Third-party Observers Research Articles

Development of a suboutcome strategy to measure interpersonal process in psychotherapy from an observer perspective.

Based on increasing recognition that the therapeutic relationship is critical in psychotherapy, the goal of this study was to establish the psychometric properties of a suboutcome strategy that could identify important in-session events involving patient-therapist interactions. Ten third-party observers were calibrated on a circumplex measure of suboutcome, a shortened version of the Wiggins' Interpersonal Adjective Scale-Revised. These observers rated four sessions from each of 28 cases of short-term psychotherapy. Each session was rated by thirds and selected to represent each quartile of a 40-session treatment protocol. The major findings indicated adequate interrater reliability and evidence for criterion validity that suggested a predictive relationship of patient and therapist affiliation to ultimate outcome, especially as observed early in treatment.

Accounts of abuse of patients at the Toronto Hospital for the Insane 1883-1937.

In an effort to uncover the experiences and perspectives of patients about abuse in institutions, this article will present the writings of asylum inmates and third-party observers, including relatives and staff, on this topic. These documents consist almost entirely of material from the Toronto Hospital for the Insane, from the late nineteenth and early twentieth centuries. References include physical, verbal, and sexual abuse. Methodological challenges when coming across this evidence will be addressed, most notably the problem of verification when charges of abuse are denied or are met with silence by hospital officials. Furthermore, this topic will include a discussion of inmates abusing other patients in an effort to compare how these episodes were reported in contrast to incidents that involved staff.

Predictors of postoperative aesthetics following explantation of the augmented breast.

Elective removal of breast implants has become a common operation for a variety of reasons. Although many women have their implants exchanged, a significant number of patients request removal without replacement. The purpose of this study was to identify factors that might predict the aesthetic result following elective explantation. Over the period of February 1990 to February 1996, 15 previously augmented patients had implant removal without replacement. Complete records including pre- and postoperative photos were available for study. Pre- and postoperative photos were rated by third-party observers as good = 3, acceptable = 2, and poor = 1. A deformity index was calculated for each patient by subtracting the average postoperative score from the average preoperative score. The observed deformity index was used to separate the patients into four groups. Next, each group was evaluated retrospectively by the authors for factors that may have contributed to the observed results. These included age of patient, duration of implant, rupture, contracture, ptosis, pseudoptosis, and concurrent mastopexy. Results of this study suggest that high-riding implants with ptotic breasts may predict an improved appearance following explantation. Some patients seemed to benefit from concurrent mastopexy. Advanced patient age, age of implant, rupture, and high-grade capsular contracture tended to predict a poor aesthetic result. Thin patients and patients who had unilateral explantation could be effectively predicted to have a poor outcome that could not be corrected by mastopexy. Implant replacement or flap reconstruction may best serve these patients who otherwise can expect a poor aesthetic result.

Interleukin‐2 diphtheria fusion protein (dab486il‐2) in refractory rheumatoid arthritis a double‐blind, placebo‐controlled trial with open‐label extension

This pilot phase II, double-blind, placebo-controlled trial of 1 month duration, with a 2-3-month open-label extension, evaluated the safety, tolerability, biologic effects, and efficacy of interleukin-2 diphtheria fusion protein (DAB486IL-2) in refractory rheumatoid arthritis (RA). Forty-five RA patients were enrolled in the trial, and were randomized, after a 3-4-week disease-modifying antirheumatic drug washout, to receive a daily intravenous dose of either DAB486IL-2 or placebo (saline) for 5 days. A blinded, third-party observer evaluated arthritis activity. Clinical response was defined as > or = 25% improvement in swollen and tender joints and > or = 25% improvement in at least 2 of 6 additional parameters. The double-blind phase was 4 weeks; placebo patients could cross over to receive open-label treatment for a maximum of 3 monthly DAB486IL-2 cycles. In the double-blind phase, 4 of 22 patients (18%) in the treated group and none in the placebo group (P = 0.05) met the criteria for clinical response. During the open-label treatment phase, 11 of 36 patients (31%) and 11 of 33 patients (33%) had a clinical response after completing 2 and 3 courses of DAB486IL-2, respectively. Adverse events included transient fever/chills (45%), nausea/vomiting (50%), elevated (< or = 3 x normal) transaminases (55%), and increased joint pain (45%). Twelve patients (8 placebo, 4 DAB486IL-2) did not complete 3 treatment cycles. No apparent differences were noted in CD4+ CD25+ cells of responders versus nonresponders, or of DAB486IL-2-treated versus placebo-treated patients. Clinical responses were noted in patients treated with DAB486IL-2 (18%) compared with placebo (0%) in the double-blind phase. In the open-label phase, 33% of patients completing 3 monthly DAB486IL-2 cycles had improvement in arthritis activity. Further studies of IL-2 diphtheria fusion proteins are warranted to elucidate factors that may predict clinical response and define mechanism(s) of action.

