Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

Zum Stand der forensischen und forensisch-psychiatrischen Nachsorge in der Bundesrepublik Deutschland (Daten aus der sog. Pfingstabfrage 2013)

In 2007 forensic aftercare was integrated into the German Penal Code as part of legal supervision. Since then a large and growing number of patients have been supervised by forensic psychiatric aftercare units throughout Germany. Due to the federal system in Germany the system of forensic aftercare has developed differently in the 16 federal states. The number of patients looked after varies widely and the implementation of several legal norms also differs from state to state. This article gives an overview of the situation of forensic aftercare in the different German federal states and presents some specific characteristics of the development.     

The Rhythm Method: A New Method for Measuring Cognitive Load—An Experimental Dual‐Task Study

The present study joins a series of studies that used the dual‐task paradigm to measure cognitive load while learning with multimedia instruction. The goal of the current work was to develop a secondary task, to measure cognitive load in a direct and continuous way using intra‐individual, behavioral measures. The new task is achieved by utilizing internalized cues. More specifically, a previously practiced rhythm is executed continuously by foot tapping (secondary task) while learning (primary task). Precision of the executed rhythm was used as indicator for cognitive load—the higher the precision, the lower cognitive load. The suitability of this method was examined by two multimedia experiments (n₁ = 30; n₂ = 50). Cognitive load was manipulated by seductive details (Experiment 1: with vs. without) and modality (Experiment 2: on‐screen text vs. narration). Learners who learned under low cognitive load conditions (Experiment 1: without seductive details; Experiment 2: narration) showed significantly higher rhythm precision. These results provide evidence that rhythm precision allows for a precise and continuous measurement of cognitive load during learning. Copyright © 2014 John Wiley & Sons, Ltd.     

A general proof of consistency of heuristic classification for cognitive diagnosis models

The Asymptotic Classification Theory of Cognitive Diagnosis (Chiu et al., 2009, Psychometrika, 74, 633–665) determined the conditions that cognitive diagnosis models must satisfy so that the correct assignment of examinees to proficiency classes is guaranteed when non‐parametric classification methods are used. These conditions have only been proven for the Deterministic Input Noisy Output AND gate model. For other cognitive diagnosis models, no theoretical legitimization exists for using non‐parametric classification techniques for assigning examinees to proficiency classes. The specific statistical properties of different cognitive diagnosis models require tailored proofs of the conditions of the Asymptotic Classification Theory of Cognitive Diagnosis for each individual model – a tedious undertaking in light of the numerous models presented in the literature. In this paper a different way is presented to address this task. The unified mathematical framework of general cognitive diagnosis models is used as a theoretical basis for a general proof that under mild regularity conditions any cognitive diagnosis model is covered by the Asymptotic Classification Theory of Cognitive Diagnosis.     

Sleep deprivation impairs object recognition in mice

Many studies in animals and humans suggest that sleep facilitates learning, memory consolidation, and retrieval. Moreover, sleep deprivation (SD) incurred after learning, impaired memory in humans, mice, rats, and hamsters. We investigated the importance of sleep and its timing in an object recognition task in OF1 mice subjected to 6h SD either immediately after the acquisition phase (0-6 SD) or 6h later (7-12 SD), and in corresponding undisturbed controls. Motor activity was continuously recorded with infrared sensors. All groups explored two familiar, previously encountered objects to a similar extent, both at the end of the acquisition phase and 24h later during the test phase, indicating intact familiarity detection. During the test phase 0-6 SD mice failed to discriminate between the single novel and the two familiar objects. In contrast, the 7-12 SD group and the two control groups explored the novel object significantly longer than the two familiar objects. Plasma corticosterone levels determined after SD did not differ from time-matched undisturbed controls, but were significantly below the level measured after learning alone. ACTH did not differ between the groups. Therefore, it is unlikely that stress contributed to the memory impairment. We conclude that the loss of sleep and the activities the mice engaged in during the SD, impaired recognition memory retrieval, when they occurred immediately after acquisition. The delayed SD enabled memory consolidation during the 6h when the mice were allowed to sleep, and had no detrimental effect on memory. Neither SD schedule impaired object familiarity processing, suggesting that only specific cognitive abilities were sensitive to the intervention. Sleep may either actively promote memory formation, or alternatively, sleep may provide optimal conditions of non-interference for consolidation.     

Outcome of patients rehabilitated through a New Zealand forensic psychiatry service: A 7.5 year retrospective study

This paper describes a 7.5 year retrospective study of all patients discharged from inpatient forensic services to forensic community team (FCT) follow-up from the Auckland Regional Forensic Psychiatry Service. Patients' files were studied for clinical, criminal, and risk data, type of service delivered, and final level of function achieved in the community. Rearrest, re-hospitalization, and reimprisonment data were obtained from clinical, court, and prison records.105 patients were included. The most common diagnosis was a psychotic disorder, and index offending behaviour was typically violent. The median period of inpatient stay was 36 months and mean subsequent FCT follow-up 21.7 months (SD 17.8). The majority of patients were from Maori and Pacific Island ethnic groups. At the end of the study, half were in independent living, half were in some form of employment, and 19% were readmitted to a forensic hospital.One patient was rearrested but not reimprisoned whilst under forensic community team care. However, 9 of the 48 who were discharged to general mental health services were rearrested and 5 reimprisoned. Only two offences were as serious as the original index offence.Broad based assertive, mandated, and committed forensic rehabilitation can achieve high quality outcomes. These levels of function may not be sustained under less assertive care.     

Gaze avoidance in social phobia: Objective measure and correlates

Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder.