Implementing Primary Social and Emotional Aspects of Learning (SEAL) Small Group Interventions: Recommendations for Practitioners

ERIC Educational Resources Information Center

Lendrum, Ann; Humphrey, Neil; Kalambouka, Afroditi; Wigelsworth, Michael

2009-01-01

This article presents an extended vignette describing a good practice model for implementing SEAL small group work at "Mellington Primary", a fictional school. The vignette/model was developed from in-depth case studies at five primary schools in the north-west of England during a national evaluation of primary SEAL by the authors. The…

Borderline personality disorder in men: A literature review and illustrative case vignettes.

PubMed

Bayes, Adam; Parker, Gordon

2017-11-01

The aim is to review the salient literature on borderline personality disorder (BPD) in men and link those findings with case vignettes. We provide a literature review and then report case examples of those who met DSM and clinical BPD criteria, and consider the extent to which the small male sub-set corresponded developmentally and phenomenologically with prototypic BPD in women. The review considered phenomenological, epidemiological, biological and developmental BPD factors, finding BPD men evidence elevated substance abuse, and 'externalising' patterns of behavior, antisocial personality traits, violent self-harm and interpersonal aggression, whereas women display more 'internalising' strategies. The five male vignettes enriched the literature review providing support for gender differences reported in our review. The literature and case vignette findings should assist clinicians in recognising that BPD in men may not be as rare as generally viewed, and which may reflect BPD being commonly viewed as weighted to women and being misdiagnosed as an antisocial personality disorder (ASPD) in men. Copyright © 2017 Elsevier B.V. All rights reserved.

Promoting Student-Centered Learning Using iPads in a Grade 1 Classroom: Using the Digital Didactic Framework to Deconstruct Instruction

ERIC Educational Resources Information Center

Woloshyn, Vera Ella; Bajovic, Mira; Worden, Melissa Maney

2017-01-01

In this qualitative case study, we provide a series of vignettes illustrating a Grade 1 teacher's experiences integrating iPad technology into her instruction over a school year. We use the digital didactic model to deconstruct these vignettes and draw upon the teacher's reflections to gain further insights about her instructional experiences…

Are Clinicians Better Than Lay Judges at Recalling Case Details? An Evaluation of Expert Memory.

PubMed

Webb, Christopher A; Keeley, Jared W; Eakin, Deborah K

2016-04-01

This study examined the role of expertise in clinicians' memory for case details. Clinicians' diagnostic formulations may afford mechanisms for retaining and retrieving information. Experts (N = 41; 47.6% males, 23.8% females; 28.6% did not report gender; age: mean [M] = 54.69) were members of the American Board of Professional Psychologists. Lay judges (N = 156; 25.4% males, 74.1% females; age: M = 18.85) were undergraduates enrolled in general psychology. Three vignettes were presented to each group, creating a 2 (group: expert, lay judge) x 3 (vignettes: simple, complex-coherent, complex-incoherent) mixed factorial design. Recall accuracy for vignette details was the dependent variable. Data analyses used multivariate analyses of variance to detect group differences among multiple continuous variables. Experts recalled more information than lay judges, overall. However, experts also exhibited more false memories for the complex-incoherent case because of their schema-based knowledge. This study supported clinical expertise as beneficial. Nonetheless, negative influences from experts' schema-based knowledge, as exhibited, could adversely affect clinical practices. © 2016 Wiley Periodicals, Inc.

The Treatment of Anorexia Nervosa in a General Hospital: A Case Vignette of a Multi-Disciplinary General Hospital-Based Approach.

ERIC Educational Resources Information Center

Kronenberg, J.; And Others

1994-01-01

Describes anorexia nervosa as condition variable in etiology and resistant to treatment, which may lead to mortality in 5% of treated cases. Notes that efforts have been made for treating disorder in nonstigmatizing medical units outside psychiatric hospitals. Describes, through presentation of short case vignette, advantages of treating…

[GP medication prioritisation in older patients with multiple comorbidities recently discharged from hospital: a case-based bottom-up approach].

PubMed

Herrmann, M L H; von Waldegg, G H; Kip, M; Lehmann, B; Andrusch, S; Straub, H; Robra, B-P

2015-01-01

After the hospital discharge of older patients with multiple morbidities, GPs are often faced with the task of prioritising the patients' drug regimens so as to reduce the risk of overmedication. How do GPs prioritise such medications in multimorbid elderly patients at the transition between inpatient and home care? The experience by the GPs is documented in typical case vignettes. 44 GPs in Sachsen-Anhalt were recruited--they were engaged in focus group discussions and interviewed using semi-standardised questionnaires. Typical case vignettes were developed, relevant to the everyday care that elderly patients would typically receive from their GPs with respect to their drug optimisation. According to the results of the focus groups, the following issues affect GPs' decisions: drug and patient safety, their own competence in the health system, patient health literacy, evidence base, communication between secondary and primary care (and their respective influences on each other). When considering individual cases, patient safety, patient wishes, and quality of life were central. This is demonstrated by the drug dispositions of one exemplary case vignette. GPs do prioritise drug regimens with rational criteria. Initial problem delineation, process documentation and the design of a transferable product are interlinking steps in the development of case vignettes. Care issues of drug therapy in elderly patients with multiple morbidities should be investigated further with larger representative samples in order to clarify whether the criteria used here are applied contextually or consistently. Embedding case vignettes into further education concepts is also likely to be useful. © Georg Thieme Verlag KG Stuttgart · New York.

Survey of recognition and treatment of at-risk mental state by Japanese psychiatrists.

PubMed

Tsujino, Naohisa; Tagata, Hiromi; Baba, Yoko; Kojima, Akiko; Yamaguchi, Taiju; Katagiri, Naoyuki; Nemoto, Takahiro; Mizuno, Masafumi

2018-02-27

The importance of early intervention in psychiatry is widely recognized among psychiatrists. However, it is unknown whether precise knowledge of at-risk mental state has been disseminated. With this survey, we aimed to reveal how Japanese psychiatrists diagnose patients with at-risk mental state and prescribe treatment strategies for them. Using fictional case vignettes, we conducted a questionnaire survey of psychiatrists (n = 1399) who worked in Tokyo. We mailed study documents to all eligible participants in November 2015 with a requested return date in December. Two hundred and sixty (19.3%) psychiatrists responded to the survey. Their correct diagnosis rates for the patients in the at-risk mental state vignettes were low (14.6% for the vignette describing at-risk mental state with attenuated positive symptom syndrome; 13.1% for the vignette describing at-risk mental state with brief intermittent psychotic syndrome). Many psychiatrists selected pharmacotherapy and antipsychotics to treat patients in the at-risk mental state vignettes. The psychiatrists who correctly diagnosed patients in the at-risk mental state vignettes had significantly fewer years of clinical psychiatric experience than did those who diagnosed them as having a non-at-risk mental state (12.5 years vs 22.7 years for the vignette describing at-risk mental state with attenuated positive symptom syndrome, P < 0.01; 14.3 years vs 22.2 years for the vignette describing at-risk mental state with brief intermittent psychotic syndrome, P < 0.01). This study suggests that precise knowledge of at-risk mental state has not been disseminated among Japanese psychiatrists. © 2018 The Authors. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care.

PubMed

Wissow, Lawrence S; Zafar, Waleed; Fothergill, Kate; Ruble, Anne; Slade, Eric

2016-01-22

To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77% female, 58% at their site 10 or more years; 44% in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50%) increase in work (95% CL .94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P < .001) while medical co-morbidity increased it the least (.44 units, p < .001). Factors most strongly associated with increased overall work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work ratings than did those without co-located staff. Both diagnosis and cross-diagnosis complicating factors contribute to the work involved in providing mental health services in primary care. Vignette studies may facilitate understanding which mental health services can be most readily incorporated into primary care as it is presently structured and help guide the design of training programs and other implementation strategies.

Endorsement of Couples Counseling in a Domestic Violence Case as a Function of Training

ERIC Educational Resources Information Center

Bapat, Mona; Tracey, Terence

2009-01-01

Reactions of students in helping professions to domestic violence were examined with respect to whether or not the students had any training in domestic violence. One hundred, four students read one of two vignettes describing a domestic violence case and responded to statements related to treatment options. The vignettes differed only in…

Assessing clinicians' management of first episode schizophrenia using clinical case vignettes.

PubMed

Huffman, Jeff C; Freudenreich, Oliver; Romeo, Sarah; Baer, Lee; Sutton-Skinner, Kelly; Petersen, Tim; Fromson, John A; Birnbaum, Robert J

2010-02-01

Patients with first episode schizophrenia may present in a variety of clinical settings to providers who have a range of knowledge and skills. A thoughtful workup of patients with new-onset psychosis is critical, and the treatment of first episode schizophrenia differs from that of chronic psychotic disorders. Clinical case vignettes with free-form responses can be used to carefully assess whether front line practitioners provide guideline-adherent management of first episode psychosis. A clinical case vignette, presenting a patient with first episode schizophrenia, was created and administered to the attendees of a continuing medical education programme. Free-form responses to questions regarding differential diagnosis, workup, treatment and treatment duration were scored based on published practice guidelines. Response frequencies were tabulated and performance was compared among professional disciplines. Sixty-two attendees completed the vignette. Though the attendees typically considered a broad differential diagnosis and appropriately initiated treatment with antipsychotics, the respondents' proposed medical workup was limited, and they prescribed antipsychotics at higher doses and for a shorter duration than recommended in the literature. The prescribers outperformed the non-prescribers on treatment questions (P = 0.006), but the two groups' performance did not significantly differ on the assessment questions (P = 0.08). The front line clinicians who encounter patients with first episode schizophrenia may have significant practice gaps in the initial and follow-up care of these patients. Given the preliminary nature of this study and the debate about the optimal care for first episode psychosis, further study is needed. If such gaps are confirmed, additional educational interventions are required to align clinical management with published practice guidelines.

Weaving together peer assessment, audios and medical vignettes in teaching medical terms.

PubMed

Allibaih, Mohammad; Khan, Lateef M

2015-12-06

The current study aims at exploring the possibility of aligning peer assessment, audiovisuals, and medical case-report extracts (vignettes) in medical terminology teaching. In addition, the study wishes to highlight the effectiveness of audio materials and medical history vignettes in preventing medical students' comprehension, listening, writing, and pronunciation errors. The study also aims at reflecting the medical students' attitudes towards the teaching and learning process. The study involved 161 medical students who received an intensive medical terminology course through audio and medical history extracts. Peer assessment and formative assessment platforms were applied through fake quizzes in a pre- and post-test manner. An 18-item survey was distributed amongst students to investigate their attitudes and feedback towards the teaching and learning process. Quantitative and qualitative data were analysed using the SPSS software. The students did better in the posttests than on the pretests for both the quizzes of audios and medical vignettes showing a t-test of -12.09 and -13.60 respectively. Moreover, out of the 133 students, 120 students (90.22%) responded to the survey questions. The students gave positive attitudes towards the application of audios and vignettes in the teaching and learning of medical terminology and towards the learning process. The current study revealed that the teaching and learning of medical terminology have more room for the application of advanced technologies, effective assessment platforms, and active learning strategies in higher education. It also highlights that students are capable of carrying more responsibilities of assessment, feedback, and e-learning.

Impact of selective reporting of antibiotic susceptibility test results on the appropriateness of antibiotics chosen by French general practitioners in urinary tract infections: a randomised controlled case-vignette study.

PubMed

Bourdellon, Loic; Thilly, Nathalie; Fougnot, Sébastien; Pulcini, Céline; Henard, Sandrine

2017-08-01

Selective reporting of antibiotic susceptibility test (AST) results is a potential intervention for laboratory-based antibiotic stewardship. The aim of this study was to assess the impact of AST reporting on the appropriateness of antibiotics selected by French general practitioners for urinary tract infections (UTIs). A randomised controlled case-vignette study in a region of northeast France surveyed general practitioners between July and October 2015 on treatment of four clinical cases of community-acquired Escherichia coli UTIs (two cases of complicated cystitis, one of acute pyelonephritis and one male UTI). In Group A, selective reporting of AST results was used for the first two cases and complete reporting for the other two cases; these were reversed in Group B. The overall participation rate was 131/198 (66.2%). Provision of selective AST results significantly increased the rate of adherence to national guidelines for first-line antibiotic treatment in Cases 1, 3 and 4 by 22.4% (55.2% vs. 32.8%, P = 0.01), 67.5% (75.0% vs. 7.5%, P <0.001) and 36.3% (45.3% vs. 9.0%, P <0.001), respectively. The improvement in compliance was not significant for Case 2. Prescriptions of amoxicillin-clavulanic acid, fluoroquinolones and cephalosporins decreased by 25.0% to 45.0%, depending on the clinical vignette. Most (106/131, 81.0%) participants favoured the routine use of selective reporting of AST results. In conclusion, selective reporting of AST results seems to improve antibiotic prescribing practices in primary care, and may be considered a key element of antimicrobial stewardship programmes. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Do Consultation Psychiatrists, Forensic Psychiatrists, Psychiatry Trainees, and Health Care Lawyers Differ in Opinion on Gray Area Decision-Making Capacity Cases? A Vignette-Based Survey.

PubMed

Armontrout, James; Gitlin, David; Gutheil, Thomas

2016-01-01

Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in "gray area" cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds. Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying "yes/no" question regarding capacity and a certainty scale for each vignette. Participants were identified from mailing lists of professional organizations and local hospitals. We received responses from psychiatry trainees, consultation-liaison psychiatrists, forensic psychiatrists, and lawyers with experience in health care law. Results were analyzed using SPSS. Across the 3 vignettes, the percentage agreeing that the individual described had capacity to refuse medical treatment ranged between 35% and 40% for trainees, 33% and 67% for consult psychiatrists, 41% and 76% for forensic psychiatrists, and 40% and 83% for health care lawyers. Only question 2 reached significance between-group differences (Pearson χ(2) = 11.473, p < 0.01). Across vignettes, trainees were less likely to consider patients to have capacity for decision-making than were forensic psychiatrists and lawyers. As found in previous research, agreement among experienced evaluators appears generally low in gray area capacity cases. It is noteworthy that individuals of different professional backgrounds at times offer divergent between-group opinions on capacity. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Improving Vignette Descriptions and Question Formats to Measure Distance Vision: Evidence from Cognitive Interviews among Students in China

ERIC Educational Resources Information Center

Su, Yanfang; Willis, Gordon; Salomon, Joshua A.

2017-01-01

Vignette design has been largely neglected in anchoring vignette studies. This study aimed to contribute to the science of vignette design by developing and evaluating vignettes for measuring vision in rural China. Cognitive interviews were conducted among 36 participants in a Chinese middle school. The respondents either directly evaluated vision…

Weaving together peer assessment, audios and medical vignettes in teaching medical terms

PubMed Central

Khan, Lateef M.

