USING PARENTS TO MAINTAIN IMPROVED DENTAL FLOSSING SKILLS IN CHILDREN

An experimenter-administered intervention involving prompts, self-monitoring, permanent product collection, rewards for plaque reduction, and corrective feedback was used to improve the flossing skills of four 7- to 11-year-old children. Parents were subsequently trained in the reward and feedback procedures to facilitate maintenance. In a multiple baseline across subjects design, all four subjects snowed improvement in plaque between teeth during experimenter-administered intervention. Three subjects maintained low plaque levels during the 3- to 4-month parent-administered rewards and feedback follow-up condition. Improved plaque levels on nontargeted tooth surfaces also were observed. Pediatric dentistry applications are discussed.     

Psychological aspects of scuba diving injuries: Suggestions for short-term treatment from a psychodynamic perspective

Dive medicine is described as an area of practice in which psychologists may choose to expand their clinical service and research activities. The author argues that most research studying risk behavior and sports take into account biological, behavioral or cognitive approaches, while ignoring unconscious conflict in risk-taking and injury management. The present paper uses a psychodynamically-oriented, interview-based approach to studying psychological reactions to decompression sickness in three experienced scuba divers. Brief interventions and their outcomes are described.     

Building a primary care discipline: Notes from a psychologist in family medicine

Psychologists of a variety of emphases have actively participated in the growth of family medicine as an academic discipline. Rather than simply collaborate, they have shaped the very nature of the field. This paper describes a number of contributions from psychologists in family systems and educational arenas. In particular, physician-psychologist collaborative work is highlighted.     

The anthropological tradition in the philosophy of medicine

The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images.     

OPERANT TREATMENT OF OROFACIAL DYSFUNCTION IN NEUROMUSCULAR DISORDERS

The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.     

BEHAVIORAL ASSESSMENT AND TREATMENT OF CHRONIC FOOD REFUSAL IN HANDICAPPED CHILDREN

In this study, we examined the eating behavior of four handicapped children, none of whom exhibited self-feeding skills. All children had a history of food refusal and were nutritionally at risk; one child received all nourishment by way of a gastrostomy tube. Baseline data taken during mealtimes indicated that all children accepted very little food, expelled food frequently, and engaged in a number of disruptive behaviors. Treatments consisted of one or more of the following contingent events: social praise, access to preferred foods, brief periods of toy play, and forced feeding. Results of multiple-baseline and reversal designs showed marked behavioral improvement for each child and increases in the amount of food consumed. Further improvements were noted at follow-up, which ranged from 7 to 30 months posttreatment.     

Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: (1) Address the role of history and experience on trust, (2) engage concerns about potential group harm, (3) address cultural values and communication barriers, and (4) integrate patient values and expectations into oversight and governance structures.     

The Ethics of Smart Pills and Self-Acting Devices: Autonomy,Truth-Telling,and Trust at the Dawn of Digital Medicine

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care.     

医疗文书签字扩大化失去意义的原因分析

随着近年医患关系的紧张,越来越多的医疗工作需要履行签字手续,呈现了签字扩大化的态势。签字扩大化是防御性医疗的一种表现形式,但并未带来医疗纠纷减少,也不是医疗纠纷产生的主要原因,又给医疗工作增加了繁琐程度,而且并未达到知情同意的内涵。所以,签字扩大化失去了其应有的意义。     

信任及其对公共财物两难博弈中合作行为影响

社会两难的行为动机研究认为,害怕和贪婪是人们选择不合作的原因。信任的心理学研究为社会两难的合作行为提供了另一种观点,即害怕被利用的背后实际上体现了博弈者对对方的信任的缺失。鉴于传统社会两难范式存在难以区分信任和合作两个因素的问题,本研究设计了“信任一合作”二阶段模拟实验,通过操作重复信托博弈中的信息反馈,研究虚拟多人信托博弈中初始信任和基于经验的信任对随后的公共财物两难博弈中合作行为的影响,结果发现：（1）初始信任对基于经验的信任的建立具有一定的积极影响,但是它对合作行为的作用远不如随后的基于经验的信任;（2）基于经验的信任水平高的被试在随后的公共财物两难博弈中也表现出较高的合作行为。