External, Not Internal Challenges to Interdisciplinary Research

This commentary draws on personal experience with interdisciplinary collaborations to suggest that Maton, Perkins, and Saegert (this issue) may overstate the challenges internal to interdisciplinary work groups. It supports their discussion of external challenges, and comments on the efforts they suggest to further interdisciplinary work.     

Career Research Interests and Training of Genetic Counseling Students

Research is important to validate clinical services, provide information on the effectiveness of practice techniques, and develop the knowledge base of a clinical profession. Genetic counseling students from American Board of Genetic Counseling (ABGC) accredited training programs were surveyed to determine their career research interests and interest in pursuing a hypothetical doctoral degree in genetic counseling. Genetic counseling program directors were surveyed to assess the emphasis on research training within their programs. A substantial number (46%, n = 92) of genetic counseling students are interested in performing research in their careers and many (40%, n = 80) would pursue a doctoral degree in genetic counseling if it was available. Students and directors from programs with a thesis requirement reported a significantly higher emphasis on career research preparation than those from programs without a thesis requirement. The results of this study indicate that future genetic counselors are interested in contributing to the research base that will advance the field. This study suggests a need to strengthen research training within ABGC accredited graduate programs and explore the development of a doctoral degree option in genetic counseling.     

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.     

A new perspective on visual word processing efficiency

As a fundamental part of our daily lives, visual word processing has received much attention in the psychological literature. Despite the well established advantage of perceiving letters in a word or in a pseudoword over letters alone or in random sequences using accuracy, a comparable effect using response times has been elusive. Some researchers continue to question whether the advantage due to word context is perceptual. We use the capacity coefficient, a well established, response time based measure of efficiency to provide evidence of word processing as a particularly efficient perceptual process to complement those results from the accuracy domain.     

Evaluation of the attentional capacities and working memory of early and late blind persons

Although attentional processes and working memory seem to be significantly involved in the daily activities (particularly during navigating) of persons who are blind and who use these abilities to compensate for their lack of vision, few studies have investigated these mechanisms in this population. The aim of this study is to evaluate the selective, sustained and divided attention, attentional inhibition and switching and working memory of blind persons. Early blind, late blind and sighted participants completed neuropsychological tests that were designed or adapted to be achievable in the absence of vision. The results revealed that the early blind participants outperformed the sighted ones in selective, sustained and divided attention and working memory tests, and the late blind participants outperformed the sighted participants in selective, sustained and divided attention. However, no differences were found between the blind groups and the sighted group in the attentional inhibition and switching tests. Furthermore, no differences were found between the early and late blind participants in this set of tests. These results suggest that early and late blind persons can compensate for the lack of vision by an enhancement of the attentional and working memory capacities.     

Speech and bimanual hand organization in adult stutterers and nonstutterers

A multivariate approach was used to investigate the relationship between speech fluency and bimanual handwriting in right-handed male stutterers and nonstutterers. Handedness was determined by the Harris Test of Lateral Dominance. Subjects were required to write the numbers 1 through 12 simultaneously, as quickly as possible. Speech measures were derived from the Stuttering Severity Instrument and from a reading passage. Stutterers performed more poorly than nonstutterers on all speech measures. There were no differences in bimanual handwriting performance for the dominant hand. However, stutterers performed more poorly than nonstutterers in nondominant handwriting. There were no relationships between speech measures and bimanual handwriting for stutterers or nonstutterers. Some stutterers performed better on the handwriting task than did some nonstutterers. It is suggested that disorganization in interhemispheric integration functions may be a more fundamental problem in stuttering than is incomplete cerebral dominance.     

Effectiveness of the ‘Hold me Tight’ Relationship Enhancement Program in a Self‐referred and a Clinician‐referred Sample: An Emotionally Focused Couples Therapy‐Based Approach

While evidence‐based couple therapies are available, only a minority of troubled couples seek help and they often do this too late. To reach more couples earlier, the couple relationship education (CRE) group program “Hold me Tight” (HmT) based on Emotionally Focused Couples Therapy (EFCT) was developed. This study is the first to examine the effectiveness of HmT. Using a three‐wave (waiting period, treatment, and follow‐up) within‐subject design, HmT was delivered to 79 self‐referred couples and 50 clinician‐referred couples. We applied a comprehensive outcome measure battery. Our main findings were that (1) self‐referred couples significantly improved during HmT on all measures, that is relationship satisfaction, security of partner‐bond, forgiveness, daily coordination, maintenance behavior, and psychological complaints, with a moderate‐to‐large mean effect size (d = .63), which was maintained (d = .57) during the 3.5 month follow‐up; (2) in clinician‐referred couples, who were vulnerable in terms of insecure attachment status and psychopathology, the improvement during HmT was moderate (d = .42), but this was reduced during the 3.5‐month follow‐up to a small effect (d = .22); (3) emotional functioning (typical HmT target) as well as behavioral functioning (typical Behavioral Couples Therapy‐based CRE target) improved during HmT; and (4) individual psychological complaints, although not specifically targeted, were reduced during HmT. These findings suggest that HmT is a promising intervention for enhancement of relationship functioning. Clinical implications are discussed.