Do adapted vignettes improve medical decision‐making capacity for individuals with Alzheimer's disease?

Medical decision‐making capacity (MDC) is known to decline in individuals with Alzheimer's disease (AD). The vignette method uses hypothetical information as a prerequisite for measuring the capacity to make well‐informed decisions to clinical trials. Our aim was to investigate if adapted vignettes can help individuals with mild AD to assimilate information, make decisions and express them in an understandable way, compared to corresponding decisions based on linguistically more demanding vignettes, as measured by the Swedish Linguistic Instrument for Medical Decision‐making (LIMD). Two vignettes from LIMD were altered linguistically with the aim to facilitate understanding for individuals with AD. An experimental within‐subject design was used to study the influence on MDC of readability (original/adapted vignettes) and content (two different clinical trials). We included 24 patients with mild AD in this prospective study, which read all four vignettes along with a few other tests. This allowed us to investigate the association between MDC and cognitive function. Adapted vignettes did not yield significant differences regarding MDC as compared with original vignettes using a two‐way repeated measures analysis of variance. A difference was found between the two clinical trials where LIMD score was significantly higher for Kidney disease than hypertension vignettes. Our results indicate that adapted vignettes may not improve MDC for individuals with mild AD. MDC was affected by which clinical trial the vignettes regarded, which implies that other factors affecting MDC need to be investigated, like length of text and vocabulary used.     

Matthews Model of Clinical Reasoning: A Systematic Approach to Conceptualize Evaluation and Intervention

Clinical reasoning is a complex process required for effective therapeutic encounters. Its development is poorly understood. The clinical reasoning process is placed in a historical context based on the occupational therapy literature. An emerging model of clinical reasoning is proposed. This model of clinical reasoning provides a unique perspective in order to compartmentalize the person, environment, and occupation constructs around the person’s life story, connect it directly to the occupational therapy practice framework, and determine treatment priorities, emphasizing a client-centered perspective. A client-centered model of clinical reasoning supports efforts to provide effective intervention.     

Do sales and service compete? The impact of multiple psychological climates on frontline employee performance

This research examines how employees’ climate perceptions – or psychological climate – influence their performance of climate-related outcomes. We focus on two specific climates arguably most relevant to boundary-spanning organizations: service and sales climates. Building from the resource-allocation framework, the authors examine the way employees reconcile these multiple psychological climates. Polynomial regression and response surface modeling are used to test for the influence of these distinct climates on employee outcomes using a sample of 252 marketing employees and their 68 immediate supervisors. Specifically, the authors examine relationships between service and sales climates and the employee performance outcomes of customer satisfaction, helping behavior, effort, and sales performance. Results provide insight into the benefits and pitfalls of sales and service climates co-existing. Specifically we find that while sales effort is highest in climates that heavily favor sales, sales performance may exist in both sales-favored and service-favored climates (yet not in the presence of both). From a customer satisfaction perspective we find no significant impact of increasing sales climate in the presence of high service perceptions. These findings – both significant and non-significant – provide implications for future research in the realm of service-sales ambidexterity and interface as well as insight and direction for frontline managers.     

Repression and splitting: towards a method of conceptual comparison

An attempt is made to compare two psychoanalytic concepts which by ‘belonging’ to different psychoanalytic groups have come to be defined and used differently. The paper is also an inquiry into the possibility of a comparative psychoanalytic method. The two concepts are ‘repression’ and ‘splitting of the ego’ and an examination is made of the semantic similarities and differences. Some clinical material is offered that adds indicative clinical evidence to test the semantic comparison. The aim is to answer the question: Are the terms simply alternative ones for similar clinical phenomena? The paper offers one method which could provide an answer. It represents a general method for clarifying and maybe reconciling the differing points of view of competing psychoanalytic schools.     

Some brief considerations on the relationship between theory and practice

The present crisis in models of training and in psychoanalytical education in general can be linked to the gulf that has come to be created between analytical theory and clinical practice. The paper(1) examines the historical facts that have led to this split and suggests the need to return to the models of Freud and Jung. Both these fathers of depth psychology stressed the dangers inherent in the dogmatic use of theory and both insisted that theory must always spring from and be able to account for clinical practice rather than vice versa, as is so often the case today. The paper also looks at how theory should be taught in our analytical institutes in order to ensure that what we transmit to our candidates is not knowledge in the form of dogma but rather a way of proceeding that will enable them to think creatively about their clinical practice and thus produce new knowledge, essential if depth psychology is to remain relevant to our post-modern culture.     

A field experiment testing the utility of regulatory fit messages for promoting physical activity

Guided by regulatory focus theory, we examined whether messages tailored to individuals’ promotion- or prevention-goal orientation (regulatory focus) elicit positive thoughts and feelings about physical activity and increase participation in physical activity. Inactive participants (N = 206) were assigned randomly to receive either promotion-focused or prevention-focused messages encouraging physical activity. Two weeks after message exposure, we assessed participants’ thoughts and feelings about physical activity and physical activity behavior. Tailored messages that fit individuals’ regulatory focus led to greater physical activity participation and more positive feelings than non-fit messages, particularly in the promotion-focused condition. Furthermore, positive retrospective feelings about physical activity mediated the effects of the tailored messages on behavior. These findings provide support for regulatory focus theory and direction for enhancing the effectiveness of messages encouraging physical activity and other health behaviors.     

AN ISLAMIC APPRAISAL OF MINDING THE GAP

The neglect of psycho‐spiritual needs of patients as they traverse the modern healthcare system has been a featured theme in medical literature over the past decade. This literature, which often highlights in‐patient palliative care, as well as acute and critical care settings, influences practice guidelines and protocols of doctors and nurses. In this essay, I review some of the pertinent issues raised in the literature and examine the validity of placing an ethical perspective on this issue. I also compare Islamic theocentric perspectives with secular, non‐theistic perspectives on restoring psycho‐spiritual care for patients. I then develop a framework for pastoral intervention based on aspects of the Islamic tradition and elaborate this framework by addressing clinical contexts and cases. The essay is an exposition based upon a review of the modern medical literature, an analysis of some of the traditional Islamic written sources, and the observations of the investigator, a practicing physician and an American Muslim.