Dimensions Of Clinical Practice Research Articles

Delineating apathy profiles in Huntington's disease with the short-Lille Apathy Rating Scale

IntroductionApathy, a prevalent feature in neurological disorders including Huntington's disease (HD), is characterized by a reduction in goal-directed behavior across cognitive, auto-activation (i.e., self-activating thoughts/behavior), and emotional domains. Nonetheless, current diagnostic criteria are incapable of distinguishing multidimensional apathy profiles. Meanwhile, the short-Lille Apathy Rating Scale (LARS-s) bears potential as an operative diagnostic tool to disentangle apathy dimensions in clinical practice. The present study thereby examines the psychometric properties and factor structure of the LARS-s to tap into apathy profiles and their underlying neural correlates in HD. MethodsForty HD individuals were scanned and evaluated for apathy using the LARS-s, assessed for reliability and validity in HD, and the short-Problem Behavior Assessment (PBA-s). To study the dimensional structure of apathy, principal component analysis (PCA) of the LARS-s was implemented. Resulting factors were associated with gray matter volume through whole-brain voxel-based morphometry. ResultsThe LARS-s demonstrated satisfactory psychometric properties, sharing convergent validity with PBA-s apathy and discriminant validity against depression. PCA resulted in three factors representative of apathy profiles across cognitive, auto-activation, and emotional domains. Anatomically, global apathy was significantly related with large-scale motor, cognitive, and limbic networks. Exploratory analyses of apathy profiles revealed correspondence between each factor and distinct cortical and subcortical nodes. ConclusionThe LARS-s is capable of capturing the multidimensional spectrum of apathy. At the same time, apathy profiles in HD are underpinned by functionally diverse neural networks. Such findings promote the continued study of apathy domains to pinpoint personalized therapeutic targets in neurologic disorders in addition to HD.

Ratings of dimensional traits in clinical practice: Comparing therapist and client perspectives.

Research has repeatedly evidenced the structural validity of the five-factor model (FFM), but questions remain about the use of its dimensions in clinical practice. Samuel and colleagues (2018) found therapists reported their clients had lower levels of personality pathology compared with clients' own self-reports when using the unipolar Personality Inventory for the DSM-5 (PID-5) scale. The present study utilized the same sample of 54 client-therapist dyads to examine their use of the bipolar FFM Rating Form. When comparing the clinical ratings to expertly rated healthy profile ratings, clients rated themselves as more aligned with healthy than their therapists rated them. Alternatively, clients were up to 3.6 times more likely to use the extreme (i.e., theoretically pathological) ratings of the FFM Rating Form compared with their therapists. These results suggest that therapists and clients use these measures quite differently, and we cannot firmly conclude which source reports more pathology. Theoretical explanations, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluation of the Usability of the Tiger Full-Foot Three-Dimensional Scanner for the Measurements of Basic Foot Dimensions in Clinical Practice.

Foot dimension information is important both for footwear design and clinical applications. In recent years, noncontact three-dimensional (3-D) foot digitizers/scanners have become popular because they are noninvasive and are valid and reliable for most of the measures. Some of them also offer automated calculations of basic foot dimensions. We aimed to determine test-retest reliability, objectivity, and concurrent validity of the Tiger full-foot 3-D scanner and the relationship between manual measures of the medial longitudinal arch of the foot and alternative parameters obtained automatically by the scanner. Intraclass correlation coefficients and minimal detectable change values were used to assess the reliability and objectivity of the scanner. Concurrent validity and the relationships between the arch height measures were determined by the Pearson correlation coefficient and the limits of agreement between the scanner and the caliper method. The relative and absolute agreement between the repeated measurements obtained by the scanner show excellent reliability and objectivity of linear measures and only good to nearly good test-retest reliability and objectivity of arch height. Correlations between the values obtained by the scanner and the caliper were generally higher in linear measures (rp ≥ 0.929). The representativeness of state of bony architecture by the soft-tissue margin of the medial foot arch demonstrates the lowest correlation among the measurements (rp ≤ 0.526). The Tiger full-foot 3-D scanner offers excellent reliability and objectivity in linear measures, which correspond to those obtained by the caliper method. However, values obtained by both methods should not be used interchangeably. The arch height measure is less accurate, which could limit its use in some clinical applications. Orthotists and related professions probably appreciate the scanner more than other specialists.

