Practitioner Review Research Articles

Evaluation of the known behavioral heterogeneity in conduct disorder to improve its assessment and treatment.

Conduct Disorder (CD) is among the most highly represented diagnostic problems in child and adolescent mental health treatment settings. There is a great deal of heterogeneity within the CD category, with potentially important implications for case conceptualization and treatment. The current review sought to detail forms of heterogeneity within CD, including callous-unemotional traits, comorbid Attention-Deficit Hyperactivity Disorder (ADHD), aggressive and nonaggressive antisocial behavior, and age of onset. The current review summarizes research on etiological factors, correlates, and trajectories associated with distinguishable dimensions of CD, and considers how this heterogeneity should be incorporated into the assessment and treatment of CD. Callous-unemotional traits have been associated with a more severe and persistent form of CD, as have comorbid ADHD and child-onset CD. Aggressive antisocial behavior is a stable behavioral dimension that emerges in early childhood and is associated with high levels of neuroticism. Nonaggressive antisocial behavior demonstrates specific associations with impulsivity, is most frequent during adolescence, and evidences more moderate levels of stability. Conduct disorder is a highly heterogeneous disorder. Although the clinical implications of this heterogeneity are discussed, future research is clearly needed to shore up our understanding of the clinical ramifications of the sub-dimensions within CD.

Practitioner review: A critical perspective on gene-environment interaction models--what impact should they have on clinical perceptions and practice?

Psychiatric disorders run in families, and early twin, family and adoption studies confirmed that this was due in part to shared genetic inheritance. While candidate gene studies largely failed to reliably identify genetic variants associated with psychiatric disorders, genome-wide association studies are beginning to do so. However, the proportion of phenotypic variance explained remains well below what would be expected from previous heritability estimates. We review possible reasons for this 'missing heritability', and whether incorporating gene by environment interactions into our models will substantially improve our understanding of the aetiology of psychiatric disorders, and inform clinical perceptions and practice. We discuss potential limitations of the gene by environment interaction approach. In particular, we discuss whether these are likely to be a major contributor to psychiatric disorders at the level of the specific interaction (as opposed to at an aggregate level). Gene by environment interaction studies offered initial promise that a far greater proportion of phenotypic variance could be explained by incorporating measures of environmental exposures into genetic studies. However, in our opinion, there are few (if any) clear examples of gene by environment interactions in psychiatry, and their scope for informing either our understanding of disease pathology or clinical practice remains limited at present.

Psychotherapeutic Outcomes Measures: A Critical Review for Practitioners

Use of psychotherapeutic outcome measures improves patient outcomes and demonstrates patient improvement. However, practitioners infrequently use these measures because of concerns regarding their practicality and utility. We critically evaluate global self-report measures of adult psychotherapeutic outcome on key practical and utilitarian criteria. The following measures were evaluated according to practical criteria (e.g., administration time and cost) and utilitarian criteria (e.g., psychometrics and sensitivity to change): Behavior and Symptom Identification Scale-24; Clinical Outcomes in Routine Evaluation Outcome Measure; Depression Anxiety Stress Scales; Health Survey Short Form-36; Outcome Questionnaire-45; Patient Reported Outcome Measurement Information System; Symptom Checklist-90-Revised; and Brief Symptom Inventory. All of the reviewed outcome measures had a number of practical strengths, including short administration time. However, we also identified utilitarian concerns for each measure that are likely to affect their use and interpretation. Each of the reviewed outcome measures mostly address practitioners' concerns regarding practicality and utility. This critical review can aid practitioners in selecting an outcome measure based on their preferences.

Control Charts for Dispersed Count Data: An Overview

Control charts based on the Poisson distribution are commonly used to monitor count data in attributes. However, the Poisson distribution is based on the underlying equidispersion assumption that is limiting as discussed by different researchers in the literature. Therefore, a generalized control chart is required that can be used to monitor both overdispersed and underdispersed count data. This article reviews the methods to implement for dispersed count data and present ideas for future work in this area. A comprehensive literature review for researchers and practitioners is presented in this article. Copyright © 2014 John Wiley & Sons, Ltd.

