Introducing SYPRENE: An International Practice Research Network for Strategic and Systemic Therapists and Researchers

SYPRENE, a new international Systemic Practice Research Network (PRN), has been established to fill the gap in practice-based research on the effectiveness and efficiency of strategic therapies. This article presents the rationale for the creation of SYPRENE and describes data collection methods, and the encoding system implemented within this PRN. More developments are expected in the recruitment of practitioners, the types of data collected, findings, and the implementation of SYPRENE in supervision, trainings, and professional schools.     

Therapeutic Utility of Discussing Therapist/Client Intersectionality in Treatment: When and How?

The impact of the therapeutic alliance on positive clinical outcomes has been established in the literature; however, literature is lacking on how the intersection of therapist and client identities influences this process. We propose that the relational intersectionality resulting from similarities or differences in therapist and client identities has the potential to impact the bonds, tasks, and goals of treatment (key components of the therapeutic alliance; Bordin, 1979) depending on how it is addressed or avoided in therapy. In this paper, we present a model containing pragmatic steps therapists can follow to navigate these conversations with clients in a way that is therapeutically beneficial and culturally sensitive and attuned. Additionally, we provide suggestions for using the proposed model to train new student therapists (or expose experienced therapists) to ideas of intersectionality and social justice by reflecting on the intersection of their own identities, acknowledging dynamics of power and oppression, and understanding how this could shape their relationship with clients.     

Exploring emotions in dialog between health provider,parent and child. An observational study in pediatric primary care

IntroductionThis paper is part of the theoretical thread of health psychology and it presents a study aimed to recognize information useful to implement psychological interventions finalized to personalize medical treatments and engage users in pediatrics.ObjectiveIn this paper is presented an observational study aimed to explore doctor-patient dialog about worries in pediatric primary care; it has been carried out identifying dialogical interaction patterns, or typical dialog between health providers, parent and child.MethodWe documented conversations in 265 visits; we audio-recordered, transcribed and analyzed them with Verona Coding Definitions of Emotional Sequences. Dialogs between participants were analyzed one by one. Frequencies of emotions’ signals (cues/concerns) and responses were analyzed through Redundancy Analysis, aimed to establish a quantitative relationship between these pair of groups of variables considering the asymmetrical relationship between them.ResultsSix “Dialogical Interaction Patterns” were obtained by interpreting these relationships; they show dialogs mainly aimed at obtaining information useful for diagnosis and treatment, with a limited exploration of worries or issues related to the condition of the child. Pediatric conversations seem to be characterized by a very high attention to cognitive aspects of medical questions with a poor consideration of emotions as useful information to medical practice.ConclusionsThese dialogs seem to ensure the rapidity and the efficiency of medical visits. Nevertheless, it could be useful to implement psychological interventions to achieve an enrichment of the dialog between participants, helping them to recognize users’ emotions as useful to define shared medical strategies.     

A Classification Framework using a Diverse Intensified Strawberry Optimized Neural Network (DISON) for Clinical Decision-making

A novel classification framework for clinical decision making that uses an Extremely Randomized Tree (ERT) based feature selection and a Diverse Intensified Strawberry Optimized Neural network (DISON) is proposed. DISON is a Feed Forward Artificial Neural Network where the optimization of weights and bias is done using a two phase training strategy. Two algorithms namely Strawberry Plant Optimization (SPO) algorithm and Gradient-descent Back-propagation algorithm are used sequentially to identify the optimum weights and bias. The novel two phase training method and the stochastic duplicate-elimination strategy of SPO helps in addressing the issue of local optima associated with conventional neural networks. The relevant attributes are selected based on the feature importance values computed using an ERT classifier.Vertebral Column, Pima Indian diabetes (PID), Cleveland Heart disease (CHD) and Statlog Heart disease (SHD) datasets from the University of California Irvine machine learning repository are used for experimentation. The framework has achieved an accuracy of 87.17% for Vertebral Column, 90.92% for PID, 93.67% for CHD and 94.5% for SHD. The classifier performance has been compared with existing works and is found to be competitive in terms of accuracy, sensitivity and specificity. Wilcoxon test confirms the statistical superiority of the proposed method.     