SPN 2021 Poster Abstract Awards

SPN 2021 Poster Abstract Awards

Workplace difficulties, health-related quality of life, and perception of stigma from the perspective of patients with Multiple Sclerosis

IntroductionIn Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health-related quality of life, depression, and stigma and how these factors affect employment status. MethodsA multicenter, non-interventional, cross-sectional study was conducted in adults with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). Patient-reported questionnaires included: 23-item Multiple Sclerosis Work Difficulties Questionnaire, 29-item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory-Fast Screen. ResultsA total of 199 individuals (mean age = 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS) participated in the study. Mean time from diagnosis was 9.6 ± 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0–3.5). Employment rate was 47.2% (n = 94). Mean physical and psychological MSIS-29 impact sub-scores were 40.38 ± 17.1 and 20.24 ± 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate-to-severe depression. Work difficulties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health-related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work-related problems. ConclusionsWork difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.

An Exploratory Study of Adult Baby-Diaper Lovers' Characteristics in an Italian Online Sample.

Background: Knowledge of the Adult Baby-Diaper Lovers (ABDL) phenomena is quite recent and there are, of yet, few studies on this phenomenon. Aim: This study was conceived to investigate the functions of ABDL behaviours and the characteristics of ABDL in an online Italian community sample. We hypothesized that ABDL phenomena were associated with general psychological maladjustment and with an experience of parental rejection during childhood. It was also assumed that there would be differences in ABDL profiles based on the age of appearance of their first Adult Baby-Diaper Lover (ABDL) fantasies. Method: An internet-based study was conducted and it involved 38 adults aged between 18 and 74 years (M = 34.95; SD = 12.25). Participants were first given an ad hoc questionnaire, which was devised to obtain information about the anamnestic variables related to ABDL. Then, the participants filled out the Cognitive Behaviour Assessment 2.0 battery to obtain anamnestic information regarding their psychological, medical, and personal history and to evaluate primary psychological dimensions in clinical practice. Finally, they filled out the Adult Parental Acceptance–Rejection Questionnaire, to evaluate their recollections of parental perceived rejection, and the Personality Assessment Questionnaire, to evaluate the primary psychological aspects related to parental rejection. Results: The data indicated that adults with ABDL showed the presence of anxious traits and recollections of parental rejection during childhood. Moreover, associations were observed between current or previous ABDL phenomena enuresis and negative mood states. Conclusion: Specific kinds of parental modes, anxiety traits, and enuresis seem to be the source of ABDL interests. Moreover, ADBL behaviours seem to assume different functions and meanings.

Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy

The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.

Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa

BackgroundEchocardiographic reference ranges are important to identify abnormalities of cardiac dimensions. Reference ranges for children in sub-Saharan Africa have not been established. The aim of this study was to establish echocardiographic z-score references for Black children in sub-Saharan Africa. Methods282 healthy subjects aged 6–16years (143 [51%] males) with no known history of cardiac disease were enrolled in the study in Harare, Zimbabwe between 2014 and 2016. Standard M-mode echocardiography was performed and nine cardiac chamber dimensions were obtained. Two non-linear statistical models (gamma weighted model and cubic polynomial model) were tested on the data and the best fitting model was used to calculate z-scores of these cardiac chamber measures. The reference ranges are presented on scatter plots against BSA. ResultsNormative data for the following cardiac measures were obtained and z-scores calculated: right ventricular diameter at end diastole (RVEDD); left ventricular diameter at end diastole (LVEDD) and systole (LVESD); interventricular septal wall thickness at end diastole (IVSd) and systole (IVSs); left ventricular posterior wall thickness at end diastole (LVPWd) and systole (LVPWs); left atrium diameter at end systole (LA) and tricuspid annular plane systolic excursion (TAPSE). Girls had higher values for BMI and heart rate than boys (p=0.048 and p=0.001, respectively). Mean interventricular septal and left ventricular posterior walls thickness was higher than published normal values in predominantly Caucasian populations. ConclusionThese are the first echocardiographic reference ranges for children from sub Saharan Africa and will allow accurate assessment of cardiac dimensions in clinical practice.

A Bioética na Tomada de Decisão na Atenção Primária à Saúde

RESUMO A prática médica se alicerça no julgamento e na tomada de decisão acerca das ações de cuidado – dirigidas aos usuários, às famílias e às comunidades –, o que implica a composição das dimensões técnica e ética da prática clínica. Partindo do pressuposto da importância do processo decisório e do julgamento na prática médica, busca-se discutir essa dimensão no cotidiano do médico de família e comunidade em seu trabalho assistencial na Atenção Primária à Saúde. Para isto, apresenta-se uma situação clínica fictícia e com base nela são feitas considerações sobre raciocínios éticos no âmbito da bioética, em busca da resolução do problema. Chama-se a atenção para a importância de estimular tais raciocínios na práxis desses profissionais.