2015-01-01

Objectives The current study aims at exploring the possibility of aligning peer assessment, audiovisuals, and medical case-report extracts (vignettes) in medical terminology teaching. In addition, the study wishes to highlight the effectiveness of audio materials and medical history vignettes in preventing medical students' comprehension, listening, writing, and pronunciation errors. The study also aims at reflecting the medical students' attitudes towards the teaching and learning process. Methods The study involved 161 medical students who received an intensive medical terminology course through audio and medical history extracts. Peer assessment and formative assessment platforms were applied through fake quizzes in a pre- and post-test manner. An 18-item survey was distributed amongst students to investigate their attitudes and feedback towards the teaching and learning process. Quantitative and qualitative data were analysed using the SPSS software. Results The students did better in the posttests than on the pretests for both the quizzes of audios and medical vignettes showing a t-test of -12.09 and -13.60 respectively. Moreover, out of the 133 students, 120 students (90.22%) responded to the survey questions. The students gave positive attitudes towards the application of audios and vignettes in the teaching and learning of medical terminology and towards the learning process. Conclusions The current study revealed that the teaching and learning of medical terminology have more room for the application of advanced technologies, effective assessment platforms, and active learning strategies in higher education. It also highlights that students are capable of carrying more responsibilities of assessment, feedback, and e-learning. PMID:26637986

Attributing Responsibility for Child Maltreatment when Domestic Violence Is Present

ERIC Educational Resources Information Center

Landsman, Miriam J.; Hartley, Carolyn Copps

2007-01-01

Objective: The purpose of this study was to examine factors that influence how child welfare workers attribute responsibility for child maltreatment and child safety in cases involving domestic violence. Methods: The study used a factorial survey approach, combining elements of survey research with an experimental design. Case vignettes were…

Decision making under uncertainty, therapeutic inertia, and physicians' risk preferences in the management of multiple sclerosis (DIScUTIR MS).

PubMed

Saposnik, Gustavo; Sempere, Angel Perez; Raptis, Roula; Prefasi, Daniel; Selchen, Daniel; Maurino, Jorge

2016-05-04

The management of multiple sclerosis (MS) is rapidly changing by the introduction of new and more effective disease-modifying agents. The importance of risk stratification was confirmed by results on disease progression predicted by different risk score systems. Despite these advances, we know very little about medical decisions under uncertainty in the management of MS. The goal of this study is to i) identify whether overconfidence, tolerance to risk/uncertainty, herding influence medical decisions, and ii) to evaluate the frequency of therapeutic inertia (defined as lack of treatment initiation or intensification in patients not at goals of care) and its predisposing factors in the management of MS. This is a prospective study comprising a combination of case-vignettes and surveys and experiments from Neuroeconomics/behavioral economics to identify cognitive distortions associated with medical decisions and therapeutic inertia. Participants include MS fellows and MS experts from across Spain. Each participant will receive an individual link using Qualtrics platform(©) that includes 20 case-vignettes, 3 surveys, and 4 behavioral experiments. The total time for completing the study is approximately 30-35 min. Case vignettes were selected to be representative of common clinical encounters in MS practice. Surveys and experiments include standardized test to measure overconfidence, aversion to risk and ambiguity, herding (following colleague's suggestions even when not supported by the evidence), physicians' reactions to uncertainty, and questions from the Socio-Economic Panel Study (SOEP) related to risk preferences in different domains. By applying three different MS score criteria (modified Rio, EMA, Prosperini's scheme) we take into account physicians' differences in escalating therapy when evaluating medical decisions across case-vignettes. The present study applies an innovative approach by combining tools to assess medical decisions with experiments from Neuroeconomics that applies to common scenarios in MS care. Our results will help advance the field by providing a better understanding on the influence of cognitive factors (e.g., overconfidence, aversion to risk and uncertainty, herding) on medical decisions and therapeutic inertia in the management of MS which could lead to better outcomes.

Mental health literacy: A cross-cultural study from Britain, Hong Kong and Malaysia.

PubMed

Loo, Phik-Wern; Wong, Sharon; Furnham, Adrian

2012-06-01

A cross-cultural study was conducted on the identification of psychiatric problems comparing British, Hong Kong and Malaysian participants. To investigate the ability to correctly identify different psychiatric problems and recommend strategies for treatment. A total of 440 participants were shown vignettes of schizophrenia, obsessive compulsive disorder (OCD), social phobia, depression, bipolar disorder, stress, child attention-deficit hyperactivity disorder (ADHD), child depression and child "daily troubles". In each they were asked to say what they thought the person's problem was and how they could be helped as well as give their confidence ratings on both judgments. The British were the most adept at correctly identifying the cases of mental disorders in the vignettes followed by the Hong Kong Chinese and Malaysians. Overall, the depression cases were the best identified and social phobia was the least identified. In terms of help recommendation, a higher percentage of British participants endorsed professional help as useful for the person in the vignette compared to Hong Kong and Malaysian participants. The findings were discussed along with suggestions on how to improve mental health literacy. The ethnocentric nature of applying Western concepts in the East was acknowledged. Copyright © 2012 Blackwell Publishing Asia Pty Ltd.

How do general practitioners manage patients with cancer symptoms? A video-vignette study.

PubMed

Jiwa, Moyez; Meng, Xingqiong; O'Shea, Carolyn; Magin, Parker; Dadich, Ann; Pillai, Vinita

2015-09-14

Determine how general practitioners (GPs) manage patients with cancer symptoms. GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations. Australian primary care sector. 102 practising GPs participated in this study, including trainees. The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study. This paper reports on how the participants would manage the patients depicted in each vignette. In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options-that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a 'prescription only' or 'referral only' option. They were less likely to manage prostate cancer with a 'prescription only', yet more likely to manage it with a 'referral with investigation'. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a 'referral only' or a 'referral with investigation'. Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests. ACTRN12611000760976. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Promises and Pitfalls of Anchoring Vignettes in Health Survey Research

PubMed Central

Verdes-Tennant, Emese; McEniry, Mary; Ispány, Márton

2016-01-01

Data harmonization is a topic of growing importance to demographers, who increasingly conduct domestic or international comparative research. Many self-reported survey items cannot be directly compared across demographic groups or countries because these groups differ in how they use subjective response categories. Anchoring vignettes, already appearing in numerous surveys worldwide, promise to overcome this problem. However, many anchoring vignettes have not been formally evaluated for adherence to the key measurement assumptions of vignette equivalence and response consistency. This article tests these assumptions in some of the most widely fielded anchoring vignettes in the world: the health vignettes in the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) and World Health Survey (WHS) (representing 10 countries; n = 52,388), as well as similar vignettes in the Health and Retirement Study (HRS) (n = 4,528). Findings are encouraging regarding adherence to response consistency, but reveal substantial violations of vignette equivalence both cross-nationally and across socioeconomic groups. That is, members of different sociocultural groups appear to interpret vignettes as depicting fundamentally different levels of health. The evaluated anchoring vignettes do not fulfill their promise of providing interpersonally comparable measures of health. Recommendations for improving future implementations of vignettes are discussed. PMID:26335547

The recognition of child abuse and the perceived need for intervention by school personnel of primary schools: Results of a vignette study on the influence of case, school personnel, and school characteristics.

PubMed

Vanderfaeillie, Johan; De Ruyck, Karolien; Galle, Johan; Van Dooren, Erik; Schotte, Chris

2018-05-01

In 2015, 523 reports of suspected child abuse and neglect (CAN) were brought to the attention of the Confidential Center of Child Abuse and Neglect (CCCAN) of Brussels. Around 38% of these reports came from school personnel. This study investigated which factors affect the recognition of CAN by school personnel of Dutch-speaking primary education in Brussels and their intervention need. Two hundred seventy-nine staff members of 16 schools professionally working with children, filled in a Questionnaire Assessment of Situations of CAN. The instrument consists of 24 vignettes describing CAN. Respondents were asked questions regarding recognition and intervention need about each vignette. Detection, severity assessment, the need for professional help, the need for referral to a CCCAN and the need to involve judicial authorities were mainly associated with case characteristics. Although most situations of CAN were detected, situations of emotional abuse were less often recognized. Situations involving non-Western victims were considered to be more severe and the perceived need for involvement of professional help, CCCAN and judicial authorities was larger. Ethnic stereotypes affect the actions undertaken in case of CAN. Awareness of these reactions may result in equal treatment for all victims. Staff characteristics were little associated with detection and intervention need. Copyright © 2018 Elsevier Ltd. All rights reserved.

How Veterans Health Administration Suicide Prevention Coordinators Assess Suicide Risk.

PubMed

Pease, James L; Forster, Jeri E; Davidson, Collin L; Holliman, Brooke Dorsey; Genco, Emma; Brenner, Lisa A

2017-03-01

This cross-sectional study was designed to examine the suicide risk assessment practices of Suicide Prevention Coordinators (SPCs) within the Veterans Health Administration. Specifically, this study sought to (1) identify factors SPCs consider most important in assessing risk and patient priority; (2) measure the level of consistency and agreement between SPCs in assessing suicide risk and prioritizing cases; and (3) measure individual SPC consistency between cases. SPCs (n = 63) responded to online survey questions about imminent and prolonged risk for suicide in response to 30 fictional vignettes. Combinations of 12 acute and chronic suicide risk factors were systematically distributed throughout the 30 vignettes using the Fedorov () procedure. The SPCs were also asked to identify the level of priority for further assessment both disregarding and assuming current caseloads. Data were analysed using clinical judgement analysis. Suicidal plan, β = 1.64; 95% CI (1.45, 1.82), and preparatory behaviour, β = 1.40; 95% CI (1.23, 1.57), were considered the most important acute or imminent risk factors by the SPCs. There was less variability across clinicians in the assessment of risk when alcohol use (p = 0.02) and hopelessness (p = 0.03) were present. When considering acute or imminent risk factors, there was considerable variability between clinicians on a vignette-by-vignette basis, median SD = 0.86 (range = 0.47, 1.13), and within individual clinicians across vignettes, median R 2  = 0.80 (0.49, 0.95). These findings provide insight into how this group of providers think about acute and chronic risk factors contributing to imminent suicide risk in Veterans. Copyright © 2016 John Wiley & Sons, Ltd. Identifies factors that practitioners consider most important in suicide risk assessment Discusses how to distinguish between chronic and acute risk for suicide Identifies factors that lead to more consistent clinical judgments. Copyright © 2016 John Wiley & Sons, Ltd.

Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries

PubMed Central

Peabody, John W; Tozija, Fimka; Muñoz, Jorge A; Nordyke, Robert J; Luck, Jeff

2004-01-01

Objective To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries. Data Source/Study Setting Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government-run outpatient facilities in Macedonia. Study Design Randomly selected, eligible Macedonian and U.S. physicians (>97 percent participation rate) completed vignettes for four common outpatient conditions. Responses were judged against a master list of explicit quality criteria and scored as percent correct. Data Collection/ Extraction An ANOVA model and two-tailed t-tests were used to compare overall scores by case, study site, and country. Principal Findings The mean score for U.S. physicians was 67 percent (+/−11 percent) compared to 48 percent (+/−11 percent) for Macedonian physicians. The quality of clinical practice, which emphasizes basic skills, varied greatly in both sites, but more so in Macedonia. However, the top Macedonian physicians in all sites approached or—in one case—exceeded the median score in the U.S. sites. Conclusions Vignettes are a useful method for making cross-national comparisons of the quality of care provided in very different settings. The vignette measurements revealed that some physicians in Macedonia performed at a standard comparable to that of their counterparts in the United States, despite the disparity of the two health systems. We infer that in poorer countries, policy that promotes improvements in the quality of clinical practice—not just structural inputs—could lead to rapid improvements in health. PMID:15544639

Selective reporting of antibiotic susceptibility data improves the appropriateness of intended antibiotic prescriptions in urinary tract infections: a case-vignette randomised study.

PubMed

Coupat, C; Pradier, C; Degand, N; Hofliger, P; Pulcini, C

2013-05-01

The purpose of this investigation was to assess the impact of selective reporting of antibiotic susceptibility data on the appropriateness of intended documented antibiotic prescriptions in urinary tract infections (UTIs) among residents training in general practice. We conducted a randomised-controlled case-vignette study in three French universities using a questionnaire with four UTI vignettes. In each university, residents were randomly allocated to two groups: a control group with usual full-length reporting of antibiotic susceptibility data (25 antibiotics) and an intervention group with selective reporting of antibiotic susceptibility data (2 to 4 antibiotics only). 326/611 residents (53 %) participated in the survey, 157/305 (52 %) in the intervention group and 169/306 (55 %) in the control group. For all four UTI scenarios, selective reporting of antibiotic susceptibility data significantly improved the appropriateness of antibiotic prescriptions (absolute increase ranging from 7 to 41 %, depending on the vignette). The variety of antibiotic prescriptions was reduced in the intervention group, and cephalosporins and fluoroquinolones were less often prescribed. Among 325 respondents, 124 (38 %) declared being either not really or not at all at ease with antibiotic susceptibility data, whereas 112/157 (71 %) of the residents in the intervention group declared that selective reporting of antibiotic susceptibility data made their antibiotic choice easier. Selective reporting of antibiotic susceptibility data could be a promising strategy to improve antibiotic use in UTIs, as part of a multi-faceted antibiotic stewardship programme. Microbiology laboratories should be aware that they can have a significant influence on antibiotic use.

Another missed opportunity? Recognition of alcohol use problems by mental health providers.

PubMed

Freimuth, Marilyn

2008-09-01

Alcohol use problems (AUPs) are prevalent among people seeking psychotherapy. Despite mandates from managed care companies to routinely screen for AUPs, little is known about the screening practices of providers or their ability to identify AUPs based on presenting symptoms. Participants (N = 117) read two case vignettes and suggested initial diagnoses and questions they would ask in order to clarify a diagnosis. Participants were more likely to ask about substance use and diagnose an AUP when the vignette contained explicit reference to the client's substance use as compared to a vignette where the signs of an AUP were more subtle. In both vignettes, a mental health problem was a more likely diagnosis than an AUP. Neither participant attributes nor personal or professional experiences with AUPs reliably shaped responses to the vignettes. The findings are discussed in light of their implications for future research and improved training in addictions for mental health providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Exploring the Educational Value of Clinical Vignettes from the Society of General Internal Medicine National Meeting in the Internal Medicine Clerkship

PubMed Central

Wofford, James L; Singh, Sonal

2006-01-01

INTRODUCTION Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE To explore the relevance and learning value of clinical vignettes from the SGIM national meeting in the Internal Medicine clerkship. SETTING Third year Ambulatory Internal Medicine clerkship at one academic medical center (academic year 2005 to 2006). METHODS Students were introduced to the clinical vignette and oriented to the database of clinical vignettes available through the SGIM annual meeting website. Students then reviewed 5 to 10 clinical vignettes using a worksheet, and rated the learning value of each vignette using a 5-point Likert scale (1 = least, 5 = greatest). A single investigator evaluated congruence of the vignette with the Clerkship Directors of Internal Medicine (CDIM)-SGIM curriculum to assess relevance. MAIN RESULTS A total of 42 students evaluated 371 clinical vignettes from the 2004 and 2005 meetings. The clinical vignettes were curriculum-congruent in 42.6% (n = 175), and clearly incongruent in 40.4% (n = 164). The mean rating for learning value was 3.8 (±1.0) (5 signifying greatest learning value). Curriculum-congruent vignettes had a higher mean learning value compared with curriculum-incongruent vignettes (4.0 vs 3.6, Student's t-test, P =.017). CONCLUSION The clinical vignettes presented at the national SGIM meeting offer clinical content that is relevant and of some educational value for third year clerkship students. Based on this pilot study, the educational value and strategies for their use in the clinical clerkships deserve further study. PMID:17026730

Appendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

PubMed

Quentin, Wilm; Scheller-Kreinsen, David; Geissler, Alexander; Busse, Reinhard

2012-02-01

As part of the EuroDRG project, researchers from 11 countries (i.e., Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their diagnosis-related groups (DRG) systems deal with appendectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of appendicitis treated with a procedure of appendectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify appendectomy patients according to different sets of variables (between two and six classification variables) into diverging numbers of DRGs (between two and 11 DRGs). The most complex DRG is valued 5.1 times more resource intensive than an index case in France but only 1.1 times more resource intensive than an index case in Finland. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the most complex case vignette amount to only 1,005 in Poland but to 12,304 in France. Large variations in the classification of appendectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons and national DRG authorities should consider how other countries' DRG systems classify appendectomy patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement.

