Analysis and meta-analysis of single-case designs with a standardized mean difference statistic: A primer and applications

This article presents a d-statistic for single-case designs that is in the same metric as the d-statistic used in between-subjects designs such as randomized experiments and offers some reasons why such a statistic would be useful in SCD research. The d has a formal statistical development, is accompanied by appropriate power analyses, and can be estimated using user-friendly SPSS macros. We discuss both advantages and disadvantages of d compared to other approaches such as previous d-statistics, overlap statistics, and multilevel modeling. It requires at least three cases for computation and assumes normally distributed outcomes and stationarity, assumptions that are discussed in some detail. We also show how to test these assumptions. The core of the article then demonstrates in depth how to compute d for one study, including estimation of the autocorrelation and the ratio of between case variance to total variance (between case plus within case variance), how to compute power using a macro, and how to use the d to conduct a meta-analysis of studies using single-case designs in the free program R, including syntax in an appendix. This syntax includes how to read data, compute fixed and random effect average effect sizes, prepare a forest plot and a cumulative meta-analysis, estimate various influence statistics to identify studies contributing to heterogeneity and effect size, and do various kinds of publication bias analyses. This d may prove useful for both the analysis and meta-analysis of data from SCDs.     

The effect of external perturbations on variability in joint coupling and single joint variability

This paper explores the effect of goal-oriented external perturbations created by elastic tubes attached to the hip and ankles on lower limb joint variability and hip–knee and knee–ankle coordination variability during running. Kinematics of ten healthy male runners were analysed prior to and following a 7-week tube running intervention while running with and one without this constraint. The training intervention was based on variable training aspects to increase within-movement variability and adaptability of the running pattern. To analyse the effects of the tubes on the running pattern, the phase plot vector length deviation (i.e., the standard deviation of the phase plot vector length) for the within-joint variability and the continuous relative phase variability for the joint coupling variability were calculated. Results revealed acute increases of variability in both parameters. However, after the intervention, variability of the tube running situation returned to normal for all couplings and joints except the knee. No transfer effects to normal running were observed. This suggests very rapid adaptations to such perturbations. In the long-term, it may ask for more or different variations.     

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.     

终末期肾病单病种付费实施现况及个人支付费用影响因素研究

单病种付费对于控制医疗费用的不合理增长与促进机构医疗服务质量的提高具有重要意义.通过对浙江省某市终末期肾病参保患者医疗费用支出、卫生服务利用等数据的收集,运用统计学分析工具,分析不同类型参保患者实际费用支出及卫生服务利用的差异,并探讨个人支付费用的影响因素.建议该市在终末期肾病单病种政策制定中建立动态的定额结算标准;鼓励与引导病情较轻的患者优先进行腹膜透析;并完善多层次的医疗保障制度,鼓励低收入家庭患者尽早就医.     

病例报告与临床科研思维

病例报告属于描述性研究方法,是通过记录非同寻常的临床现象,可能揭示新病种、特殊机制、新疗法等,为临床工作经验介绍、总结的初步形式。在医学科学探索的历程中,病例报告拥有特殊的地位和曾经的辉煌,目前仍是医学研究的一种重要体裁。"一个好的病例报告就是一个有教育意义的好故事",一个不同寻常的现象,可能是一个新的病种、一个特殊的机制或一种特殊的组织病变或生理功能紊乱所致。一篇好的病例报告为临床医生和科研工作者提供直接生动的第一手临床资料,能促进临床医生和医学生热爱临床工作,养成面对难题、独立思考、追根朔源、发现与解决问题的能力,值得重视。     

Implications for Wellness‐Based Supervision and Professional Quality of Life

This study evaluated the efficacy of the wellness model of supervision (WELMS; Lenz & Smith, 2010 ) for promoting changes across the perceptions of counselors‐in‐training (CITs) regarding professional quality of life. Three female participants (1 Caucasian, 2 Hispanic) were enrolled in a program accredited by the Council for Accreditation of Counseling and Related Educational Programs. Results of a single‐case research design with multiple baselines indicated that the WELMS was efficacious across client–CIT interactions on professional quality of life.     

Trauma-Focused CBT in the Context of Parental Chronic Medical Conditions: A Case Report

Parental chronic medical conditions (CMCs) are relatively common and have been shown to impact children’s psychosocial functioning. Previous research suggests that, for some youth, parental CMCs may be conceptualized as a form of traumatic stress. Trauma-focused cognitive behavioral therapy (TF-CBT) is a multicomponent, evidence-based intervention that is designed to reduce symptoms of posttraumatic stress, depression, and anxiety, as well as behavioral problems, among children and adolescents. Despite its robust empirical support, however, no known studies have utilized this treatment approach to address the mental health needs of youth affected by parental CMCs. The purpose of this article is to describe the application of TF-CBT to treat an adolescent male whose mother was diagnosed with a CMC, which had resulted in continuous family stressors since his birth. Results suggest that TF-CBT offers a promising approach for treating symptoms of posttraumatic stress, anxiety, and depression among children of parents with CMCs, and clinical trials to investigate its effectiveness among this population may be warranted.     

发展性协调障碍与书写困难个案研究

该研究对一个14岁书写困难儿童zl的动作和认知技能进行了系统的考察。zl的书写困难主要表现在以下几方面：书写速度慢,字与字之间的空间距离非常近,字迹难以辨认,笔画顺序混乱。该研究首先测查了zl的基本智能和一系列精细动作技能、视觉、视空以及序列加工能力。结果发现他的基本智能、视觉加工能力正常,动作技能和视空加工能力皆显著落后于控制组儿童。语言能力测试发现,他的识字量、阅读理解和听力理解均正常。他在汉字单字、双字词、数字和图片命名上的正确率与控制组没有显著差异,但命名速度明显慢于控制组。神经生理检查发现,他的脑电波轻度异常,核磁共振扫描(MRI)显示双侧脑室体后部和枕角周围白质和小脑发育异常。这些结果表明该儿童的书写困难是更广泛的动作协调障碍的一种体现,并可能以他的脑神经发育状况为基础。文章讨论了zl书写障碍的认知神经机制及对书写障碍早期鉴别和训练的意义。