The reliability of using postero-anterior cephalometry and cone-beam CT to determine transverse dimensions in clinical practice

Abstract Aim: This study primarily aimed to assess the accuracy of classically-advocated reference points for the measurement of transverse jaw-base and dental relationships using conventional Postero-Anterior Cephalometry (PAC) and Cone-Beam Computed Tomography (CBCT). Method: PAC and CBCT images were collected from 31 randomly selected orthodontic patients (12 males, 19 females), all of whom had a full permanent dentition. The transverse widths of the maxilla, mandible and the dentition were measured using reference points on both image modalities. Confidence intervals, intra-class coefficients and Bland Altman plots were used to assess the measurement differences derived from the two acquirement methods. Results: Measurements on PAC and CBCT images demonstrated statistically significant differences in the majority of the assessed variables. The interjugal (J-J) width was one of only two variables which did not demonstrate a statistically significant difference on image comparison. The mean differences of the antegonial width (Ag-Ag) (-4.44mm, 95% CI -5.38 to -3.51) represented the greatest difference between the imaging techniques. The application of these points to a transverse skeletal analysis (J-J/Ag-Ag ratio) revealed that five of the 31 subjects (16%) recorded ‘false positive’ readings according to the derived data. Conclusion: It is recommended that clinicians are cautious when interpreting and making decisions related to transverse dimensions derived from a PAC. The PAC has a higher tendency to falsely identify individuals who require maxillary expansion procedures based on conventional clinical criteria. The errors primarily associated with identifying structures which represent the width of the mandible are significant in both PAC and CBCT techniques and require further investigation. It is postulated that the confounding effects of overlying soft tissues have a significant impact on a clinician’s ability to identify relevant landmarks.

Staying Present to Youth with an Unknown Future

The intention of this workshop is to provide an opportunity to explore the various dimensions of clinical practice known to support and enhance coping in adolescents living with a life-threatening illness. The objectives are to: 1) Present recent research findings related to the future thinking activities of adolescents in pediatric palliative care; 2) Acknowledge that these findings stretch us as clinicians to “sit with” and \"create time for\" the youth’s exploration of future in the context of an anticipated shortened life; 3) Discuss several cases and provide experiential activities that can prepare the clinician in ‘being with’ and ‘staying present’ to youth who are exploring their future that remains unknown by virtue of the trajectory of illness.The workshop will be broken down into three parts. In the first 30 minutes the findings from a doctoral study aimed at examining the future thinking of adolescents living with a progressive life-threatening neurodegenerative illness will be presented and discussed. Secondly, consideration will be given to how clinicians can mindfully prepare themselves for supporting adolescents and to consider aspects of the clinical self in our work with this population and finally, through both storytelling and the facilitation of active experiential activities, the presenters will share stories and ideas that have been integrated into existing practices.

Teaching Interpersonal and Communication Skills

The Accreditation Council for Graduate Medical Education mandates that radiology residency programs provide instruction and assessment in six core competencies. Among these are professionalism, interpersonal and communication skills, and patient care. Although no one contests the importance of these competencies, many faculty members, program directors, and residents express uncertainty about how they should be taught. Traditional instructional methods such as lectures and readings exhibit shortcomings. Consider the teaching of interpersonal and communication skills. Methods such as lecture and reading tend to place learners in a passive mode, merely absorbing information. Learning by doing is often preferable and more productive. What we need are opportunities for more active participation that facilitate role modeling and the development of practical skills. We need to develop opportunities to learn such skills that do not place patients at risk, while enabling learners to practice what they are learning. One relatively recent innovation is the development and implementation of medical simulations. Most of these have focused on the development of technical skills, such as intubation, catheterization, and resuscitation. But simulation can also be used to develop other dimensions of clinical practice, such as interpersonal and communication skills. Just as people can become more adept at catheter placement and manipulation by placing and manipulating catheters, so they can become more effective communicators by communicating with patients and families. We recently attended the Program to Enhance Relational and Communication Skills (PERCS), which is sponsored by the Institute for Professionalism and Ethical Practice. The daylong session took place at Boston Children’s Hospital. Although the institute’s programs are targeted at a variety of medical and health care fields, this session was part of a series designed for radiologists, and participants included faculty

Research evidence uptake in a developing country: a survey of attitudes, education and self‐efficacy, engagement, and barriers among physical therapists in the Philippines