Reactions to the 1985 Mexican earthquake: case vignettes.

PubMed

Gavalya, A S

1987-12-01

In September 1985 the strongest earthquake ever recorded in Mexico City devastated parts of a city already burdened by complex economic, political, and social problems. Overall, residents of the city demonstrated resilience and strength in dealing with the physical and psychosocial aspects of the disaster. Many in the unaffected areas responded quickly to provide assistance, and most residents continued to function in spite of the trauma. Primarily through case vignettes, the author describes reactions of individuals and families to the quake.

Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows.

PubMed

Sales, Justin W; Bulloch, Blake; Hostetler, Mark A

2011-05-01

Febrile seizures are the most common type of childhood seizure and are categorized as simple or complex. Complex febrile seizures (CFSs) are defined as events that are focal, prolonged (> 15 minutes), or recurrent. The management of CFS is poorly defined. The objective of this study was to determine the degree of variability in the emergency department evaluation of children with CFSs. An online survey questionnaire was developed and sent to physicians identified via the listserv of the emergency medicine section of the American Academy of Pediatrics and the pediatric emergency medicine discussion list. The questionnaire consisted of five hypothetical case vignettes describing children under 5 years of age presenting with a CFS. Following review of the first four vignettes, participants were asked if they would (1) obtain blood and urine for evaluation; (2) perform a lumbar puncture; (3) perform neurologic imaging while the child was in the emergency department; (4) admit the child to the hospital; or (5) discharge with follow-up as an outpatient, with either the primary care provider or a neurologist. The final vignette determined if antiepileptic medication would be prescribed by the physician on discharge. Of the 353 physicians who participated, 293 (83%) were pediatric emergency medicine attending physicians and 60 (17%) were pediatric emergency medicine fellows. Overall, 54% of participants indicated that they would obtain blood for evaluation, 62% would obtain urine, 34% would perform a lumbar puncture, and 36% would perform neurologic imaging. The overall hypothetical admission rate for the case vignettes was 42%. This study indicates that extensive variability exists in the emergency department approach to patients with CFS. Our findings suggest that optimal management for CFS remains unclear and support the potential benefit of future prospective studies on this subject.

A Picture of Burnout: Case Studies and Solutions Toward Improving Radiologists' Well-being.

PubMed

Restauri, Nicole; Flug, Jonathan A; Mcarthur, Tatum A

This article uses case fictional case vignettes as a vehicle to discuss the complex way organizational and individual factors contribute to physician burnout. The article incorporates a review of the current literature on physician burnout focusing on work place inefficiency and ineffective leadership. Copyright © 2017 Elsevier Inc. All rights reserved.

Children with Disabilities in the Child Protective Services System: An Analog Study of Investigation and Case Management

ERIC Educational Resources Information Center

Manders, Jeanette E.; Stoneman, Zolinda

2009-01-01

Objective: The study used a series of vignettes to investigate how the presence of three disabilities (cerebral palsy, intellectual disabilities, emotional/behavioral disabilities) affects the processes and outcomes of child abuse investigations at two levels of child injury severity (moderate, severe). Method: Seventy-five CPS case workers…

Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion: results from a national vignette experiment.

PubMed

Rasinski, Kenneth A; Yoon, John D; Kalad, Youssef G; Curlin, Farr A

2011-12-01

Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee--whether the doctor referred and whether the doctor disclosed their objection to the abortion. 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Physicians indicated their approval for the vignette doctor's decision. Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.

Lessons from the use of vignettes in the study of mental health service disparities.

PubMed

Lapatin, Sheri; Gonçalves, Marta; Nillni, Anna; Chavez, Ligia; Quinn, Roxana Llerena; Green, Alexander; Alegría, Margarita

2012-06-01

To examine the development, feasibility, and use of a vignette approach as an important tool in health services disparities research. Interviews with vignette developers and qualitative data from a novel mental health services disparities study that used vignettes in two samples: (1) predominantly low-income parents of children attending mental health specialty care who were Latino or non-Latino White and (2) Latino and non-Latino mental health clinicians who treat children in their practice. We conduct a content analysis of qualitative data from patients and providers in the Ethnic Differences Study to explore the feasibility of vignette methodology in health services disparities research, and we identify lessons learned that may guide future vignette development. Vignettes provide a valuable approach that is acceptable to participants, elicits important insight on participant experience and services, and sheds light on factors that can help optimize study design for exploring health disparities questions. Researchers, clinicians, and others should consider a set of factors that help determine when a vignette approach is warranted in research, training, or for other uses, including how best to address identified weaknesses. © Health Research and Educational Trust.

Evidence of the preferential use of disease prototypes over case exemplars among early year one medical students prior to and following diagnostic training.

PubMed

Papa, Frank J; Li, Feiming

2015-12-01

Two core dual processing theory (DPT) System I constructs (Exemplars and Prototypes) were used to: 1) formulate a training exercise designed to improve diagnostic performance in year one medical students, and 2) explore whether any observed performance improvements were associated with preferential use of exemplars or prototypes. With IRB approval, 117 year one medical students participated in an acute chest pain diagnostic training exercise. A pre- and post-training test containing the same 27 case vignettes was used to determine if the subjects' diagnostic performance improved via training in both exemplars and prototypes. Exemplar and Prototype theory was also used to generate a unique typicality estimate for each case vignette. Because these estimates produce different performance predictions, differences in the subjects' observed performance would make it possible to infer whether subjects were preferentially using Exemplars or Prototypes. Pre- vs. post-training comparison revealed a significant performance improvement; t=14.04, p<0.001, Cohen's d=1.32. Pre-training, paired t-testing demonstrated that performance against the most typical vignettes>mid typical vignettes: t=4.94, p<0.001; and mid typical>least typical: t=5.16, p<0.001. Post-training, paired t-testing again demonstrated that performance against the most typical vignettes>mid typical: t=2.94, p<0.01; and mid typical>least typical: t=6.64, p<0.001. These findings are more consistent with the performance predictions generated via Prototype theory than Exemplar theory. DPT is useful in designing and evaluating the utility of new approaches to diagnostic training, and, investigating the cognitive factors driving diagnostic capabilities among early medical students.

Knowledge and Innovation: A Comparative Study of the USA, the UK and Japan. Routledge Studies in Innovation, Organizations and Technology

ERIC Educational Resources Information Center

Brown, Helen

2012-01-01

This new book presents case studies from the US, the UK and Japan. Packed full of vignettes from cases studies and subscribing to a socio-cultural approach rather than the often tacit assumption that knowledge and "technology transfer" is a logistical problem, this excellent volume illuminates the often misunderstood process of knowledge…

Adding a second surprise question triggers general practitioners to increase the thoroughness of palliative care planning: results of a pilot RCT with cage vignettes.

PubMed

Weijers, F; Veldhoven, C; Verhagen, C; Vissers, K; Engels, Y

2018-04-19

In our aging society, palliative care should be a standard component of health care. However, currently it is only provided to a small proportion of patients, mostly to those with cancer, and restricted to the terminal phase. Many general practitioners (GPs) say that one of their most significant challenges is to assess the right moment to start anticipatory palliative care. The "Surprise Question" (SQ1: "Would I be surprised if this patient were to die in the next 12 months"?), if answered with "no", is an easy tool to apply in identifying patients in need of palliative care. However, this tool has a low specificity. Therefore, the aim of our pilot study was to determine if adding a second, more specific "Surprise Question" (SQ2: "Would I be surprised if this patient is still alive after 12 months"?) in case SQ1 is answered in the negative, prompts GPs to plan for anticipatory palliative care. By randomization, 28 GPs in the south-eastern part of the Netherlands were allocated to three different groups. They all received a questionnaire with four vignettes, respectively representing patients with advanced organ failure (A), end stage cancer (B), frailty (C), and recently diagnosed cancer (D). GPs in the first group did not receive additional information, the second group received SQ1 after each vignette, and the third group received SQ1 and SQ2 after each vignette. We rated their answers based on essential components of palliative care (here called RADIANT score). GPs in group 3 gave higher RADIANT scores to those vignettes in which they would be surprised if the patients were still alive after 12 months. In all groups, vignette B had the highest mean RADIANT score, followed by vignettes A and C, and the lowest on vignette D. Seventy-one percent of GPs in groups 2 and 3 considered SQ1 a helpful tool, and 75% considered SQ2 helpful. This innovative pilot study indicates that the majority of GPs think SQ2 is a helpful additional tool. The combination of the two "Surprise Questions" encourages GPs to make more specific plans for anticipatory palliative care.

Physicians' pharmacogenomics information needs and seeking behavior: a study with case vignettes.

PubMed

Heale, Bret S E; Khalifa, Aly; Stone, Bryan L; Nelson, Scott; Del Fiol, Guilherme

2017-08-01

Genetic testing, especially in pharmacogenomics, can have a major impact on patient care. However, most physicians do not feel that they have sufficient knowledge to apply pharmacogenomics to patient care. Online information resources can help address this gap. We investigated physicians' pharmacogenomics information needs and information-seeking behavior, in order to guide the design of pharmacogenomics information resources that effectively meet clinical information needs. We performed a formative, mixed-method assessment of physicians' information-seeking process in three pharmacogenomics case vignettes. Interactions of 6 physicians' with online pharmacogenomics resources were recorded, transcribed, and analyzed for prominent themes. Quantitative data included information-seeking duration, page navigations, and number of searches entered. We found that participants searched an average of 8 min per case vignette, spent less than 30 s reviewing specific content, and rarely refined search terms. Participants' information needs included a need for clinically meaningful descriptions of test interpretations, a molecular basis for the clinical effect of drug variation, information on the logistics of carrying out a genetic test (including questions related to cost, availability, test turn-around time, insurance coverage, and accessibility of expert support).Also, participants sought alternative therapies that would not require genetic testing. This study of pharmacogenomics information-seeking behavior indicates that content to support their information needs is dispersed and hard to find. Our results reveal a set of themes that information resources can use to help physicians find and apply pharmacogenomics information to the care of their patients.

Web-Based Case Conferencing for Preservice Teacher Education: Electronic Discourse from the Field.

ERIC Educational Resources Information Center

Bonk, Curtis Jay; Malikowski, Steve; Angeli, Charoula; East, Judy

1998-01-01

The purpose of this study was to foster preservice teacher learning of educational psychology by creating a Web-based learning community using actual case situations experienced during field observations. Participants (146 undergraduate students) were assigned to two electronic-conferencing groups where they generated teaching vignettes related to…

Use of Epidemiological Data in the Diagnosis of Physical Child Abuse: Variations in Response to Hypothetical Cases.

ERIC Educational Resources Information Center

Wissow, Lawrence S.; Wilson, Modena E. H.

1992-01-01

Study investigates whether epidemiological data describing injuries could help physicians differentiate intentional from unintentional injury. Case vignettes describing child's injury were sent to 280 physicians. Responses were received from 59 percent; 48 percent were pediatricians, and 37 percent had trained in emergency medicine. Pediatricians…

Agreement among healthcare professionals in ten European countries in diagnosing case-vignettes of surgical-site infections.

PubMed

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00-0.35) to 0.65 (0.45-0.82). Inter-specialty agreement varied from 0.04 (0.00-0.62) in to 0.55 (0.37-0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14-0.42) and good for ICPs (0.41, 0.28-0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00-0.10) to 0.50 (0.45-0.55) and was not improved by reading SSI definition. Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

PubMed Central

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

Objective Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Methods Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Results Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00–0.35) to 0.65 (0.45–0.82). Inter-specialty agreement varied from 0.04 (0.00–0.62) in to 0.55 (0.37–0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14–0.42) and good for ICPs (0.41, 0.28–0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00–0.10) to 0.50 (0.45–0.55) and was not improved by reading SSI definition. Conclusion Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries. PMID:23874690

Developing and Using Vignettes to Explore the Relationship Between Risk Management Practice and Recovery-Oriented Care in Mental Health Services.

PubMed

Holley, Jessica; Gillard, Steven

2018-02-01

There is a lack of literature evaluating the development and use of vignettes to explore contested constructs in qualitative health care research where a conventional interview schedule might impose assumptions on the data collected. We describe the development and validation of vignettes in a study exploring mental health worker and service user understandings of risk and recovery in U.K. mental health services. Focus groups with mental health workers and service users explored study questions from experiential perspectives. Themes identified in the groups were combined with existing empirical literature to develop a set of vignettes. Feedback focus groups were conducted to validate and amend the vignettes. Following use in research interviews, results suggested that the vignettes had successfully elicited data on issues of risk and recovery in mental health services. Further research using creative, comparative methods is needed to fully understand how vignettes can best be used in qualitative health care research.

The effects of physical activity vignettes on physical activity-related social cognitions among people with spinal cord injury.

PubMed

Foulon, Brianne L; Ginis, Kathleen A Martin

2013-01-01

The purpose of this study was to explore the effectiveness of informational portrait vignettes for enhancing physical activity-related psychosocial cognitions in adults with spinal cord injury (n = 90). Using the Health Action Process Approach (HAPA), participants were classified as being in the motivational or volitional phase of behavior change. Half of the participants were randomly allocated to read an experimental vignette, which described the physical activity behaviours, thoughts, and feelings of a character demographically similar to the reader. The remainder read a control vignette. Social cognitions were measured one-week before, and immediately after reading the vignette. Analyses revealed no significant effects of the vignettes on social cognitions (p > 0.05). Informational portrait vignettes describing a physically active person with SCI and targeting multiple HAPA-based social cognitions are not recommended as a physical activity promotional strategy for people with SCI. The effectiveness of other types of vignettes should be examined. Until further research is completed to determine whether social comparison strategies play a meditational role in accounting for the impact of a tailored informational portrait vignette to alter leisure time physical activity among those with spinal cord injury, these types of informational intervention should not be utilized in a rehabilitation, or real-world, setting. Although informational portrait vignettes may not be effective in altering leisure time physical activity social cognitions among those with spinal cord injury, different types of vignettes, such as composite vignettes, should be explored.

Multidisciplinary Child Protection Decision Making About Physical Abuse: Determining Substantiation Thresholds and Biases

PubMed Central

Jent, Jason F.; Eaton, Cyd K.; Knickerbocker, Lauren; Lambert, Walter F.; Merrick, Melissa T.; Dandes, Susan K.