An assessment of osteoporosis health beliefs based on the health belief model

Osteoporosis health beliefs are components of theoretical models that predict changes in osteoporosis preventive behaviors. A literature review was conducted to assess osteoporosis health beliefs, particular those of the health belief model (HBM), such as the perceived susceptibility to osteoporosis, perceived severity of osteoporosis, perceived benefits of osteoporosis preventive behaviors to prevent osteoporosis, perceived barriers to osteoporosis preventive behaviors, and self-efficacy for osteoporosis preventive behaviors. To find research that assessed these osteoporosis health beliefs based on the HBM, a search was conducted to determine which articles used the Osteoporosis Health Belief Scale and Osteoporosis Self-Efficacy Scale to determine measures for each of the osteoporosis health beliefs based on the HBM, but also included these health beliefs measured with other instruments. Having assessed these osteoporosis health beliefs, they can be applied to theoretical models, such as the HBM, for creating and implementing interventions that predict osteoporosis preventive behaviors. The assessment of osteoporosis health beliefs was also compared with health beliefs of other diseases, such as heart disease and breast cancer, and an assessment was done in demographic groups in addition to Caucasian women that have been less investigated, such as women of Asian, African, and Hispanic race, and in men. A summary is provided to aid in the application of the findings of this literature review for researchers and practitioners.

CAPBLAT: An Innovative Computer-Assisted Assessment for Problem-Based Learning Approach

This paper presents the development and implementation of Computer-Assisted Assessments (CAA) for helping lecturer in assessing students' achievements on the Problem-Based Learning (PBL) Approach. PBL Assessment is typically formative; it includes delivery achievement feedback for the student, with the aim of improving their skills. The use of CAA in PBL gives advantages for both of lecturer and students by providing them with detailed formative feedback on their learning achievements compare to conventional It also reduces lecturer's tedious load by automating parts of the task of marking students' work. The methodology applied to this research was literature review and investigation of practitioners' perception about assessment in PBL. The literatures showed that there are methods of assessments that have been used successfully in PBL, but the research selected seven methods as a PBL assessment framework; there are Peer-assessment, Self-assessment, Group-presentation, Individualactivities, Group-report assessment, pre-test and post-test assessment. The framework applied to the tool that encompasses the use of computer (called with CAPBLAT) for helping lecturer in assessing students' achievements. In addition, the CAPBLAT helps to store assessment material, deliver assessment, and does an auto-rating of the assessment result.

CAPBLAT: An Innovative Computer-Assisted Assessment for Problem-Based Learning Approach

This paper profiles the potential of developing and implementing Computer-Assisted Assessments (CAA) for helping lecturer in assessing students’ achievements on the Problem-Based Learning (PBL) Approach. PBL Assessment is typically formative; it includes delivery of feedback to the student, with the aim of improving their skills. The use of CAA in PBL gives advantages for both of lecturer and students by providing them with detailed formative feedback on their learning achievements compare to conventional assessment. It also reduces lectures tedious load by automating parts of the task of marking students’ work. The methodology applied to this research was literature review and investigation of practitioners’ perception about assessment in PBL. The literatures showed that there are methods of assessments that have been used successfully in PBL, but the research selected five methods as PBL assessment framework; there are “Peer-assessment, Self-assessment, Group presentation, Individual activities, and Group report assessment”. The framework applied into the tool that encompasses the use of computer (called with CAPBLAT) for helping lecturer in assessing students’ achievements. In addition, the CAPBLAT helps to store assessment material, deliver assessment, and do auto-rating of the assessment result. The evaluation results concerning technology acceptance demonstrated that incorporating CAPBLAT can get better technology acceptance.