Use of evidence from systematic research is critical in evidence-based physical therapy, yet this has not been described well in developing countries where its purported benefits are most needed. This study explored research evidence uptake among physical therapists in the Philippines. A probability survey of practitioners in tertiary hospitals in the Philippines' National Capital Region was conducted. Of the 188 questionnaires distributed, 152 were returned for an 81% response rate. Positive attitudes were consistently reported (78-93%), although education and self-efficacy related to key dimensions such as searching, appraising and integrating evidence were varied (53-82%). Less than 50% reported using research evidence routinely in five of six dimensions of clinical practice, except in selecting treatments (53%). Textbooks, own observations and expert opinion were consistently relied upon (74-96%) while average-month approximations of engagement in relevant activities such as searching, reading, appraising and applying research literature were low (10-18%). Participants faced a number of barriers such as lack of time, resources, skills, access to research literature, supporting administrative policies, in-service training and authority in decision making. The low research evidence uptake and heavy reliance on potentially biased evidence sources strongly indicate the need for effective professional education for practitioners to address current barriers as well as early intensive undergraduate education for students to ensure adequate preparation on being effective research evidence consumers. Given the profile of Filipino physical therapists, alternatives to 'from scratch' evidence searching and appraisal are required if widespread uptake is envisaged.

Confidence in Clinical Practice of Chinese Medicine Degree Graduates 1 Year After Graduation: A Pilot Study

The issue of transition from student to practitioner of Chinese medicine (CM) in Australia and other Western countries has received little formal attention. Workforce studies, while not up to date nationally in Australia, suggest that the majority of CM practitioners practice as sole practitioners or in small practices. Data from the state of Victoria suggest that a significant proportion of the CM workforce is relatively new to the profession. It is not known how many graduates successfully enter the workforce and importantly, remain in it. An initial survey of final-year bachelor degree CM students in Australian education institutions in 2008 suggested that students felt "somewhat" prepared for clinical practice in eight dimensions of clinical practice. The authors conducted a follow-up study to this initial one, seeking to investigate perceptions of confidence in CM graduates in various aspects of clinical practice within the first year of completing their degree. A content-validated survey based on the previous study was distributed to a subset of 30 graduates from the original study cohort who had indicated a willingness to participate in this follow-up survey. There were a small number of responses (n=12), limiting the usefulness of the quantitative questions. However, some interesting qualitative outcomes from the long-answer part of the survey support findings from the previous study that recent practitioners would like more clinical experience, as well as support in developing their business and interpersonal skills, and the option to participate in a professional mentoring arrangement. Results of this study suggest that both education providers and professional associations may be able to play important and complementary roles in assisting CM students to successfully transition into the workforce. If CM is to continue to develop as a profession in Australia, it will be important that more attention be given to how to assist new graduates to successfully transition into and remain in clinical practice.

Students’ reflections in a portfolio pilot: Highlighting professional issues

Background: Portfolios are highlighted as potential assessment tools for professional competence. Although students’ self-reflections are considered to be central in the portfolio, the content of reflections in practice-based portfolios is seldom analysed.Aim: To investigate whether students’ reflections include sufficient dimensions of professional competence, notwithstanding a standardized portfolio format, and to evaluate students’ satisfaction with the portfolio.Methods: Thirty-five voluntary final-year medical students piloted a standardized portfolio in a general practice (GP) attachment at Lund University, Sweden. Students’ portfolio reflections were based upon documentary evidence from practice, and aimed to demonstrate students’ learning. The reflections were qualitatively analysed, using a framework approach. Students’ evaluations of the portfolio were subjected to quantitative and qualitative analysis.Results: Among professional issues, an integration of cognitive, affective and practical dimensions in clinical practice was provided by students’ reflections. The findings suggested an emphasis on affective issues, particularly on self-awareness of feelings, attitudes and concerns. In addition, ethical problems, clinical reasoning strategies and future communication skills training were subjects of several reflective commentaries. Students’ reflections on their consultation skills demonstrated their endeavour to achieve structure in the medical interview by negotiation of an agenda for the consultation, keeping the interview on track, and using internal summarizing. The importance of active listening and exploration of patient's perspective was also emphasized. In students’ case summaries, illustrating characteristic attributes of GP, the dominating theme was ‘patient-centred care’, including the patient–doctor relationship, holistic modelling and longitudinal continuity. Students were satisfied with the portfolio, but improved instructions were needed.Conclusions: A standardized portfolio in a defined course with a limited timeframe provided ample opportunities for reflections on professional issues. Support by mentors and a final examiner interview contributed to the success of the portfolio with students. The interview also allowed students to deepen their reflections and to receive feedback.

