Improving the quality of medical care: the normativity of evidence-based performance standards

Poor quality medical care is sometimes attributed to physicians?? unwillingness to act on evidence about what works best. Evidence-based performance standards (EBPSs) are one response to this problem, and they are increasingly employed by health care regulators and payers. Evidence in this instance is judged according to the precepts of evidence-based medicine (EBM); it is probabilistic, and the randomized controlled trial (RCT) is the gold standard. This means that EBPSs suffer all the infirmities of EBM generally??well rehearsed problems with the external validity of research findings as well as the inferential leap from study results in the aggregate to individual patient care. These theoretical weaknesses promise to have a practical impact on the care of patients. To avoid this, EBPSs should be understood as guidelines indicative of average effectiveness rather than standards to be applied in every case.     

Executive function in Parkinson’s disease: contributions of the dorsal frontostriatal pathways to action and motivation

Disruption of the dorsal frontostriatal pathways in Parkinson’s disease (PD) is associated with impairments in motivation, as well as in executive function. The goal of this study was to investigate whether these impairments are related and, if so, whether the disruption of frontostriatal pathways compromises the ability to process the motivational aspects of feedback in such tasks. In Experiment 1, informative feedback improved the performance of young, healthy participants in a task-switching paradigm. This task-switching paradigm was then used in Experiment 2 to test whether feedback would improve the performance of 17 PD patients and age-matched controls. The PD group benefitted from feedback to the same degree as control participants; however, depression scores on the Beck Depression Inventory were significantly related to feedback usage, especially when response selection demands were high. Regardless of feedback, PD patients were more impaired when response demands were high than in an equally difficult condition with low action demands. These results suggest that response selection is a core impairment of insufficient dopamine to the dorsal frontal striatal pathways.     

Emotional regulation of fertility decision making: What is the nature and structure of "baby fever"?

Baby fever-a visceral physical and emotional desire to have a baby-is well known in popular culture, but has not been empirically studied in psychology. Different theoretical perspectives suggest that desire for a baby is either superfluous to biological sex drives and maternal instincts, a sociocultural phenomenon unrelated to biological or evolutionary forces, or an evolved adpatation for regulating birth timing, proceptive behavior, and life history trajectories. A series of studies (involving 337 undergraduate participants and 853 participants from a general population Internet sample) found that: (a) a simple scale measure could elicit ratings of desire frequency; (b) these ratings exhibited significant sex differences; (c) this sex difference was distinct from a general desire for sexual activity; and (d) these findings generalize to a more diverse online population. Factor analyses of ratings for desire elicitors/inhibitors identified three primary factors underlying baby fever. Baby fever appears to be a real phenomenon, with an underlying multifactorial structure. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The influence of emotional labour and emotional work on the occupational health and wellbeing of South Australian hospital nurses

Nursing is an emotionally complex occupation, requiring performance of both emotional labour (for the benefit of the organisation and professional role) and emotional work (for the benefit of the nurse-patient relationship). According to the Conservation of Resources Theory, such processes can have a significant effect on psychological wellbeing and occupational stress, although little is known about the factors that moderate their effects. This exploratory study investigated the relationship between emotional labour and emotional work on psychological wellbeing and occupational stress in 239 nurses sampled from a South Australian hospital. The multi-component questionnaire study focused on the emotional labour elements of emotion expression and suppression, as well as surface acting and deep acting, and examined the companionship, help, and regulation elements of emotional work. In a multivariate model, emotional work was found to be less strongly predictive of negative psychological outcomes than was emotional labour, but was more strongly predictive of positive outcomes. Social support may moderate or be an antecedent to the performance of emotional labour and emotional work. The findings support the Conservation of Resources Theory with emotional work, rather than emotional labour, enabling the uptake of resources and leading to positive occupational health and wellbeing.     