Child Death Reviews: Developing CLEAR Recommendations

This paper is based on a study commissioned by the Department of Children and Youth Affairs in Ireland. It addresses the topic of recommendations emanating from child death inquiries and reviews; it looks at the factors which privilege some recommendations over others when it comes to implementation and explores whether a more collaborative approach to development might be more beneficial. As part of the study, the researchers to propose a new model for developing recommendations which will address the complexity of child protection practice, reflect its core principles and promote learning.‘New model for developing recommendations which will address the complexity of child protection practice, reflect its core principles and promote learning’The study found that recommendations were generally implemented when they fitted with social norms and aspiration of the time and particularly when they synchronised with policy developments that had already been initiated and required increased investment and public support to reach completion. The research drew a distinction between addressing and implementing recommendations, and overall found that a type of ‘recommendation fatigue’ had evolved following the succession if inquiries. It proposed that in the future, recommendations should be drafted in collaboration with key stakeholders which would provide the team with a range of expert knowledge strengthen the methodological rigour of the process and promote the likelihood that they would be feasible and realistic. The study proposed a new model of CLEAR recommendations (Case for change; Learning orientated: Evidence based; Assigning responsibility and easy to Review). Copyright © 2014 John Wiley & Sons, Ltd.Key Practitioner Messages When inquiry or review recommendations are too numerous, impractical, expensive, lack relevance and are too far out of step with social norms, they are unlikely to be implemented A collaborative approach can ensure that recommendations are informed by relevant sources of information, knowledge and expertise. Recommendations should be framed in a way that illustrates the rationale for change, promotes learning, cites evidence and identifies the organisations responsible for implementation.

Hospital‐based nurse practitioner roles and interprofessional practice: A scoping review

This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital-based nurse practitioner literature was mapped to country of origin, and thematically summarized. Second, clearly developed and consistently defined key interprofessional concepts were identified in the interprofessional literature then conceptually mapped to the nurse practitioner studies by their operationalization. The nurse practitioner review located 103 abstracts. Twenty-nine, originating from four countries, met the inclusion criteria. The interprofessional concept review identified a total of 137 relevant abstracts, however, only ten met the inclusion criteria. Understanding the nurse practitioner role within hospital teams remains limited due to a small number of countries producing evidence, the lack of nurse practitioner role title standardization hindering consistent knowledgebase development, and limited application and inconsistent operationalization of concepts within nurse practitioner research. Research focused on role enactment is needed to understand the uniqueness of the hospital-based nurse practitioner role.

Practitioner review: Dysphoria and its regulation in child and adolescent depression.

By emphasizing the importance of emotions, the 'affect revolution' in how human behavior is conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at familial risk for depression. We review clinical, behavioral, and functional neuroimaging studies of dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of parents with histories of clinical depression. We discuss the implication of the literature in the context of maternal depression. Findings confirm the high rate of clinically significant dysphoria in depressed children and adolescents and reveal notable affective lability in daily life as a function of context and activity. Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, never-depressed offspring at familial risk for depression display problems in mood repair and impaired mood repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in response to emotion triggers. The evaluation of depressed youngsters should include questions about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage (respond to) their own sadness and distress. The resultant information may help the clinician to restructure a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But interventions must consider that many depressed and high-risk children have depressed mothers, who may be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response of offspring, mothers of depressed children should therefore be routinely screened for depression and treated, as warranted.

M8 The effect of distance from the hospital, public transport availabity and socioeconomic deprivation on non-attendance at a difficult asthma clinic

IntroductionRegular clinic review is an important factor in reducing morbidity in asthma1. In a specialist difficult asthma clinic at our large city centre teaching hospital seeing more than 100 new...

ITSy--Simplicity Research in Information and Communication Technology

Basic to information and communication technology design, simplicity as a driving concept receives little formal attention from the ICT community. A recent literature review and survey of scholars, researchers, and practitioners conducted through the Information Technology Simply Works (ITSy) European Support Action reveals key findings about current perceptions of and future directions for simplicity in ICT. The Web extra at http://youtu.be/Tbp_IeY596A is an audio recording of Barry Floyd of California Polytechnic State University, San Luis Obispo, discussing current perceptions of and future directions for simplicity in information and communication technology.