Chinese Medicine Students' Preparedness for Clinical Practice: An Australian Survey

Little is known about how prepared Chinese medicine (CM) students perceive themselves to enter the workforce. The objective of this study was to investigate perceptions of preparedness for clinical practice of final-year CM students in Australia. The study design consisted of a written survey focusing on eight dimensions relating to practice: Interpersonal Skills, Confidence/Coping Skills, Professional Networks, Professional Practice Management, Professional Patient Management, Prevention, Holistic Care, and Self-Directed Learning. Part 1 of the survey required participants to choose from six possible responses on how well they believe their CM course has prepared them in relation to 41 statements about aspects of practice (1 = very inadequately through to 6 = very adequately). Part 2 consisted of nine open-ended questions. The study participants were final-year Bachelor degree CM and acupuncture students from Australian universities and privately operated educational institutions. ANALYSIS AND MAIN OUTCOME MEASURES: Part 1 of survey: mean scores on the eight dimensions of practice. Part 2 of survey: transcribed responses were imported into NVivo8. Each part of the questions was analyzed and grouped into broad themes. Seventy-one (71) of one hundred and seven (71/107) invited students (average age 29.4 years +/- 7.4 years) participated in the survey conducted in 2008. Mean scores on eight dimensions of clinical practice were as follows: Interpersonal Skills 3.9 (+/-1.1), Confidence/Coping Skills 4.0 (+/-0.8), Professional Networks 4.2 (+/-0.8), Professional Practice Management 4.2 (+/-0.8), Professional Patient Management 4.7 (+/-0.7), Prevention 4.6 (+/-0.7), Holistic Care 4.4 (+/-0.7), and Self-Directed Learning 4.6 (+/-0.6). There was no significant difference in mean scores across gender. Responses to Part 2 indicated a range of suggestions on the strengths of educational courses and how transition to clinical practice could be facilitated. In general, CM students perceived themselves to be "somewhat adequately" or "adequately" prepared for various aspects of clinical practice. Survey results may help inform CM educators about how to better prepare students for entry into the workforce.

Perioperative medical assessment of the podiatric surgical patient.

Patients undergoing podiatric surgery should receive a thorough perioperative evaluation. Medical "clearance" is no longer sufficient; rather, formal risk assessment should be performed and risk-reducing strategies provided. A collaborative, multidisciplinary approach involving practitioners in internal medicine, anesthesiology, and podiatry is generally most appropriate. Unfortunately, expertise and training in this critical dimension of clinical practice are variable. Thus podiatric physicians should develop independent competence in perioperative evaluation in order to ensure optimal care for their patients. A general systematic approach is described that can be readily incorporated into clinical practice.

Book Review Heroic Self: Sociological Dimensions of Clinical Practice by C. Margaret Hall (Charles C Thomas, Springfield, IL)

Book Review Heroic Self: Sociological Dimensions of Clinical Practice by C. Margaret Hall (Charles C Thomas, Springfield, IL)

Moral perception and the pursuit of medical philosophy.

This paper begins by examining the claim that the practice of medicine is essentially a moral endeavor. According to this view, all clinical practice has moral content, and each clinical situation has a moral dimension. I suggest that in order to recognize this moral dimension, clinicians must engage in an interpretive process, and that they must be able to interpret clinical data in ethical terms. However, clinicians often lack the 'moral perception' required to appreciate this moral dimension. I will argue that physicians lack moral perception when the clinical data they are given do not offer sufficient opportunity for interpretation. This paper draws on the work of Merleau-Ponty to suggest that this loss of interpretation is, paradoxically, the result of the way that patients experience illness. This thesis may be productive, first, because it suggests opportunities to explore the process of moral perception. This thesis also suggests ways for ethicists and educators to enhance clinicians' perception of the ethical dimensions of clinical practice. Finally, the concept of moral perception, when grounded in the patient's experience of illness, creates a fruitful area of inquiry that warrants inclusion in what may someday be the philosophy of medicine's canon.

A Structural Summary Approach for the MMPI-A: Development and Empirical Correlates

The 69 scales and subscales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) are highly intercorrelated and furnish redundant information concerning adolescents' personality functioning. A recent study by Archer, Belevich, and Elkins (1994) identified eight scale-level factors for the MMPI-A. In this article we present a Structural Summary of the MMPI-A based on the scale-level factor structure of this instrument and describe the development and organization of a Structural Summary form. We also provide new research data concerning the empirical correlates of the Structural Summary factors for the MMPI-A normative sample, and for a clinical sample of 122 adolescents, which clarifies the characteristics measured by these dimensions. The Structural Summary approach cuts across the largely arbitrary distinctions between basic, content, and supplementary scales and permits a more organized and parsimonious interpretive approach. Future research should be directed toward further refinement of methods for using the Structural Summary dimensions in clinical practice.