2011-01-01

The current study examined the threshold at which multidisciplinary child protection team (CPT) professionals substantiate physical abuse allegations and the extent that they utilize potentially biased constructs in their decision making when presented with the same case evidence. State legal definitions of child maltreatment are broad. Therefore, the burden of interpretation is largely on CPT professionals who must determine at what threshold physical acts by parents surpass corporal discipline and constitute child physical abuse. Biased or subjective decisions may be made if certain case-specific characteristics or CPT professionals’ personal characteristics are used in making physical abuse determinations. Case vignettes with visual depictions of inflicted injuries were sent to CPT professionals in Florida and their substantiation decisions, personal beliefs about corporal discipline, and coercive discipline were collected. Results of the study demonstrated relatively high agreement among professionals across vignettes about what constitutes physical abuse. Further, CPT professionals strongly considered their perceptions of the severity of inflicted injuries in substantiation decisions. Although case specific characteristics did not bias decisions in a systematic way, some CPT professional characteristics influenced the substantiation of physical abuse. Practice implications and future directions of research are discussed. PMID:21804681

Genes and plays: bringing ELSI issues to life.

PubMed

Rothenberg, Karen H; Bush, Lynn W

2012-02-01

Ethical complexities surround the promise of genomic technology and the power of genetic information as they alter conceptions of identity and dynamics within personal and professional relationships. Creative approaches such as dramatic vignettes offer a unique analytical stage for imagining the bioethical past and future. Dramatic narratives can bring to life images of differing perspectives and values when experiencing innovations in medicine. Although the scientific landscape shifts, concerns expressed in theatre from 50 years ago parallel many contemporary ELSI (ethical, legal, and social implications) issues, highlighting the ongoing struggle to appreciate the impact of emerging genetic technologies on relationships. To illuminate these enduring concerns, we explore how perceptions and relationships have influenced-and been influenced by-genetics as portrayed through dramatic vignettes. We build on the legacy of using case vignettes as a clinical teaching modality, and believe similar value exists within the research ethics domain. The selection of dialogue discussed encompasses abbreviated excerpts from two existing and one original vignette that we staged at the ELSI 2011 Congress and various academic and health institutions.

The Therapist's Feelings

ERIC Educational Resources Information Center

Silvestre, Rafaela Luisa Silva; Vandenberghe, Luc

2008-01-01

The present article discusses possible uses of the therapist's feelings to enhance treatment following Kohlenberg and Tsai's conceptualization of the therapist-client relationship. Four vignettes from a case study involving a couple are used as illustrative material. It is argued that the therapist's feelings can serve as clues for identifying…

Patient factors that influence clinicians' decision making in self-management support: A clinical vignette study.

PubMed

Bos-Touwen, Irene D; Trappenburg, Jaap C A; van der Wulp, Ineke; Schuurmans, Marieke J; de Wit, Niek J

2017-01-01

Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current decision making of health professionals can support future tailoring of self-management interventions. The aim of this study is to identify the relative importance of patient factors in health professionals' decision making regarding self-management support. A factorial survey was presented to primary care physicians and nurses. The survey consisted of clinical vignettes (case descriptions), in which 11 patient factors were systematically varied. Each care provider received a set of 12 vignettes. For each vignette, they decided whether they would give this patient self-management support and whether they expected this support to be successful. The associations between respondent decisions and patient factors were explored using ordered logit regression. The survey was completed by 60 general practitioners and 80 nurses. Self-management support was unlikely to be provided in a third of the vignettes. The most important patient factor in the decision to provide self-management support as well as in the expectation that self-management support would be successful was motivation, followed by patient-provider relationship and illness perception. Other factors, such as depression or anxiety, education level, self-efficacy and social support, had a small impact on decisions. Disease, disease severity, knowledge of disease, and age were relatively unimportant factors. This is the first study to explore the relative importance of patient factors in decision making and the expectations regarding the provision of self-management support to chronic disease patients. By far, the most important factor considered was patient's motivation; unmotivated patients were less likely to receive self-management support. Future tailored interventions should incorporate strategies to enhance motivation in unmotivated patients. Furthermore, care providers should be better equipped to promote motivational change in their patients.

Vignettes: Implications for LIS Research

ERIC Educational Resources Information Center

Benedetti, Allison; Jackson, John; Luo, Lili

2018-01-01

Vignettes, brief descriptions of fictional characters and situations, serve as a tool to study people's lives, perceptions, beliefs, and attitudes about specific situations. Although not widely used in library and information science (LIS) research, vignettes can depersonalize responses to controversial situations or behavioral responses related…

African American Male College Athletes' Narratives on Education and Racism

ERIC Educational Resources Information Center

Singer, John N.

2016-01-01

This study presents narrative case study vignettes of three elite African American male football athletes at a major historically White institution of higher education with a big-time athletics department. More specifically, I draw from critical race theory to garner insight into their secondary schooling background, what education means to them,…

Structuring Contexts: Pathways toward Un-Obstructing Race-Consciousness

ERIC Educational Resources Information Center

Berchini, Christina

2016-01-01

This research is situated in second-wave White Teacher Identity studies and investigates the ways context structures a high school English teacher's white identity, practices, and race-consciousness. Working with detailed data and vignettes from a single case study, the author highlights the teaching of a unit on the Holocaust. Using the required…

Microblogging Activities: Language Play and Tool Transformation

ERIC Educational Resources Information Center

Hattem, David

2014-01-01

The following is a qualitative case study presenting three vignettes exploring the use of language play while microblogging during an academically sanctioned task. Ten students and one teacher used "Twitter" in an intensive, English as a second language advanced grammar course to practice writing sentences with complex grammatical…

Allogeneic BMT and patient eligibility based on psychosocial criteria: a survey of BMT professionals.

PubMed

Foster, L W; McLellan, L J; Rybicki, L A; Dabney, J; Welsh, E; Bolwell, B J

2006-01-01

BMT professionals were compared regarding their willingness to proceed with allogeneic BMT given select psychosocial issues. A questionnaire was sent to 660 physician members of ASBMT, 92 social work members of BMT Special Interest Group, Association of Oncology Social Work, and 626 nurse members of BMT Special Interest Group, Oncology Nursing Society; 597 responded with a response rate of 43.5%. Items included background information, followed by 17 case vignettes; each represented a different psychosocial issue to which respondents indicated whether or not they would recommend proceeding with allogeneic BMT. In every vignette, at least 10% of respondents indicated they would not proceed. In six vignettes, at least 64% indicated do not proceed: suicidal ideation (86.8%), uses addictive illicit drugs (81.7%), history of noncompliance (80.5%), no lay caregiver (69.3%), alcoholic (64.8%), and mild dementia/Alzheimer's (64.4%). In 10 vignettes, at least 73% indicated proceed. On four vignettes, professional subgroups differed in their recommendation on whether or not to proceed with allogeneic BMT. Qualitative data suggest that this decision is contingent on the perceived acuity, severity, and currency of the psychosocial issue, patient ability to comply with treatment given the issue, and its manageability as a risk factor for treatment related vulnerability and outcomes.

Working towards a 'fit note': an experimental vignette survey of GPs.

PubMed

Sallis, Anna; Birkin, Richard; Munir, Fehmidah

2010-04-01

The Department for Work and Pensions (DWP) has designed a trial medical statement. To compare fitness for work assessment outcomes and written advice across current and trial medical statements. To examine the use of and suggestions to improve the trial medical statement. Comparative study with a two-way mixed design using questionnaire-based vignettes presenting GPs with three hypothetical sick leave cases (back pain, depression, combined back pain and depression) and medical statements (current or trial). The questionnaire also gathered GP views of using the trial Med 3. Nine primary care organisations (PCOs) in England, Scotland, and Wales. Five hundred and eighty-three GPs employed in PCOs in summer 2008 were randomised to receive a current or trial Med 3 postal questionnaire. GPs assessed vignette patients' fitness for work using the questionnaire medical statements. GPs using the trial Med 3 were less likely to advise refraining from work and more likely to provide written fitness for work advice compared to GPs using the current Med 3 form. Date sections of the trial Med 3 were used inconsistently, and a return to work date was unclear. GPs wanted further clarification of the implications of assessing a case as 'fit for some work' and its relationship to employers' willingness to follow GP advice about work. The study indicates a revised form may reduce the number of patients advised to refrain from work and increase the provision of written fitness for work information.

Using Vignettes to Tap Into Moral Reasoning in Public Health Policy: Practical Advice and Design Principles From a Study on Food Advertising to Children

PubMed Central

Taylor, Emily; Hoang, Sylvia; Cook, Brian

2014-01-01

In this article, we describe a process for designing and applying vignettes in public health policy research and practice. We developed this methodology for a study on moral reasoning underpinning policy debate on food advertising to children. Using vignettes prompted policy actors who were relatively entrenched in particular ways of speaking professionally about a controversial and ethically challenging issue to converse in a more authentic and reflective way. Vignettes hold benefits and complexities. They can focus attention on moral conflicts, draw out different types of evidence to support moral reasoning, and enable simultaneous consideration of real and ideal worlds. We suggest a process and recommendations on design features for crafting vignettes for public health policy. PMID:25121818

Using vignettes to tap into moral reasoning in public health policy: practical advice and design principles from a study on food advertising to children.

PubMed

Mah, Catherine L; Taylor, Emily; Hoang, Sylvia; Cook, Brian

2014-10-01

In this article, we describe a process for designing and applying vignettes in public health policy research and practice. We developed this methodology for a study on moral reasoning underpinning policy debate on food advertising to children. Using vignettes prompted policy actors who were relatively entrenched in particular ways of speaking professionally about a controversial and ethically challenging issue to converse in a more authentic and reflective way. Vignettes hold benefits and complexities. They can focus attention on moral conflicts, draw out different types of evidence to support moral reasoning, and enable simultaneous consideration of real and ideal worlds. We suggest a process and recommendations on design features for crafting vignettes for public health policy.

The role of clinical experience, diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders: A vignette and survey investigation.

PubMed

Dorahy, Martin J; Lewis-Fernández, Roberto; Krüger, Christa; Brand, Bethany L; Şar, Vedat; Ewing, Jan; Martínez-Taboas, Alfonso; Stavropoulos, Pam; Middleton, Warwick

2017-01-01

Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients' vignettes influenced clinicians' preference for phase-oriented treatment and whether clinicians' treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients' deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.

Simulation-Based Dysphagia Training: Teaching Interprofessional Clinical Reasoning in a Hospital Environment.

PubMed

Miles, Anna; Friary, Philippa; Jackson, Bianca; Sekula, Julia; Braakhuis, Andrea

2016-06-01

This study evaluated hospital readiness and interprofessional clinical reasoning in speech-language pathology and dietetics students following a simulation-based teaching package. Thirty-one students participated in two half-day simulation workshops. The training included orientation to the hospital setting, part-task skill learning and immersive simulated cases. Students completed workshop evaluation forms. They filled in a 10-question survey regarding confidence, knowledge and preparedness for working in a hospital environment before and immediately after the workshops. Students completed written 15-min clinical vignettes at 1 month prior to training, immediately prior to training and immediately after training. A marking rubric was devised to evaluate the responses to the clinical vignettes within a framework of interprofessional education. The simulation workshops were well received by all students. There was a significant increase in students' self-ratings of confidence, preparedness and knowledge following the study day (p < .001). There was a significant increase in student overall scores in clinical vignettes after training with the greatest increase in clinical reasoning (p < .001). Interprofessional simulation-based training has benefits in developing hospital readiness and clinical reasoning in allied health students.

Development of Clinical Vignettes to Describe Alzheimer's Disease Health States: A Qualitative Study

PubMed Central

Oremus, Mark; Xie, Feng; Gaebel, Kathryn

2016-01-01

Aims To develop clinical descriptions (vignettes) of life with Alzheimer’s disease (AD), we conducted focus groups of persons with AD (n = 14), family caregivers of persons with AD (n = 20), and clinicians who see persons with AD in their practices (n = 5). Methods Group participants read existing descriptions of AD and commented on the realism and comprehensibility of the descriptions. We used thematic framework analysis to code the comments into themes and develop three new vignettes to describe mild, moderate, and severe AD. Results Themes included the types of symptoms to mention in the new vignettes, plus the manner in which the vignettes should be written. Since the vignette descriptions were based on focus group participants’ first-hand knowledge of AD, the descriptions can be said to demonstrate content validity. Conclusion Members of the general public can read the vignettes and estimate their health-related quality-of-life (HRQoL) as if they had AD based on the vignette descriptions. This is especially important for economic evaluations of new AD medications, which require HRQoL to be assessed in a manner that persons with AD often find difficult to undertake. The vignettes will allow the general public to serve as a proxy and provide HRQoL estimates in place of persons with AD. PMID:27589604

Impact of advance directives and a health care proxy on doctors' decisions: a randomized trial.

PubMed

Escher, Monica; Perneger, Thomas V; Rudaz, Sandrine; Dayer, Pierre; Perrier, Arnaud

2014-01-01

Advance directives or proxy designations are widely recommended, but how they affect doctors' decision making is not well known. The aim of this study was to quantify the influence of advance directives and proxy opinions on doctors' decisions. We mailed to all the generalists and internists in French-speaking Switzerland (N = 1962) three vignettes describing difficult decisions involving incapacitated patients. In each case, the advance directive requested that further care be withheld. One vignette tested the impact of a written advance directive vs. a proxy. Another compared the impact of a handwritten directive vs. a formalized document. The third vignette compared the impact of a family member vs. a doctor as a proxy. Each vignette was prepared in three or four versions, including a control version in which no directive or proxy was present. Vignettes were randomly allocated to respondents. We used logistic regression to predict the decision to forgo a medical intervention. Compared with the control condition, the odds of forgoing a medical intervention were increased by the written advance directive (odds ratio [OR] 7.3; P < 0.001), the proxy (OR 7.9; P < 0.001), and the combination of the two (OR 35.7; P < 0.001). The handwritten directive had the same impact (OR 13.3) as the formalized directive (OR 13.8). The effect of proxy opinion was slightly stronger when provided by a doctor (OR 11.3) rather than by family (OR 7.8). Advance directives and proxy opinions are equally effective in influencing doctors' decisions, but having both has the strongest effect. The format of the advance directive and the identity of the proxy have little influence on decisions. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Effect of clinical vignettes on senior medical students' opinions of climate change.

PubMed

Prasad, Vinay; Thistlethwaite, William; Dale, William

2011-06-01

The consequences of climate change directly threaten human health. Some have argued that, as such, doctors have a special duty to solve climate change. Despite such recommendations, to our knowledge, there has been no previous work documenting physician attitudes on climate change, or the stability of those opinions. We invited 523 fourth-year medical students to a survey asking their opinion on climate change and their opinion regarding one of two fictional medical vignettes. In the vignettes, which are analogous to the climate change issue, students decide whether to discontinue a drug that may be adversely affecting laboratory values. In the climate change question, students are asked whether the United States should take efforts to discontinue the use of fossil fuels. Students are randomized to the order in which they receive the questions. Ninety-five percent (95% CI 89.1%-100%) of students initially asked about climate change feel the United States should take steps to curb carbon dioxide emissions, while only 73% (95% CI 57.5%-89.2%) of students respond similarly if first given an analogous patient vignette. Conversely, in all cases where a fictional medical vignette follows the climate change question, students are more likely to cease using a potentially harmful agent (66% CI 53.5%-71.8% vs. 52% CI 43.3%-67.1%). Our results suggest that student physician attitudes to climate change are mutable. Priming students into "medical mode" may alter their opinions on the scientific merit of nonmedical issues, and may be a vestige of a hidden medical curriculum. Further studies should explore the interrelationship between other sociopolitical beliefs and medical decision making.