Practitioner Review: Maternal mood in pregnancy and child development – implications for child psychology and psychiatry

The empirical base suggesting a link between prenatal maternal anxiety, stress or depression and cognitive, behavioral, and biological outcomes in the infant and child has increased dramatically in the past 10 years. In this review, we consider the relevance of prenatal maternal mood for child mental health practitioners; the empirical base for a likely causal impact of the link between prenatal anxiety, depression, or stress and child outcomes; the degree to which the available evidence is sufficient for informing or altering clinical practice; and the possible role of prenatal interventions for promoting child health and development. A selective review of PubMed, Cochrane Library and other sources was undertaken. Clinically significant links between maternal prenatal distress and child behavioral and cognitive outcomes have been reported; predictions to stress physiology, immunology, and neurodevelopment have been reported but the effect sizes and clinical significance is less clear. Several candidate mechanisms have been proposed, with some supporting evidence. Many behavioral treatments for prenatal maternal distress exist, but their application to promoting child health is largely unknown. Research on maternal prenatal distress is a good example of translational research and offers a strong paradigm for promoting interdisciplinary clinical research on child health and development.

A systematic review of medical and non-medical practitioners’ views of the impact of ehealth on shared care

PurposeTo explore medical and non-medical practitioners’ views of the impact of ehealth on shared care.MethodA systematic review was conducted using a meta-narrative approach with publication search dates limited from 1...

Practitioner Review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications

DSM-5 sees the introduction of Social (Pragmatic) Communication Disorder (SPCD), characterized by persistent difficulties using verbal and nonverbal communication for social purposes, in the absence of restricted and repetitive interests and behaviours. There is currently much confusion about the precise diagnostic criteria for SPCD and how this disorder relates to autism spectrum disorders (ASD), previous descriptions of pragmatic language impairment (PLI) and more specific language disorders (LD). Proposed criteria for SPCD are outlined. A selective review of the evidence considers whether these criteria form a cohesive and distinct diagnostic entity. Approaches to assessment and intervention are discussed. Implementing the new diagnosis is currently challenged by a lack of well-validated and reliable assessment measures, and observed continuities between SPCD and other neurodevelopmental disorders. High rates of comorbidity between SPCD and other seemingly disparate disorders (including conduct disorder, ADHD and disorders of known genetic origin) raise questions about the utility of this diagnostic category. SPCD is probably best conceptualized as a dimensional symptom profile that may be present across a range of neurodevelopmental disorders, although there is an urgent need to investigate the latent structure of SPCD using consistent diagnostic criteria. In addition, social communication and aspects of pragmatic language may be dissociated, with the latter heavily influenced by structural language attainments. Finally, there is a dearth of reliable and culturally valid assessment measures with which to make a differential diagnosis, and few rigorously tested intervention programmes. The implications for research and clinical practice are outlined.

Practitioner Review: Evidence‐based practice guidelines on alcohol and drug misuse among adolescents: a systematic review