Calendrical savants: exceptionality and practice

The exceptionality of the skills of calendrical savants and the role of practice were investigated. Experiment 1 compared four autistic calendrical savants to Professor Conway, a distinguished mathematician with calendrical skills. Professor Conway answered questions over a greater range of years but some savants knew more calendrical regularities. Experiment 2 studied the development of a calendrical savant's ability to answer date questions for very remote future years. He started by making written calculations and progressed to mental calculation. His variation in response time for remote dates was similar to that for near dates. The findings are consistent with the view that calendrical savants develop their skills through practice.     

Up front and personal: confronting dynamics in the Family Group Conference

The Family Group Conference is a participatory model of decision making with families in child protection. It is a legal process that brings together the family, including the extended family, and the professionals in a family-led decision-making forum. Bringing together extended family and professionals to discuss child protection concerns can create a highly charged dynamic. Workers are challenged by family, family are challenged by workers, and family members challenge each other. Practice is also exposed to wider scrutiny as professionals also challenge the work. This article briefly describes the development and practice of family group conferencing as a family-centred legal process in Aotearoa, New Zealand. It then examines the findings of a study exploring the dynamics emerging from family group conference practice from the perspective of the coordinators who convene them. Family group conferencing as a family strengthening practice is discussed.     

Incremental Validity of Cognitions in a Clinical Case Formulation: An Intraindividual Test in a Case Example

Incremental validity, the ability of a measure to predict or explain variance over and above other measures, is an important psychometric characteristic of standardized measures, but has received little attention idiographically. Idiographic assessment may be an important part of developing a clinical case formulation, guiding treatment by developing an individualized understanding of the variables that trigger and maintain distress. This study examined whether the idiosyncratic cognitive schema hypothesized by a clinician in a cognitive case formulation explained distress incrementally over that of situational triggers. Using daily ratings of situational triggers, idiosyncratic cognitions, and distress, the incremental validity of cognitions in predicting each of six distress measures was tested in a case example using dynamic time series regression. The incremental variance explained by cognitions varied across the distress measures, suggesting that, in this case example, targeting thoughts and beliefs for treatment may be important for only certain types of distress.

Promoting Generalization of Oral Reading Fluency: Providing Drill versus Practice Opportunities

Extensive evidence exists demonstrating the benefits of repeated readings (RR) interventions at increasing students’ fluency on intervention passages. Few studies however have examined the extent to which repeatedly reading one passage improves students’ reading fluency on similar passages. Using an alternating treatment design, we examined the extent to which two interventions resulted in improvements in students’ fluency on generalization passages. While both interventions incorporated RR, one intervention involved students reading one passage four times and the other involved students reading two similar passages each twice. Intervention effects were evaluated by having students read a generalization passage prior to and following intervention implementation. Results indicate that both interventions were effective in increasing students reading fluency on generalization passages. For 3 participants the RR intervention produced greater gains in fluency on the generalization passages, while data for the remaining 3 participants are inconclusive. Implications of these findings for practice and for better understanding application of the instructional hierarchy to the development of reading interventions are discussed.

Neurofibromatosis Type 1 in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors

The objective of this document is to provide recommendations for the genetic counseling of patients and families undergoing evaluation for neurofibromatosis type 1 (NF1) or who have received a diagnosis of NF1. These recommendations are the opinions of a multi-center working group of genetic counselors with expertise in the care of individuals with NF1. These recommendations are based on the committee’s clinical experiences, a review of pertinent English language medical articles, and reports of expert committees. These recommendations are not intended to dictate an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider’s professional judgment based on the clinical circumstances of an individual patient. Both Heather B. Radtke and Courtney D. Sebold contributed equally to this document.     

Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.