Learning to Teach in the Early Years Classroom

ERIC Educational Resources Information Center

Blaise, Mindy; Nuttal, Joce

2011-01-01

"Learning to Teach in the Early Years Classroom" helps teacher education students understand the complexities of teaching in early years' classrooms. It integrates research and theory with practice through vignettes, based on authentic classroom case studies, in order to show students how educators make decisions and achieve expected outcomes.…

Assessing Multicultural Competence: Perceived versus Demonstrated Performance

ERIC Educational Resources Information Center

Cartwright, Brenda Y.; Daniels, Judy; Zhang, Shuqiang

2008-01-01

This study compares self-report scores generated by the Multicultural Awareness Knowledge Skills Survey-Counselor Edition-Revised (B. S. K. Kim, B. Y. Cartwright, P. A. Asay, & M. J. D'Andrea, 2003) with independent observer ratings of actual videotaped demonstrations of multicultural competence in response to a preselected case vignette.…

Evolution Education in Policy and Practice: An Ethnographic Perspective

ERIC Educational Resources Information Center

Long, David E.

2012-01-01

Evolution education in the US is conducted unevenly, or in cases is absent. Showing the strength of ethnography as a means of deeper explication in science education, this article explores the interactions of policy and practice in evolution education. Discussing vignettes from a larger ethnographic study, Creationist rationales and practices…

[Health status identification and their relationship with socieconomics and geographic characteristics: a population survey analysis in México].

PubMed

Vargas-Palacios, Armando; Gutiérrez, Juan Pablo; Carreón-Rodríguez, Víctor

2006-01-01

To estimate the effectiveness of using standardized health vignettes to adjust self-reported health taking into account household and community variables to correct for systematic bias. The national health survey "Evaluación del Desempeño 2002" (Mexican component of the World Health Survey) was used. This survey analyzed subject's health perception based on their responses to hypothetical questions referring to third parties in the vignettes within eight domains. Variations in responses were attributed to socio-demographic, socioeconomic, community, differences of the subjects. To assess those variations, an index for each domain was constructed and used as a variable in a series of linear regression models to estimate the relation between health perceptions, self-reported health, socioeconomic and socio-demographic characteristics. The health perception index derived from the vignettes showed a positive, logarithmic correlation with household expenditure for each health domain, after controlling for socio-demographic, health and community characteristics. No relationship was found between the health status described in the vignettes and self-reported health status. In no case was the explanatory power above 10%. The low explanatory power of the models, and the lack of correlation between self reported health status and the health perception index, suggest that the variability in the vignettes responses cannot be explained by differences in self-reported health status or socioeconomic and socio-demographic characteristics. These results from Mexico suggest that vignette-based methods to correct for systematic variability in perception of own health status are of limited efficacy and reinforce the importance of collecting objective measures of health status in health surveys.

Bench-marking effects in the blaming of professionals for incidents of aggression and assault.

PubMed

Carifio, J; Lanza, M

1994-01-01

This study compared all possible orders of responding to three vignettes describing incidents between a male patient and a female nurse in which the nurse is mildly assaulted, severely assaulted, or verbally abused by the patient (the control condition). Subjects were 32 female senior-year nursing students and 28 practicing nurses. It was found that response levels to a given vignette could predict a respondent's response to the other vignettes. Also, a significant "bench-marking" effect was found: if a subject responded to the mild assault vignette first, the subject's overall response pattern best fit the general nonlinear assignment-of-blame pattern observed, but if the subject responded to the severe assault or control vignette first, this vignette set a bench mark for responding from which the subject's subsequent responses did not deviate greatly, which slightly distorted the subject's V-shaped nonlinear response pattern.

Changing attitudes towards obesity - results from a survey experiment.

PubMed

Luck-Sikorski, C; Riedel-Heller, S G; Phelan, J C

2017-05-02

This experimental study in a population-based sample aimed to compare attitudes towards obesity following three different causal explanations for obesity (individual behavior, environmental factors, genetic factors). The data were derived from an online representative sample. A random subsample of n = 407 participants was included. Two independent variables were investigated: cause of obesity as described in the vignette and cause of obesity as perceived by the participant regardless of vignette. Quality features of the vignettes (accuracy and bias of the vignette) were introduced as moderators to regression models. Three stigma-related outcomes (negative attitudes, blame and social distance) served as dependent variables. Inaccuracy and bias was ascribed to the social environmental and genetic vignettes more often than to the individual cause vignette. Overall, participants preferred individual causes (72.6%). While personal beliefs did not differ between the genetic and environmental cause conditions (Chi 2  = 4.36, p = 0.113), both were different from the distribution seen in the individual cause vignette. Negative attitudes as well as blame were associated with the belief that individuals are responsible for obesity (b = 0.374, p = 0.003; 0.597, p < 0.001), but were not associated with vignette-manipulated causal explanation. The vignette presenting individual responsibility was associated with lower levels of social distance (b = -0.183, p = 0.043). After including perceived inaccuracy and bias as moderators, the individual responsibility vignette was associated with higher levels of blame (emphasis: b = 0.980, p = 0.010; bias: b = 0.778, p = 0.001) and the effect on social distance vanished. This study shows that media and public health campaigns may solidify beliefs that obesity is due to individual causes and consequently increase stigma when presenting individual behavior as a cause of obesity. Public health messages that emphasize the role of social environmental or genetic causes may be ineffective because of entrenched beliefs.

Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers.

PubMed

Bowman, Jason; George, Naomi; Barrett, Nina; Anderson, Kelsey; Dove-Maguire, Kalie; Baird, Janette

2016-06-01

The Palliative Care and Rapid Emergency Screening (P-CaRES) Project is an initiative intended to improve access to palliative care (PC) among emergency department (ED) patients with life-limiting illness by facilitating early referral for inpatient PC consultations. In the previous two phases of this project, we derived and validated a novel PC screening tool. This paper reports on the third and final preimplementation phase. Examine the acceptability of the P-CaRES tool among PC and ED providers as well as test its reliability on case vignettes. Compare variations in reliability and acceptability of the tool based on ED providers' roles (attendings, residents, and nurses) and lengths of experience. A two-part electronic survey was distributed to ED providers at multiple sites across the United States. We tested the reliability of the tool in the first part of the survey, through a series of case vignettes. A criterion standard of correct responses was first defined by consensus input from expert PC physicians' interpretations of the vignettes. The experts' input was validated using the Gwet's AC1 coefficient for inter-rater reliability. ED providers were then presented with the case vignettes and asked to use the P-CaRES tool to correctly identify which patients had unmet PC needs. ED provider responses were compared both against the criterion standard and against different subsets of respondents (divided both by role and by level of experience). The second part of the survey assessed acceptability of the P-CaRES tool among ED providers using responses to questions from a modified Ottawa Acceptability of Decision Rules Instrument, based on a 1-5 Likert rating scale. Descriptive statistics were used to report all outcomes. In total, 213 ED providers employed in three different regions across the country responded to the survey (39.4%) and 185 (86.9%) of those completed it. The majority of providers felt that the tool would be useful in their practice (80.5%), agreed that the tool was clear and unambiguous (87.1%), thought that use of the tool would likely benefit patients (87.5%), and thought that it would result in improved use of resources to help severely ill patients (83.6%). Over three-quarters of ED providers (78.5%) also self-reported that they refer patients with unmet PC needs less than 10% of the time, and only 10.8% of respondents believed that they are already utilizing an effective strategy to screen or refer patients to PC. Applying our P-CaRES tool to case vignettes, ED providers generated PC referrals in concordance with PC experts over 88.7% of the time (95% confidence interval = 86.4% to 90.6%), with an overall sensitivity of more than 90%. These results varied minimally regardless of the respondent's role in the ED or their level of experience. Screening by emergency medicine providers for unmet PC needs using a brief, novel, content-validated screening tool is acceptable and is also reliable when applied to case vignettes-regardless of provider role or experience. Clinical trial and further study are warranted and are currently under way. © 2016 by the Society for Academic Emergency Medicine.

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

PubMed Central

2011-01-01

Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298). Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions. PMID:21569613

Assessment of mental competency in community-dwelling elderly.

PubMed

Schmand, B; Gouwenberg, B; Smit, J H; Jonker, C

1999-01-01

We studied the utility of a "vignette method" to assess mental competency for decision making on medical treatment and research participation. A vignette is a description of an imaginary situation in which the subject is asked to decide on a proposed treatment or on participation in research. His or her understanding of the situation and the quality of the reasoning underlying that choice are tested by a short series of questions. Subjects were participants in the Amsterdam Study of the Elderly (AMSTEL), a population-based study on cognitive decline and dementia. The sample consisted of elderly people (70-90 years), who were cognitively intact (n = 176) or had a dementia syndrome (n = 64; mostly Alzheimer disease). Dementia was diagnosed using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) schedule. Two vignettes were used as competency assessment instruments. The answers to the vignette questions were summed to form a competency score. The reliability (internal consistency) of this score was 0.82 for both vignettes combined. After dichotomization into competent/incompetent (cutoff at the fifth centile of the control group), the agreement between the vignette method and a physician's judgment of competency was poor (kappa = 0.36) in the demented group. There was no agreement whatsoever when subjects with "minimal dementia" (n = 14) were left out of this analysis (kappa = 0.04). As expected, mean competency scores declined with increasing dementia severity. A multiple regression analysis showed that mental competency as measured by the vignette method was determined mainly by recent memory, expressive language, and abstract thinking. In the control group the competency score was only slightly related to education (r = 0.12) and verbal intelligence (r = 0.27). We conclude that the vignette method is a reliable and valid method for the assessment of mental competency in elderly people with cognitive decline. The vignette method is preferred over a physician's judgment, especially in patients with early dementia.

Ethical principles and the rationing of health care: a qualitative study in general practice

PubMed Central

Berney, Lee; Kelly, Moira; Doyal, Len; Feder, Gene; Griffiths, Chris; Jones, Ian Rees

2005-01-01

Background Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. Aim To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. Design of study A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Setting Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Method Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. Results With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making. Conclusion The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice. PMID:16105371

Measuring individual differences in responses to date-rape vignettes using latent variable models.

PubMed

Tuliao, Antover P; Hoffman, Lesa; McChargue, Dennis E

2017-01-01

Vignette methodology can be a flexible and powerful way to examine individual differences in response to dangerous real-life scenarios. However, most studies underutilize the usefulness of such methodology by analyzing only one outcome, which limits the ability to track event-related changes (e.g., vacillation in risk perception). The current study was designed to illustrate the dynamic influence of risk perception on exit point from a date-rape vignette. Our primary goal was to provide an illustrative example of how to use latent variable models for vignette methodology, including latent growth curve modeling with piecewise slopes, as well as latent variable measurement models. Through the combination of a step-by-step exposition in this text and corresponding model syntax available electronically, we detail an alternative statistical "blueprint" to enhance future violence research efforts using vignette methodology. Aggr. Behav. 43:60-73, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Studying medical communication with video vignettes: a randomized study on how variations in video-vignette introduction format and camera focus influence analogue patients' engagement.

PubMed

Visser, Leonie N C; Bol, Nadine; Hillen, Marij A; Verdam, Mathilde G E; de Haes, Hanneke C J M; van Weert, Julia C M; Smets, Ellen M A

2018-01-19

Video vignettes are used to test the effects of physicians' communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants' engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants' engagement with a video vignette showing a bad news consultation. Introduction format (A = audiovisual vs. B = written) and camera focus (1 = the physician only, 2 = the physician and the patient at neutral moments alternately, 3 = the physician and the patient at emotional moments alternately) were varied in a randomized 2 × 3 between-subjects design. One hundred eighty-one students were randomly assigned to watch one of the six resulting video-vignette conditions as so-called analogue patients, i.e., they were instructed to imagine themselves being in the video patient's situation. Four dimensions of self-reported engagement were assessed retrospectively. Emotional engagement was additionally measured by recording participants' electrodermal and cardiovascular activity continuously while watching. Analyses of variance were used to test the effects of introduction format, camera focus and their interaction. The audiovisual introduction induced a stronger blood pressure response during watching the introduction (p = 0.048, [Formula: see text]= 0.05) and the consultation part of the vignette (p = 0.051, [Formula: see text]= 0.05), when compared to the written introduction. With respect to camera focus, results revealed that the variant focusing on the patient at emotional moments evoked a higher level of electrodermal activity (p = 0.003, [Formula: see text]= 0.06), when compared to the other two variants. Furthermore, an interaction effect was shown on self-reported emotional engagement (p = 0.045, [Formula: see text]= 0.04): the physician-only variant resulted in lower emotional engagement if the vignette was preceded by the audiovisual introduction. No effects were shown on the other dimensions of self-reported engagement. Our findings imply that using an audiovisual introduction combined with alternating camera focus depicting patient's emotions results in the highest levels of emotional engagement in analogue patients. This evidence can inform methodological decisions during the development of video vignettes, and thereby enhance the ecological validity of future video-vignettes studies.

Creating a Novel Video Vignette Stroke Preparedness Outcome Measure Using a Community-Based Participatory Approach.

PubMed

Skolarus, Lesli E; Murphy, Jillian B; Dome, Mackenzie; Zimmerman, Marc A; Bailey, Sarah; Fowlkes, Sophronia; Morgenstern, Lewis B

2015-07-01

Evaluating the efficacy of behavioral interventions for rare outcomes is a challenge. One such topic is stroke preparedness, defined as inteventions to increase stroke symptom recognition and behavioral intent to call 911. Current stroke preparedness intermediate outcome measures are centered on written vignettes or open-ended questions and have been shown to poorly reflect actual behavior. Given that stroke identification and action requires aural and visual processing, video vignettes may improve on current measures. This article discusses an approach for creating a novel stroke preparedness video vignette intermediate outcome measure within a community-based participatory research partnership. A total of 20 video vignettes were filmed of which 13 were unambiguous (stroke or not stroke) as determined by stroke experts and had test discrimination among community participants. Acceptable reliability, high satisfaction, and cultural relevance were found among the 14 community respondents. A community-based participatory approach was effective in creating a video vignette intermediate outcome. Future projects should consider obtaining expert and community feedback prior to filming all the video vignettes to improve the proportion of vignettes that are usable. While content validity and preliminary reliability were established, future studies are needed to confirm the reliability and establish construct validity. © 2014 Society for Public Health Education.

Creating a Novel Video Vignette Stroke Preparedness Outcome Measure using a Community Based Participatory Approach

PubMed Central

Skolarus, Lesli E.; Murphy, Jillian B.; Dome, Mackenzie; Zimmerman, Marc A.; Bailey, Sarah; Fowlkes, Sophronia; Morgenstern, Lewis B.