Context-specific evidence-based guidelines on how to prevent and treat substance misuse among adolescents are currently lacking in many countries. Due to the time consuming nature of de novo guideline development, the ADAPTE collaboration introduced a methodology to adapt existing guidelines to a local context. An important step in this method is a systematic review to identify relevant high-quality evidence-based guidelines. This study describes the results of this step for the development of guidelines on adolescent alcohol and drug misuse in Belgium. Rigorous systematic review methodology was used. This included searches of electronic databases (Medline, Embase, Cinahl, PsychInfo, and ERIC in June 2011), websites of relevant organizations, and reference lists of key publications. Experts in the field were also contacted. Included were Dutch, English, French, or German evidence-based practice guidelines from 2006 or later on the prevention, screening, assessment, or treatment of alcohol or illicit drug misuse in persons aged 12-18 years. Two independent reviewers assessed the quality of the guidelines using the AGREE II (Appraisal of Guidelines for Research and Evaluation) instrument. This overview provides a framework of current knowledge in adolescent alcohol and drug misuse prevention and treatment. This systematic review identified 32 relevant evidence-based guidelines on substance misuse among adolescents. Nine guidelines were judged to be of high quality; of which four had recommendations specifically on adolescents: one on school-based prevention, one on substance misuse prevention in vulnerable young people and two on alcohol misuse with specific sections for the adolescent population. There were few commonalities as guidelines focused on different target groups, professional disciplines and type and level of substance misuse. Evidence to support the recommendations was sparse, and many recommendations were based on expert consensus or on studies among adults. Also, the link between evidence and recommendations was often unclear. There are a substantial number of guidelines addressing substance misuse in adolescents. However, only four high-quality guidelines included recommendations specific for adolescents. The current level of evidence that underpins the recommendations in these high-quality guidelines is low.

Practitioner Review: Schizophrenia spectrum disorders and the at‐risk mental state for psychosis in children and adolescents – evidence‐based management approaches

Schizophrenia spectrum disorders are severe mental illnesses which often result in significant distress and disability. Attempts have been made to prospectively identify and treat young people viewed as at high risk of impending nonaffective psychosis. Once a schizophrenia spectrum disorder has developed, prompt identification and management is required. This article reviews the literature relating to the assessment and management of 'at-risk mental states' (ARMS) and the treatment of schizophrenia spectrum disorders in children and adolescents. A systematic search of the literature was undertaken using EMBASE, MEDLINE, PsycINFO databases for the period January 1970-December 2012. Evidence suggests that young people fulfilling the ARMS criteria are at high risk of adverse mental health outcomes but that the majority do not develop nonaffective psychosis over the medium term. Although clinical trial findings have been inconsistent, psychosocial approaches, such as cognitive behaviour therapy, may reduce the risk of transition to psychosis and improve some symptoms, at least over the short term. The effectiveness of psychotropic medication for the ARMS is uncertain although there is accumulating evidence for potential adverse effects of antipsychotic medication, even at low dose, in this population. For the schizophrenias, clinical trial findings suggest that, as in adults, antipsychotics should be selected on the basis of side-effect profile although clozapine may be helpful in treatment refractory illness. There are almost no studies of psychosocial treatments for schizophrenia in young people under 18, and some caution must be exercised when extrapolating the findings of adult studies to younger individuals. A stepped care approach to the ARMS in young people represents a plausible potential management approach for those at high risk of serious mental health problems. However, predictive models currently lack precision and should focus on accurately identifying those at high risk for a variety of poor outcomes who may benefit most from intervention. There is also an urgent need for age-specific research in the area of psychosocial treatments for children and adolescents with schizophrenia.

A Review of the History of Hypnosis Through the Late 19th Century

A review of the history of hypnosis through the late 19th century is provided in this article. The author offers an important review for practitioners of hypnosis preparing to take diplomate board examinations. Clinicians will also be enabled to trace the evolution of clinical methods, principles, and techniques.

Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents

Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents

Identifying Transition Teacher Competencies Through Literature Review and Surveys of Experts and Practitioners

We first conducted a synthesis of literature to identify essential transition teacher competencies to guide curriculum development for a personnel preparation program. The synthesis yielded a list of 67 competencies needed by transition teachers. Using the 67 competencies, we next created an electronic survey in which respondents were asked to rate importance of transition teacher competencies. The survey was administered to two groups: national experts and transition practitioners. Expert respondents were 52 individuals. Practitioner respondents were 231 teachers, specialists, or coordinators from five states. Results indicated substantial similarities in ratings across all respondents irrespective of sample membership or service to transition-age individuals with mild/moderate or severe disabilities. Findings are discussed in regard to personnel preparation and targeted knowledge and skills.