syndrome (64 %). However, only 16 % believed availability of new noninvasive tests would be the most important factor in determining the number of pregnancies with Down syndrome terminated in the future. Additionally, 48 % believed health care providers give biased or incorrect information about Down syndrome at the time of diagnosis, and 24 % felt this incorrect information leads to terminations of pregnancies affected with Down syndrome. Results suggest although mothers of children with Down syndrome believe new noninvasive testing will lead to an increase in termination of pregnancies with Down syndrome, they do not think it is the MOST important factor. They also highlight the need to provide a diagnosis of Down syndrome in a balanced and objective manner. 相似文献
Journal of Business and Psychology - Numerous advancements have been made regarding how aspects of job roles and organizational environments affect work attitudes. However, less attention has been... 相似文献
Recent years have seen a rejuvenation of interest in studies of motivation–cognition interactions arising from many different areas of psychology and neuroscience. The present issue of Cognitive, Affective, & Behavioral Neuroscience provides a sampling of some of the latest research from a number of these different areas. In this introductory article, we provide an overview of the current state of the field, in terms of key research developments and candidate neural mechanisms receiving focused investigation as potential sources of motivation–cognition interaction. However, our primary goal is conceptual: to highlight the distinct perspectives taken by different research areas, in terms of how motivation is defined, the relevant dimensions and dissociations that are emphasized, and the theoretical questions being targeted. Together, these distinctions present both challenges and opportunities for efforts aiming toward a more unified and cross-disciplinary approach. We identify a set of pressing research questions calling for this sort of cross-disciplinary approach, with the explicit goal of encouraging integrative and collaborative investigations directed toward them. 相似文献
Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f0) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.
Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.
Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f0, voice-gender congruence, voice problems, and satisfaction with voice.
Results: A meta-analysis on f0 data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I2: 59.9%) did not achieve cisgender male normative frequencies (f0 ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I2: 0.0%) and 46% (95% CI: 14%–79%; I2: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I2: 0.0%).
Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f0 lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice. 相似文献
The goal of the present study was to examine clinician, supervisor, and organizational factors that are associated with the intensity of evidence-based treatment (EBT) focus in workplace-based clinical supervision of a specific EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Supervisors (n = 56) and clinicians (n = 207) from mental health organizations across Washington State completed online self-report questionnaires. Multilevel modeling (MLM) analyses were used to examine the relative influence of nested clinician and supervisor factors on the intensity of EBT focus in supervision. We found that 33% of the variance in clinician report of EBT supervision intensity clustered at the supervisor level and implementation climate was the only significant factor associated with EBT supervision intensity. While individual clinician and supervisor factors may play a role in EBT coverage in supervision, our results suggest that an implementation climate that supports EBT may be the most critical factor for improving intensity of EBT coverage. Thus, implementation efforts that address the extent to which EBTs are expected, rewarded, and supported within an organization may be needed to support greater coverage of EBT during workplace-based supervision. 相似文献
In reviews published more than 30 years ago, eight parameters important to the use of time-out were identified and available research was summarized. The purpose of the current paper is to provide an updated summary of existing research for each parameter of time-out. Within each parameter, we conducted a thorough review of the published literature and identified all peer-reviewed articles addressing each parameter. We identified and summarized a total of 46 articles across the eight parameters, including 32 not cited in previous reviews. Sufficient findings were available to draw conclusions regarding time-out warning, schedule of time-out, contingent versus noncontingent release, and duration. Tentative conclusions based on only a few studies could be drawn in regard to instructional versus physical administration and verbalized reason for time-out. No conclusions could be drawn regarding time-out signal and specific time-out location. While we know much more today regarding effective implementation of time-out, there is a clear need for further exploration within these identified parameters. In addition to summarizing the literature, we reviewed recommendations made by behavioral parent training programs, parenting books, and parenting Web sites, and compared how well their recommendations matched current research based on the conclusions drawn from our review. We found that parenting sources made strong and specific recommendations on several of the parameters that were either not consistent with available research or simply lacked a sufficient research base. 相似文献