2015-01-01

Evaluating the efficacy of behavioral interventions for rare outcomes is a challenge. One such topic is stroke preparedness, defined as inteventions to increase stroke symptom recognition and behavioral intent to call 911. Current stroke preparedness intermediate outcome measures are centered on written vignettes or open ended questions and have been shown to poorly reflect actual behavior. Given that stroke identification and action requires aural and visual processing, video vignettes may improve upon current measures. This article discusses an approach for creating a novel stroke preparedness video vignette intermediate outcome measure within a community based participatory research partnership. A total of 20 video vignettes were filmed of which 13 were unambiguous (stroke or not stroke) as determined by stroke experts and had test discrimination among community participants. Acceptable reliability, high satisfaction and cultural relevance were found among the 14 community respondents. A community based participatory approach was effective in creating a video vignette intermediate outcome. Future projects should consider obtaining expert and community feedback prior to filming all the video vignettes to improve the proportion of vignettes that are usable. While content validity and preliminary reliability were established, future studies are needed to confirm the reliability and establish construct validity. PMID:25367896

Racial-Ethnic Biases, Time Pressure, and Medical Decisions

ERIC Educational Resources Information Center

Stepanikova, Irena

2012-01-01

This study examined two types of potential sources of racial-ethnic disparities in medical care: implicit biases and time pressure. Eighty-one family physicians and general internists responded to a case vignette describing a patient with chest pain. Time pressure was manipulated experimentally. Under high time pressure, but not under low time…

Statin initiation by GPs in WA--a structured vignette study.

PubMed

Stafford, Leanne; Harmer, Nichola; Dhaliwal, Satvinder; Jiwa, Moyez

2009-09-01

Statins are recommended for all patients with known coronary heart disease. This pilot study investigated statin initiation by a Western Australian general practitioner cohort and the influence of prescriber and patient characteristics on prescribing. A structured vignette questionnaire was posted to members of the Fremantle GP Network. Respondents indicated their prescribing decisions for nine hypothetical patients who had recently suffered a myocardial infarction. Data analysis utilised logistic regression analyses and a generalised linear model with a logit link function. Fifty-five GPs responded (16.0% response rate). In over 20% of cases a statin was not prescribed. Male (OR 4.71; 95% CI: 1.24-17.87) and GPs with fewer years in practice (4.50; 1.21-16.77) were more likely to prescribe appropriately. Younger patients (2.21; 1.38-3.53), and those with diabetes (1.74; 1.09-2.76) or hypercholesterolaemia (4.81; 2.88-8.03) were more likely to receive therapy. Prescribing practices failed to comply with current guidelines in a significant number of cases. Further research to confirm these findings is warranted.

Supervision for treatment of depression: An experimental study of the role of therapist gender and anxiety.

PubMed

Simpson-Southward, Chloe; Waller, Glenn; Hardy, Gillian E

2016-02-01

Psychological treatments for depression are not always delivered effectively or consistently. Clinical supervision of therapists is often assumed to keep therapy on track, ensuring positive patient outcomes. However, there is a lack of empirical evidence supporting this assumption. This experimental study explored the focus of supervision of depression cases, comparing guidance given to supervisees of different genders and anxiety levels. Participants were clinical supervisors who supervised therapists working with patients with depression. Supervisors indicated their supervision focus for three supervision case vignettes. Supervisee anxiety and gender was varied across vignettes. Supervisors focused calm female supervisees more on therapeutic techniques than state anxious female supervisees. Males were supervised in the same way, regardless of their anxiety. Both male and female supervisors had this pattern of focus. Findings indicate that supervision is influenced by supervisors' own biases towards their supervisees. These factors may cause supervisors to drift from prompting their supervisees to deliver best practice. Suggestions are made for ways to improve the effectiveness of clinical supervision and how these results may inform future research practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Asking for work adjustments or initiating behavioural changes - what makes a 'problematic co-worker' score Brownie points? An experimental study on the reactions towards colleagues with a personality disorder.

PubMed

Muschalla, Beate; Fay, Doris; Seemann, Anne

2016-10-01

People with mental disorders, especially personality disorders, often face low acceptance at work. This is particularly problematic when returning to work after sick leave, because it impedes reintegration into the former workplace. This study explores colleagues' reactions towards a problematic worker dependent on the returning person's reintegration strategy: The returning person undertaking changes in their behaviour is compared with the person requesting adjustments of the workplace. In an experimental study, 188 employed persons read one of four vignettes that described a return-to-work-situation of a problematic co-worker. Across all vignettes, the co-worker was depicted as having previously caused problems in the work team. In the first vignette, the co-worker did not change anything (control condition) when she returned to work; in the second, she asked for workplace adjustments; in the third vignette she initiated efforts to change her own behaviour; and the fourth vignette combined both workplace adjustments and behavioural change. Study participants were asked for their reactions towards the problematic co-worker. Vignettes that included a behavioural change evoked more positive reactions towards the co-worker than vignettes without any behavioural change. Asking for workplace adjustments alone did not yield more positive reactions compared to not initiating any change. When preparing employees with interactional problems for their return to work, it is not effective to only instruct them on their statutory entitlement for workplace adjustments. Instead, it is advisable to encourage them to proactively strive for behaviour changes.

The ADHD Label, Analogue Methodology, and Participants' Geographic Location on Judgments of Social and Attentional Skills

ERIC Educational Resources Information Center

Koonce, Danel A.; Cruce, Michael K.; Aldridge, Jennifer O.; Langford, Courtney A.; Sporer, Amy K.; Stinnett, Terry A.

2004-01-01

Two hundred fifty-nine preservice teachers at a medium-sized university in the Southwest participated in the current study. The participants were randomly assigned to a labeled condition, Attention Deficit Hyperactivity Disorder, or nonlabeled condition, and were presented a vignette in one of three forms: a written case study, a video clip, or a…

Variations in GPs' decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes.

PubMed

Sheringham, Jessica; Sequeira, Rachel; Myles, Jonathan; Hamilton, William; McDonnell, Joe; Offman, Judith; Duffy, Stephen; Raine, Rosalind

2017-06-01

Lung cancer survival is low and comparatively poor in the UK. Patients with symptoms suggestive of lung cancer commonly consult primary care, but it is unclear how general practitioners (GPs) distinguish which patients require further investigation. This study examined how patients' clinical and sociodemographic characteristics influence GPs' decisions to initiate lung cancer investigations. A factorial experiment was conducted among a national sample of 227 English GPs using vignettes presented as simulated consultations. A multimedia-interactive website simulated key features of consultations using actors ('patients'). GP participants made management decisions online for six 'patients', whose sociodemographic characteristics systematically varied across three levels of cancer risk. In low-risk vignettes, investigation (ie, chest X-ray ordered, computerised tomography scan or respiratory consultant referral) was not indicated; in medium-risk vignettes, investigation could be appropriate; in high-risk vignettes, investigation was definitely indicated. Each 'patient' had two lung cancer-related symptoms: one volunteered and another elicited if GPs asked. Variations in investigation likelihood were examined using multilevel logistic regression. GPs decided to investigate lung cancer in 74% (1000/1348) of vignettes. Investigation likelihood did not increase with cancer risk. Investigations were more likely when GPs requested information on symptoms that 'patients' had but did not volunteer (adjusted OR (AOR)=3.18; 95% CI 2.27 to 4.70). However, GPs omitted to seek this information in 42% (570/1348) of cases. GPs were less likely to investigate older than younger 'patients' (AOR=0.52; 95% CI 0.39 to 0.7) and black 'patients' than white (AOR=0.68; 95% CI 0.48 to 0.95). GPs were not more likely to investigate 'patients' with high-risk than low-risk cancer symptoms. Furthermore, they did not investigate everyone with the same symptoms equally. Insufficient data gathering could be responsible for missed opportunities in diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Use of antipsychotic blood levels in clinician decision making: A cross-over study using clinical vignettes of patients with schizophrenia.

PubMed

Savitz, Adam; Melkote, Rama; Riley, Ralph; Pobre, Maria A; McQuarrie, Kelly; Williamson, David; Banderas, Benjamin

2018-05-19

The cause of treatment failure of antipsychotic medications is often difficult to determine in patients with schizophrenia. Evaluation of antipsychotic blood levels (ABLs) may aid clinicians in determining the cause of antipsychotic failure. The Clinical Assessment of the Schizophrenia Patient (CASP) was developed to evaluate clinical decision making during outpatient visits. The CASP assesses changes in medications, psychosocial treatments, and acute interventions along with factors influencing clinical decision making. Nine vignettes representative of clinical situations in patients with schizophrenia were created in two versions (one with ABLs, one without ABLs). The CASP was used to evaluate clinical decisions using the vignettes. Thirty-four clinicians participated in the study. In 8 out of 9 vignettes, most clinicians (at least 89.7%) made a different clinical decision with ABLs compared to without ABLs. In assessing the usefulness of ABLs, a majority (60.7%-85.7%, depending on the vignette) of clinicians responded that ABLs changed their clinical decision for 8 vignettes. Most clinicians (79%-93%) responded that they were more confident in their decisions with ABL information. This study demonstrated that ABLs have the potential to influence clinical decision making in the treatment of patients with schizophrenia. Copyright © 2018. Published by Elsevier B.V.

Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report

PubMed Central

Manchia, Mirko; Adli, Mazda; Akula, Nirmala; Ardau, Raffaella; Aubry, Jean-Michel; Backlund, Lena; Banzato, Claudio EM.; Baune, Bernhard T.; Bellivier, Frank; Bengesser, Susanne; Biernacka, Joanna M.; Brichant-Petitjean, Clara; Bui, Elise; Calkin, Cynthia V.; Cheng, Andrew Tai Ann; Chillotti, Caterina; Cichon, Sven; Clark, Scott; Czerski, Piotr M.; Dantas, Clarissa; Zompo, Maria Del; DePaulo, J. Raymond; Detera-Wadleigh, Sevilla D.; Etain, Bruno; Falkai, Peter; Frisén, Louise; Frye, Mark A.; Fullerton, Jan; Gard, Sébastien; Garnham, Julie; Goes, Fernando S.; Grof, Paul; Gruber, Oliver; Hashimoto, Ryota; Hauser, Joanna; Heilbronner, Urs; Hoban, Rebecca; Hou, Liping; Jamain, Stéphane; Kahn, Jean-Pierre; Kassem, Layla; Kato, Tadafumi; Kelsoe, John R.; Kittel-Schneider, Sarah; Kliwicki, Sebastian; Kuo, Po-Hsiu; Kusumi, Ichiro; Laje, Gonzalo; Lavebratt, Catharina; Leboyer, Marion; Leckband, Susan G.; López Jaramillo, Carlos A.; Maj, Mario; Malafosse, Alain; Martinsson, Lina; Masui, Takuya; Mitchell, Philip B.; Mondimore, Frank; Monteleone, Palmiero; Nallet, Audrey; Neuner, Maria; Novák, Tomás; O’Donovan, Claire; Ösby, Urban; Ozaki, Norio; Perlis, Roy H.; Pfennig, Andrea; Potash, James B.; Reich-Erkelenz, Daniela; Reif, Andreas; Reininghaus, Eva; Richardson, Sara; Rouleau, Guy A.; Rybakowski, Janusz K.; Schalling, Martin; Schofield, Peter R.; Schubert, Oliver K.; Schweizer, Barbara; Seemüller, Florian; Grigoroiu-Serbanescu, Maria; Severino, Giovanni; Seymour, Lisa R.; Slaney, Claire; Smoller, Jordan W.; Squassina, Alessio; Stamm, Thomas; Steele, Jo; Stopkova, Pavla; Tighe, Sarah K.; Tortorella, Alfonso; Turecki, Gustavo; Wray, Naomi R.; Wright, Adam; Zandi, Peter P.; Zilles, David; Bauer, Michael; Rietschel, Marcella; McMahon, Francis J.

2013-01-01

Objective The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the “Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder” scale currently used in the Consortium on Lithium Genetics (ConLiGen) study. Materials and Methods Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (κ)] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling. Results Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (κ = 0.66 and κ = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (ICC1 = 0.71 and ICC2 = 0.75, respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders). Conclusions We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study. PMID:23840348

New vignettes for the experimental manipulation of injury cause in prospective mild traumatic brain injury research.

PubMed

Sullivan, Karen A; Edmed, Shannon L

2016-01-01

This study developed standardized vignettes that depict a mild traumatic brain injury (TBI) from one of several causes and subjected them to formal expert review. A base vignette was developed using the World Health Organization operational criteria for mild TBI. Eight specific causes (e.g. sport vs assault) were examined. A convenience sample of mild TBI experts with a discipline background of Neuropsychology from North America, Australasia and Europe (n = 21) used an online survey to evaluate the vignettes and rated the role of cause on outcome. The vignette suite was rated as fitting the mild TBI WHO operational diagnostic criteria at least moderately well. When compared to other factors, cause was not rated as significantly contributing to outcome. When evaluated in isolation, approximately half of the sample rated cause as important or very important and at least two of three clinical outcomes were associated with a different cause. The vignettes may be useful in experimental mild TBI research. They enable the injury parameters to be controlled so that the effects of cause can be isolated and examined empirically. Such studies should advance understanding of the role of this factor in mild TBI outcome.

Public knowledge and beliefs about depression among urban and rural Chinese in Malaysia.

PubMed

Loo, Phik-Wern; Furnham, Adrian

2012-09-01

The study compared knowledge and beliefs about depression among urban and rural Chinese in a Malaysian sample. A total of 409 participants were asked to identify cases of depression varying in intensity from two vignettes and rate their beliefs regarding a list of possible causes and treatments for depression. The urban Chinese were more likely to identify depression as the problem in the vignette. Beliefs about causes of depression were factored into five components, whereas beliefs about treatment for depression factored into four components. The results indicated that the causes most strongly endorsed were stress and pressure, and standard treatments rated the highest as treatments for depression. Overall, depression literacy was moderate for Chinese Malaysians. The results are discussed in relation to Chinese cultural beliefs about depression. Limitations of this preliminary study were acknowledged. Copyright © 2012 Elsevier B.V. All rights reserved.

Assessing pharmacists' readiness to prescribe oral antibiotics for limited infections using a case-vignette technique.

PubMed

Ung, Elizabeth; Czarniak, Petra; Sunderland, Bruce; Parsons, Richard; Hoti, Kreshnik

2017-02-01

Background Pharmacist's skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents' level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.

Plastic with personality: Increasing student engagement with manikins.