Self-scenarios as a repeated measures outcome measurement of self-schemas in short-term cognitive therapy

As the role of self-representation has begun to figure more prominently in clinical theories of emotional disorder, a number of assessment methodologies have been developed to measure this construct. This report describes the construction and use of self-scenarios, an idiographic interview-based measure of self-schemas. Self-scenarios depict highly distressing events that consist of four components, which reflect schematic structure: a stimulus situation and cognitive, affective, and motoric responses. They are scaled in a 9-point Likert-type format on multiple parameters and can be rated following each therapy session, thus providing for longitudinal tracking of self-schemas over the course of treatment. This study of a repeated single-subject design analyzed data of eight cases with variable outcome from short-term cognitive therapy. The results indicated high intraclass correlation coefficients calculated from ratings on clinical relevance of the components by the patient, therapist, and third-party observer who constructed the scenarios, thus supporting the interrater reliability and concurrent validity of the measurement methodology. They also provided some evidence of discriminant validity, based on differences between patient initial parametric ratings of clinically

Prehospital venous access in an urban paramedic system--a prospective on-scene analysis.

Prehospital intravenous access has been central to the debate of paramedic intervention during management of trauma in the field. Some have suggested that excessive time requirements for IV access are detrimental to patient salvage. This prospective study objectively quantified the time required to place a peripheral IV line in our urban paramedic system. A third-party observer, nonparamedic, timed the procedure on scene with a stopwatch. Total intravenous time, including obtaining a 30-cc blood sample, was defined as the period from removal of the catheter cover until the catheter was taped. The study group included 125 patients (51 trauma and 74 nontrauma). The average total time to obtain IV access and sample blood was 2.20 +/- 0.20 and 2.71 +/- 0.18 minutes in trauma and nontrauma patients, respectively. In a subset of 63 patients in whom blood sampling time was determined separately, subtracting that from total IV time provided a net of 0.58 +/- 0.09 minutes to obtain access. Fourteen patients had a second IV line started (without blood sampling), requiring 1.25 +/- 0.38 and 0.70 +/- 0.24 minutes, respectively, for trauma and nontrauma patients. Paramedics were successful on their first IV attempt in 90% of trauma and 84% of nontrauma patients; ultimate success was 100%. This on scene study documents the time required for prehospital IV access, performed by a well-trained paramedic in an E.M.S. system with strong medical control, is less than 90 seconds.

Communicating With High-Level Plans

This paper provides support for the following points regarding the design of intelligent interfaces (or more generally, intelligent dialog systems): 1) Constraints of human dialog processing, including limited attention span and partial understanding, should be dealt with explicitly in design of intelligent dialog systems; 2) An intelligent dialog system should be a partly autonomous agent, though accountable to its users; 3) An intelligent dialog system should be designed to incorporate explicit active models of tasks, users, the system itself and the process of dialog with the user; 4) Models should be built and maintained both for types of tasks, users and dialog processes and for specific instances for tasks, users and dialogs. In particular, an intelligent dialog system should model users in terms of their individual human characteristics; 5) The configuration of models maintained by an intelligent interface should be self referencing. That is, the system's model of itself, which is a component of the model configuration, should be able to refer to the model configuration as a whole, and should be able to access the assertions in that configuration; and 6) Dialog processes should be modeled from a first-party (system) view and the system's second-party view of the user, rather than from a third-party (observer's) view.

Ambiguity and Interchangeability in Role Attribution: The Effect of Alter's Response

An orienting hypothesis that the role attributed to ego by a third-party observer of interaction will be affected substantially by the response of alter to ego's behavior is elaborated into more specific ambiguity and interchangeability hypotheses. Hypotheses are generally confirmed on the basis of interpretations of leader-follower and helperhelped dialogues by 688 college students using alternate questionnaire forms in a quasiexperimental design. Hypotheses are tested under three conditions of groupand roledesignation. Possible effects of role-adequacy judgments and variant role standpoints on role attribution are explored in a preliminary fashion.