Unique Challenges Facing Female Athletes in Urban High Schools

Although the passage of Title IX secured equity of treatment and opportunity for female high school athletes in the United States, little research has examined the social well-being of girls who participate in sports during high school. The current survey study investigated how 9th grade sports participation relates to perceived gender discrimination from peers and adults at school over four time points spanning 10th through 12th grade. The ethnically diverse sample (46.6?% Hispanic/Latina/Mexican-American, 14.1?% Asian-American/Pacific Islander, 12.8?% African-American/Black, 11.5?% European-American/White, 15.1?% Other/Mixed) consisted of 384 girls in the southwestern United States. Results of growth modeling showed that 9th grade athletes (n?=?309) perceived greater gender discrimination relative to girls who were not involved in sports (n?=?75), and accelerated in peer gender discrimination compared to non-athletes. Athletes and non-athletes did not differ in perceived gender discrimination from adults at school. Analyses conducted separately within each ethnic group revealed that ethnic groups did not differ in patterns of gender discrimination. These findings suggest that girls who play sports may experience differential treatment from their peers. Future directions and policy implications are discussed.     

Grandiose Fantasies and Low Self-Esteem: An Experimental Study

Grandiose states of mind could be an ineffective way to cope with low self-esteem. In fact, it is possible that grandiose fantasies would tend to induce doubts about personal worth and decrease self-esteem. This study explored whether grandiose fantasies help to cope with low self-esteem. The self-reported occurrence and unpleasantness of intrusive thoughts regarding the sense of exclusion, humiliation, and low self-esteem in non-clinical individuals were assessed during self-induced grandiose fantasies and self-induced relaxation. The occurrence and unpleasantness of low self-esteem intrusions were significantly higher during grandiose fantasies, suggesting that grandiose fantasy is ineffective at combating low self-esteem.     

The Impact of Modifying Interpretive Bias on Contamination-Related Obsessive–Compulsive Symptoms

Cognitive-behavioural models of obsessive–compulsive disorder (OCD) propose that a tendency to negatively interpret ambiguous thoughts and situations plays a key role in maintaining the disorder. Moreover, some researchers have proposed that negative interpretive biases may share a common processing mechanism with attentional biases, with changes in one predicted to lead to changes in the other. The current study examined whether training positive (i.e., adaptive) interpretive bias of contamination-related OCD concerns using a cognitive bias modification paradigm (CBM-I) would lead to reductions in contamination concerns, as well as changes in contamination-related attentional bias. Undergraduate students with high levels of contamination-related OCD symptoms were randomly assigned to receive either positive (n?=?31) or neutral (n?=?33) CBM-I training. Participants in the positive training condition, relative to the neutral training condition, showed a significantly greater increase in positive interpretive bias, significantly less within-session behavioural avoidance of contaminants, and significantly reduced contamination-related cognitions (at one-week follow-up). Contrary to expectations, CBM-I training did not differentially impact attentional bias nor self-reported contamination-related OCD symptoms. We discuss future directions in applying CBM-I to contamination-related OCD.

     

Religious Beliefs or Physicians’ Behavior: What Makes a Patient More Prone to Accept a Physician to Address His/Her Spiritual Issues?

The present study aims to understand the relation between religious beliefs, physicians’ behavior and patients’ opinions regarding “Spirituality, religiosity and health (S/R)” issues, and what makes a patient more prone to accept a physician to address his/her spiritual issues. A cross-sectional study was carried out in outpatients from a tertiary hospital, and a path analysis was used to examine the direct and indirect relationships between the variables. For the final analysis, 300 outpatients were evaluated. Most patients would like their doctors to address S/R issues but did not feel comfortable to ask them. In contrast, they reported most doctors have never addressed S/R issues, and they believe doctors are not prepared to address these issues. The path analysis revealed that patients’ previous experiences with their doctors may be as important as their religious/spiritual beliefs in proneness to accept a physician to address his/her spiritual issues.     

Generalizability theory: A practical guide to study design,implementation, and interpretation

Generalizability Theory (GT) offers increased utility for assessment research given the ability to concurrently examine multiple sources of variance, inform both relative and absolute decision making, and determine both the consistency and generalizability of results. Despite these strengths, assessment researchers within the fields of education and psychology have been slow to adopt and utilize a GT approach. This underutilization may be due to an incomplete understanding of the conceptual underpinnings of GT, the actual steps involved in designing and implementing generalizability studies, or some combination of both issues. The goal of the current article is therefore two-fold: (a) to provide readers with the conceptual background and terminology related to the use of GT and (b) to facilitate understanding of the range of issues that need to be considered in the design, implementation, and interpretation of generalizability and dependability studies. Given the relevance of this analytic approach to applied assessment contexts, there exists a need to ensure that GT is both accessible to, and understood by, researchers in education and psychology. Important methodological and analytical considerations are presented and implications for applied use are described.