PubMed

Power, Tamara; Virdun, Claudia; White, Haidee; Hayes, Carolyn; Parker, Nicola; Kelly, Michelle; Disler, Rebecca; Cottle, Amanda

2016-03-01

Simulation allows students to practice key psychomotor skills and gain technical proficiency, fostering the development of clinical reasoning and student confidence in a low risk environment. Manikins are a valuable learning tool; yet there is a distinct lack of empirical research investigating how to enhance engagement between nursing students and manikins. To describe student perspectives of a layered, technology enhanced approach to improve the simulation learning experience. Tanner's Model of Clinical Judgment underpins the entire curriculum. This study additionally drew on the principles of narrative pedagogy. Across ten teaching weeks, five separate case studies were introduced to students through short vignettes. Students viewed the vignettes prior to their laboratory class. In the labs, manikins were dressed in the props used in the vignettes. The innovation was trialed in a second year core subject of a Bachelor of Nursing program in a large urban university in the autumn semester of 2014. Following ethics approval, students were emailed a participant information sheet. A focus group of nine students was held. The discussion was digitally recorded and transcribed verbatim prior to being subject to thematic analysis. Students' comments (143) about the vignettes in their standard subject specific student feedback surveys were also considered as data. Four themes were identified: Getting past the plastic; knowing what to say; connecting and caring; and, embracing diversity. The feedback indicated that these measures increased students ability to suspend disbelief, feel connected to, and approach the manikins in a more understanding and empathetic fashion. In addition to achieving increased engagement with manikins, other advantages such as students reflecting on their own values and pre-conceived notions of people from diverse backgrounds were realized. Copyright © 2016 Elsevier Ltd. All rights reserved.

Family factors affect clinician attitudes in pediatric end-of-life decision making: a randomized vignette study.

PubMed

Ruppe, Michael D; Feudtner, Chris; Hexem, Kari R; Morrison, Wynne E

2013-05-01

Conflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children. We hypothesized that family factors might influence clinician decision making in these circumstances. We presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed. Three hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the "involved family" vignette were more likely to agree to continue medical care indefinitely (P<0.0005). Respondents were marginally more likely to pursue a court-appointed guardian for those patients whose families had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6-0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided "futile" care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7-1). In this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Attitudes and beliefs of the French public about schizophrenia and major depression: results from a vignette-based population survey

PubMed Central

2013-01-01

Background In their study ‘Mental Health in the General Population: Images and Realities’ Jean-Luc Roelandt et al. found a huge divide between the French public’s conceptualizations of insanity and depression. The study aims to examine whether such differences can be replicated using modern operationalized diagnostic criteria for schizophrenia and major depressive disorder. Methods In 2012, an online survey was conducted using a representative sample drawn from the adult French population (N = 1600). After presentation of a case-vignette depicting a person with either schizophrenia or major depressive disorder a fully structured interview was carried out. Results Despite some similarities marked differences between both disorders emerge regarding beliefs and attitudes. While respondents presented with the schizophrenia vignette more frequently defined symptoms as the expression of an illness with a stronger biological component and a less favorable prognosis, demanding psychiatric treatment, respondents presented with the depression vignette considered the occurrence of symptoms more frequently as the consequence of current psychosocial stress, benefitting not only from established but also from alternative treatments. People with schizophrenia were more frequently perceived as unpredictable and dangerous, there was a stronger need to separate one-self from them, they were more frequently met with fear and less frequently reacted to with pro-social feelings, and they also faced more rejection. Conclusions The French public draws a clear line between schizophrenia and major depressive disorder. This applies equally to beliefs about both disorders and to attitudes towards the persons afflicted. There is a need for interventions trying to reduce existing misconceptions in order to improve the care of patients. PMID:24252540

Establishing a composite endpoint for measuring the effectiveness of geriatric interventions based on older persons' and informal caregivers' preference weights: a vignette study.

PubMed

Hofman, Cynthia S; Makai, Peter; Boter, Han; Buurman, Bianca M; de Craen, Anton J M; Olde Rikkert, Marcel G M; Donders, Rogier A R T; Melis, René J F

2014-04-18

The Older Persons and Informal Caregivers Survey Minimal Dataset's (TOPICS-MDS) questionnaire which measures relevant outcomes for elderly people was successfully incorporated into over 60 research projects of the Dutch National Care for the Elderly Programme. A composite endpoint (CEP) for this instrument would be helpful to compare effectiveness of the various intervention projects. Therefore, our aim is to establish a CEP for the TOPICS-MDS questionnaire, based on the preferences of elderly persons and informal caregivers. A vignette study was conducted with 200 persons (124 elderly and 76 informal caregivers) as raters. The vignettes described eight TOPICS-MDS outcomes of older persons (morbidity, functional limitations, emotional well-being, pain experience, cognitive functioning, social functioning, self-perceived health and self-perceived quality of life) and the raters assessed the general well-being (GWB) of these vignette cases on a numeric rating scale (0-10). Mixed linear regression analyses were used to derive the preference weights of the TOPICS-MDS outcomes (dependent variable: GWB scores; fixed factors: the eight outcomes; unstandardized coefficients: preference weights). The mixed regression model that combined the eight outcomes showed that the weights varied from 0.01 for social functioning to 0.16 for self-perceived health. A model that included "informal caregiver" showed that the interactions between this variable and each of the eight outcomes were not significant (p > 0.05). A preference-weighted CEP for TOPICS-MDS questionnaire was established based on the preferences of older persons and informal caregivers. With this CEP optimal comparing the effectiveness of interventions in older persons can be realized.

Young Children’s Affective Responses to Another’s Distress: Dynamic and Physiological Features

PubMed Central

Fink, Elian; Heathers, James A. J.; de Rosnay, Marc

2015-01-01

Two descriptive studies set out a new approach for exploring the dynamic features of children’s affective responses (sadness and interest-worry) to another’s distress. In two samples (N study1 = 75; N study2 = 114), Kindergarten children were shown a video-vignette depicting another child in distress and the temporal pattern of spontaneous expressions were examined across the unfolding vignette. Results showed, in both study 1 and 2, that sadness and interest-worry had distinct patterns of elicitation across the events of the vignette narrative and there was little co-occurrence of these affects within a given child. Temporal heart rate changes (study 2) were closely aligned to the events of the vignette and, furthermore, affective responses corresponded to distinctive physiological response profiles. The implications of distinct temporal patterns of elicitation for the meaning of sadness and interest-worry are discussed within the framework of emotion regulation and empathy. PMID:25874952

Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.

PubMed

Tannenbaum, David; Doctor, Jason N; Persell, Stephen D; Friedberg, Mark W; Meeker, Daniella; Friesema, Elisha M; Goldstein, Noah J; Linder, Jeffrey A; Fox, Craig R

2015-03-01

Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse. The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. We surveyed 166 primary care providers in a research network of practices in the greater Chicago area, of whom 84 responded (51% response rate). Respondents and non-respondents were similar on all observable dimensions except that respondents were more likely to work in an academic setting. The questionnaire consisted of seven clinical vignettes. Each vignette described typical signs and symptoms for acute respiratory infections, and providers chose treatments from a menu of options. For each vignette, providers were randomly assigned to one of two menu partitions. For antibiotic-inappropriate vignettes, the treatment menu either listed over-the-counter (OTC) medications individually while grouping prescriptions together, or displayed the reverse partition. For antibiotic-appropriate vignettes, the treatment menu either listed narrow-spectrum antibiotics individually while grouping broad-spectrum antibiotics, or displayed the reverse partition. The main outcome was provider treatment choice. For antibiotic-inappropriate vignettes, we categorized responses as prescription drugs or OTC-only options. For antibiotic-appropriate vignettes, we categorized responses as broad- or narrow-spectrum antibiotics. Across vignettes, there was an 11.5 percentage point reduction in choosing aggressive treatment options (e.g., broad-spectrum antibiotics) when aggressive options were grouped compared to when those same options were listed individually (95% CI: 2.9 to 20.1%; p = .008). Provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise. The careful crafting of EHR order sets can serve as an important opportunity to improve patient care without constraining physicians' ability to prescribe what they believe is best for their patients.

The Life Design Group: A Case Study Vignette in Group Career Construction Counseling

ERIC Educational Resources Information Center

Barclay, Susan R.; Stoltz, Kevin B.

2016-01-01

Providing cost efficient, yet effective, student services, including career services, is a critical component in higher education. Career services must include the perspectives of the 21st-century work place. We advocate for the delivery of career development services in a group format using a narrative approach to career counseling with college…

Help-seeking beliefs for mental disorders among medical and nursing students.

PubMed

Picco, Louisa; Seow, Esmond; Chua, Boon Yiang; Mahendran, Rathi; Verma, Swapna; Xie, Huiting; Wang, Jia; Chong, Siow Ann; Subramaniam, Mythily

2018-05-09

The current study aimed to investigate beliefs about help-seeking, treatment options and expected outcomes for people with alcohol abuse, dementia, depression, obsessive-compulsive disorder and schizophrenia, using a vignette-based approach, among a sample of nursing and medical students. This was a cross-sectional online study among medical and nursing students (n = 1002) who were randomly assigned 1 of 5 vignettes. Questions were asked about whom could best help the person in the vignette, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. A total of 45.1% of students recommended seeing a psychiatrist, which was the most common source of help reported for all 5 vignettes. Help-seeking preferences were significantly associated with age, academic year and vignette type. Respondents rated seeing a psychiatrist as the most helpful intervention (92.4%) and dealing with the problem on their own as the most harmful (68.1%). Then, 81.5% of students indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. Medical and nursing students most commonly recommended seeking help from a psychiatrist for mental health-related problems, where help-seeking preferences were associated with various age, academic year and vignette type. As these students will be the future medical and nursing workforce, they need to be equipped with the skills and ability to recognize signs and symptoms of mental illness, to aid timely and appropriate treatment for people with mental illness. © 2018 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd.

Colombian Lay People's Willingness to Forgive Different Actors of the Armed Conflict: Results from a Pilot Study

ERIC Educational Resources Information Center

Lopez-Lopez, Wilson; Pineda Marin, Claudia; Murcia Leon, Maria Camila; Perilla Garzon, Diana Carolina; Mullet, Etienne

2012-01-01

A pilot study examined lay people's willingness to forgive acts that were committed by actors of the armed conflicts in Colombia. The participants (100 persons living in Bogota) were shown vignettes describing cases in which a member of the guerilla or a member of the former paramilitary forces asks for forgiveness to a victim's family, and were…

Are medical students assigning proper global assessment of functioning scores?

PubMed

Warsi, Mustafa K; Sattar, S Pirzada; Din, Amad U; Petty, Frederick; Padala, Prasad R

2007-01-01

This article seeks to determine whether medical students can estimate the appropriate score for the Global Assessment of Functioning (GAF) compared with psychiatry residents and staff psychiatrists. The authors hypothesized that medical students' estimations of GAF scores for patients in clinical vignettes would differ from those assessed by the psychiatry residents and staff psychiatrists. The authors designed a cross-sectional confidential survey of medical students, psychiatry residents, and staff psychiatrists. Consenting participants were asked to provide demographic information and then complete the accompanying questionnaire after reading two vignettes. One of the vignettes described a depressed patient and the other a psychotic patient. The subjects were asked to estimate the GAF scores for the patients in both vignettes. Then the subjects were given the GAF scoring guide to review and were asked to re-assess their initial GAF scores for the patients in the vignettes. Medical students assigned much higher GAF scores for the patient in the vignette with less severe symptoms than the psychiatry residents and staff psychiatrists. The GAF scores of all three groups for the patient in the vignette with more severe symptoms were comparable. The ability of medical students to assign proper GAF scores needs to be studied further. Our study suggests that current 1-month rotations in psychiatry, without specific training on assigning GAF scores, may not provide medical students with enough information to assess GAF scores accurately. This might need to be addressed in psychiatry clerkships.

Tangled Narratives and Wicked Problems: A Complex Case of Positioning and Politics in a Diverse School Community

ERIC Educational Resources Information Center

Nguyen, Thu Suong Thi; Scribner, Samantha M. Paredes; Crow, Gary M.

2012-01-01

The case of Allen Elementary School presents tangled narratives and wicked problems describing the multidimensionality of school community work. Using multiple converging and diverging vignettes, the case points to the distinctiveness of individual experience in schools; the ways institutionalized organizational narratives become cultural…

Psychotherapist Diagnosis of Premenstrual Syndrome.

ERIC Educational Resources Information Center

Atkinson, Donald R.; Kozitza, Linda Pepper

1988-01-01

Examined ability of 40 psychotherapists to diagnose premenstrual syndrome (PMS). Developed two case vignettes identical except for symptoms being cyclical in one and noncyclical in other. Psychotherapists made diagnosis and selected treatment. Most respondents could distinguish PMS from non-PMS case on cyclical versus noncyclical feature.…

Using Patient Case Video Vignettes to Improve Students' Understanding of Cross-cultural Communication.

PubMed

Arif, Sally; Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

2017-04-01

Objective. To develop, implement, and assess whether simulated patient case videos improve students' understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students' understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum.

Evaluation of a rule base for decision making in general practice.

PubMed Central

Essex, B; Healy, M

1994-01-01

BACKGROUND. Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM. A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD. The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS. Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION. The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice. PMID:8204334

Instructional Vignettes in Publication and Journalism Ethics in Radiology Research: Assessment via a Survey of Radiology Trainees.

PubMed

Rosenkrantz, Andrew B; Ginocchio, Luke A

2016-07-01

The aim of the present study was to assess the potential usefulness of written instructional vignettes relating to publication and journalism ethics in radiology via a survey of radiology trainees. A literature review was conducted to guide the development of vignettes, each describing a scenario relating to an ethical issue in research and publication, with subsequent commentary on the underlying ethical issue and potential approaches to its handling. Radiology trainees at a single institution were surveyed regarding the vignettes' perceived usefulness. A total of 21 vignettes were prepared, addressing institutional review board and human subjects protection, authorship issues, usage of previous work, manuscript review, and other miscellaneous topics. Of the solicited trainees, 24.7% (16/65) completed the survey. On average among the vignettes, 94.0% of the participants found the vignette helpful; 19.9 received prior formal instruction on the issue during medical training; 40.0% received prior informal guidance from a research mentor; and 42.0% indicated that the issue had arisen in their own or a peer's prior research experience. The most common previously experienced specific issue was authorship order (93.8%). Free-text responses were largely favorable regarding the value of the vignettes, although also indicated numerous challenges in properly handling the ethical issues: impact of hierarchy, pressure to publish, internal politics, reluctance to conduct sensitive conversations with colleagues, and variability in journal and professional society policies. Radiology trainees overall found the vignettes helpful, addressing commonly encountered topics for which formal and informal guidance were otherwise lacking. The vignettes are publicly available through the Association of University Radiologists (AUR) website and may foster greater insights by investigators into ethical aspects of the publication and journalism process, thus contributing to higher quality radiology research. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Anchoring Vignettes in the Health and Retirement Study: How Do Medical Professionals and Disability Recipients Characterize the Severity of Work Limitations?

PubMed Central

Heiland, Frank; Yin, Na

2015-01-01

Purpose Recent studies report systematic differences in how individuals categorize the severity of identical health and work limitation vignettes. We investigate how health professionals and disability recipients characterize the severity of work limitations and whether their reporting patterns are robust to demographic, education, and health characteristics. We use the results to illustrate the potential impact of reporting heterogeneity on the distribution of work disability estimated from self-reported categorical health and disability data. Method Nationally representative data on anchoring disability vignettes from the 2004 Health and Retirement Study (HRS) are used to investigate how respondents with an occupation background in health and Social Security disability beneficiaries categorize work limitation vignettes. Using pain, cardiovascular health, and depression vignettes, we estimate generalized ordered probit models (N = 2,660 individuals or 39,681 person-vignette observations) that allow the severity thresholds to vary by respondent characteristics. Results We find that health professionals (excluding nurses) and disability recipients tend to classify identical work limitations as more severe compared to non-health professional non-disabled respondents. For disability recipients, the differences are most pronounced and particularly visible in the tails of the work limitations distribution. For health professionals, we observe smaller differences, affecting primarily the classification of mildly and moderately severe work limitations. The patterns for health professionals (excluding nurses) are robust to demographics, education, and health conditions. The greater likelihood of viewing the vignette person as more severely work limited observed among disability recipients is mostly explained by the fact that these respondents also tend to be in poorer health which itself predicts a more inclusive scale. Conclusions Knowledge of reporting scales from health professionals and disabled individuals can benefit researchers in a broad range of applications in health and disability research. They may be useful as reference scales to evaluate disability survey data. Such knowledge may be beneficial when studying disability programs. Given the increasing availability of anchoring vignette data in surveys, this is a promising area for future evaluation research. PMID:25966316

Vignettes of Scholars: A Case Study of Black Male Students at a STEM Early College High School

ERIC Educational Resources Information Center

Adams, Tempestt Richardson

2016-01-01

Ensuring students graduate high school ready to enter college or the workforce has become a prime focus within secondary education. High school graduates are often ill-prepared for college-level work and often have to register for remedial courses before they can take standard college level courses (Southern Regional Education Board, 2010).…

An Investigation of Diagnostic Accuracy and Confidence Associated with Diagnostic Checklists as Well as Gender Biases in Relation to Mental Disorders.

PubMed

Cwik, Jan C; Papen, Fabienne; Lemke, Jan-Erik; Margraf, Jürgen

2016-01-01

This study examines the utility of checklists in attaining more accurate diagnoses in the context of diagnostic decision-making for mental disorders. The study also aimed to replicate results from a meta-analysis indicating that there is no association between patients' gender and misdiagnoses. To this end, 475 psychotherapists were asked to judge three case vignettes describing patients with Major Depressive Disorder (MDD), Generalized Anxiety Disorder, and Borderline Personality Disorder. Therapists were randomly assigned to experimental conditions in a 2 (diagnostic method: with using diagnostic checklists vs. without using diagnostic checklists) × 2 (gender: male vs. female case vignettes) between-subjects design. Multinomial logistic and linear regression analyses were used to examine the association between the usage of diagnostic checklists as well as patients' gender and diagnostic decisions. The results showed that when checklists were used, fewer incorrect co-morbid diagnoses were made, but clinicians were less likely to diagnose MDD even when the criteria were met. Additionally, checklists improved therapists' confidence with diagnostic decisions, but were not associated with estimations of patients' characteristics. As expected, there were no significant associations between gender and diagnostic decisions.

Rosenhan revisited: the scientific credibility of Lauren Slater's pseudopatient diagnosis study.

PubMed

Spitzer, Robert L; Lilienfeld, Scott O; Miller, Michael B

2005-11-01

In a recent and widely publicized book, psychologist Lauren Slater reported an attempt to test David Rosenhan's hypothesis that psychiatric diagnoses are influenced primarily by situational context rather than by patients' signs and symptoms. Slater presented herself to nine psychiatric emergency rooms with the lone complaint of an isolated auditory hallucination (hearing the word "thud"). In almost all cases, she reported receiving the diagnosis of psychotic depression and prescriptions for antidepressants and antipsychotics. Slater concluded that psychiatric diagnoses are largely arbitrary and driven by a "zeal to prescribe." Our goal was to examine the scientific credibility of Slater's findings using a vignette methodology. We presented a sample of emergency room psychiatrists (N = 74) with a detailed case vignette derived from the clinical description in Slater's book, and asked them a series of questions regarding diagnosis and treatment recommendations. In sharp contrast to what Slater reported, we found that only three psychiatrists offered a diagnosis of psychotic depression. Moreover, only one third recommended medication. Our study raises questions regarding Slater's results and conclusions, and provides scant support for the claim that psychiatric diagnoses are mostly products of fashion or fad, as claimed by Slater.

Observer perceptions of pain in children with cognitive impairments: vignette development and validation.

PubMed

Genik, Lara M; McMurtry, C Meghan; Breau, Lynn M

2015-01-01

Develop vignettes depicting different pain types in verbal and nonverbal children with cognitive impairments that could help examine pain assessment and management decisions of secondary caregivers, and conduct initial convergent and divergent validity analyses. For six vignettes, 76 undergraduate students (38 females, mean age = 19.55) rated (0-10): pain intensity, difficulty rating pain intensity, need for medical attention and need for other attention (e.g., physical comfort). Ratings significantly varied by pain source (e.g., headache was rated more painful than injections). Verbal ability did not impact ratings. Vignettes could serve as an alternative method to study pain decisions by caregivers of children with cognitive impairments when ethical barriers limit more naturalistic research.

An experimental study exploring the impact of vignette gender on the quality of university students' mental health first aid for peers with symptoms of depression.

PubMed

Davies, E Bethan; Wardlaw, John; Morriss, Richard; Glazebrook, Cris

2016-02-25

University students have high rates of depression, and friends are often the most commonly-used source of support for emotional distress in this population. This study aimed to explore students' ability to provide effective support for their peers with depressive symptoms and the factors influencing the quality of their mental health first aid (MHFA) skills, including students' gender, course of study, and gender of student experiencing depression. Via an online survey, students at two British universities (N = 483) were quasi-randomly allocated to view a video vignette of either a male or female student depicting symptoms of depression. An open-ended question probed MHFA actions they would take to help the vignette character, which were rated using a standardised scoring scheme based on MHFA guidelines. Students reported low MHFA scores (mean 2.89, out of possible 12). The most commonly reported action was provision of support and information, but only eight (1.6%) students stated an intention to assess risk of harm. Those studying clinically non-relevant degrees with limited mental health content reported poorer MHFA (p = <0.001) and were less confident about their ability to support a friend with depression (p = 0.04). There was no main effect of vignette gender, but within the group of students on non-relevant courses the male vignette received significantly poorer MHFA than the female vignette (p = 0.02). A significant three-way interaction found that male participants studying non-relevant degrees who viewed a male vignette had poorer MHFA compared to females studying non-relevant degrees who viewed the female vignette (p = 0.005). Most students lack the necessary MHFA skills to support friends suffering from symptoms of depression, or to help them get appropriate support and prevent risk of harm. Students on courses which do not include mental health related content are particularly ill-equipped to support male students, with male students receiving the poorest quality MHFA from fellow male students on these courses. MHFA training has the potential to improve outcomes for students with depression, and could have a valuable role in reducing the excess risk of harm seen in male students.

Decision rules for GHB (γ-hydroxybutyric acid) detoxification: a vignette study.

PubMed

Kamal, Rama M; van Iwaarden, Sjacco; Dijkstra, Boukje A G; de Jong, Cornelis A J

2014-02-01

GHB dependent patients can suffer from a severe and sometimes life-threatening withdrawal syndrome. Therefore, most of the patients are treated within inpatient settings. However, some prefers an outpatient approach to treatment. The aim of this study was to develop decision rules for addiction physicians to determine whether an outpatient or inpatient setting should be chosen for a safe GHB detoxification. A prospective vignette study was performed. Forty addiction medicine specialists from various treatment settings and residents of the Addiction Medicine postgraduate Master training were asked to contribute vignettes of GHB dependent patients. A focus group of 15 psychiatrists and addiction medicine specialists was asked to recommend an outpatient or inpatient setting for GHB detoxification treatment per vignette. Finally, five addiction medicine specialists, experts in GHB dependence treatment in the Netherlands, assessed the bio-psychosocial reasons for the choices of the focus group and formulated the recommended criteria. Based on the bio-psychosocial state of twenty vignette patients, addiction physicians and psychiatrists established the criteria and conditions recommended for the indication of an outpatient GHB detoxification. Intensity of addiction (GHB dose ≤32 g/d and frequency of abuse ≤2 h) was stated as the primary criterion in determining the setting as well as the complexity of the psychiatric comorbid disorders. The importance of a stable support system was emphasised. The vignette study resulted in a set of criteria with which addiction medicine specialists can make a weighted decision as to an outpatient or inpatient setting for GHB detoxification. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Genetic Literacy and Patient Perceptions of IBD Testing Utility and Disease Control: A Randomized Vignette Study of Genetic Testing

PubMed Central

Hooker, Gillian W.; Peay, Holly; Erby, Lori; Bayless, Theodore; Biesecker, Barbara B.; Roter, Debra L.

2014-01-01

Background Findings from inflammatory bowel disease (IBD) genome-wide association studies are being translated clinically into prognostic and diagnostic indicators of disease. Yet, patient perception and understanding of these tests and their applicability to providing risk information is unclear. The goal of this study was to determine, using hypothetical scenarios, whether patients with IBD perceive genetic testing to be useful for risk assessment, whether genetic test results impact perceived control, and whether low genetic literacy may be a barrier to patient understanding of these tests. Methods Two hundred fifty seven patients with IBD from the Johns Hopkins gastroenterology clinics were randomized to receive a vignette depicting either a genetic testing scenario or a standard blood testing scenario. Participants were asked questions about the vignette and responses were compared between groups. Results Perceptions of test utility for risk assessment were higher among participants responding to the genetic vignette (P < 0.001). There were no significant differences in perceptions of control over IBD after hypothetical testing between vignettes (P = 0.24). Participant responses were modified by genetic literacy, measured using a scale developed for this study. Participants randomized to the genetic vignette who scored higher on the genetic literacy scale perceived greater utility of testing for risk assessment (P = 0.008) and more control after testing (P = 0.02). Conclusions Patients with IBD perceive utility in genetic testing for providing information relevant to family members, and this appreciation is promoted by genetic literacy. Low genetic literacy among patients poses a potential threat to effective translation of genetic and genomic tests. PMID:24691112

Analogue patients' self-reported engagement and psychophysiological arousal in a video-vignettes design: Patients versus disease-naïve individuals.

PubMed

Visser, Leonie N C; Tollenaar, Marieke S; Bosch, Jos A; van Doornen, Lorenz J P; de Haes, Hanneke C J M; Smets, Ellen M A

2016-10-01

The ecological validity of video-vignettes design investigating patient-provider communication hinges on the engagement of analogue patients (APs) with the vignette. The present study aimed to compare engagement in two commonly utilized groups of APs, patients and disease-naïve individuals. Engagement was assessed by self-report and in the form of physiological arousal. Cancer patients (N=22) and disease-naïve individuals (N=24) were recruited as APs. APs completed the Video Engagement Scale after watching a vignette of a oncologic bad news consultation. Electrodermal and cardiovascular activity were assessed continuously during watching the vignette, and cortisol levels were assessed in four saliva samples. Patients reported higher engagement with the vignette than disease-naïve individuals (t=2.46, p<0.05) and showed a larger blood pressure response (systolic: F=5.87, p<0.01 and diastolic: F=4.00, p<0.05). However, these differences disappeared after adjusting for age. No group differences were found on other psychophysiological parameters. Our results suggest that patients and disease-naïve individuals are equally engaged when viewing video vignettes. When group differences were found, older age turned out to be a more prominent predictor of engagement. Researchers may consider other arguments besides APs' disease history when selecting an AP group. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Staff's reactions towards partnered sexual expressions involving people with dementia living in long-term care facilities.

PubMed

Villar, Feliciano; Celdrán, Montserrat; Serrat, Rodrigo; Fabà, Josep; Martínez, Teresa

2018-05-01

To explore staff responses, in terms of common practices, towards partnered sexual relationships in long-term care facilities where one or both people involved have dementia. It also tries to determine personal and institutional factors influencing these responses. Although some studies, mostly qualitative, have focused on reactions to residents' sexual expressions so far the issue has not been assessed in a study using large and diverse samples. Cross-sectional quantitative study using vignette technique. Participants were 2,295 staff members at 152 Spanish long-term care facilities. Data were collected during 2016. A vignette describing sexual situations involving people with dementia was presented to participants. After the vignette, participants had to answer the question: "What do you think most of your colleagues would do in this situation?" with nine possible responses. Results showed that relationships involving persons with dementia were perceived as potentially problematic by staff. In both conditions, discussing the case with a colleague or supervisor was the most frequently chosen reaction. More restrictive reactions were mentioned when only one person with dementia was involved in the relationship. Factors such as participants" age and years of experience, professional post and commitment to person-centred care practices were related with the frequency of common restriction practices. Results highlight the importance of providing staff with clear guidelines regarding the management of specific sexual situations to avoid stereotyped restrictive reactions. © 2017 John Wiley & Sons Ltd.

Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

PubMed

Bellanger, Martine M; Quentin, Wilm; Tan, Siok Swan

2013-05-01

The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. National or regional databases were used to identify childbirth cases. DRG grouping algorithms and indicators of resource consumption were compared for those DRGs which account for at least 1% of all childbirth cases in the respective database. Five standardized case vignettes were defined and quasi prices (i.e. administrative prices or tariffs) of hospital deliveries according to national DRG-based hospital payment systems were ascertained. European DRG systems classify childbirth cases according to different sets of variables (between one and eight variables) into diverging numbers of DRGs (between three and eight DRGs). The most complex DRG is valued 3.5 times more resource intensive than an index case in Ireland but only 1.1 times more resource intensive than an index case in The Netherlands. Comparisons of quasi prices for the vignettes show that hypothetical payments for the most complex case amount to only € 479 in Poland but to € 5532 in Ireland. Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Schema Effects of Rape Myth Acceptance on Judgments of Guilt and Blame in Rape Cases: The Role of Perceived Entitlement to Judge

ERIC Educational Resources Information Center

Eyssel, Friederike; Bohner, Gerd

2011-01-01

Two experiments (N = 330) examined conditions that facilitate biasing effects of rape myth acceptance (RMA) on judgments of blame in rape cases. In both experiments, participants read a short vignette depicting a rape case. In Experiment 1, the amount of case-irrelevant information about defendant and plaintiff was varied. As predicted, high-RMA…

Interactive or static reports to guide clinical interpretation of cancer genomics.

PubMed

Gray, Stacy W; Gagan, Jeffrey; Cerami, Ethan; Cronin, Angel M; Uno, Hajime; Oliver, Nelly; Lowenstein, Carol; Lederman, Ruth; Revette, Anna; Suarez, Aaron; Lee, Charlotte; Bryan, Jordan; Sholl, Lynette; Van Allen, Eliezer M

2018-05-01

Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation. We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians' genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0-18 and 1-4, respectively, higher score corresponding with improved endpoints). One hundred and five physicians at a tertiary cancer center participated (29% participation rate): 67% medical, 20% pediatric, 7% radiation, and 7% surgical oncology; 37% female. Prior to viewing the case-based vignettes, 34% of the physicians reported difficulty making treatment recommendations based on the standard static report. After vignette/report exposure, physicians' overall comprehension scores did not differ by report type (mean score: interactive 11.6 vs static 10.5, difference = 1.1, 95% CI, -0.3, 2.5, P = .13). However, physicians exposed to the interactive report were more likely to correctly assess sequencing quality (P < .001) and understand when reports needed to be interpreted with caution (eg, low tumor purity; P = .02). Overall satisfaction scores were higher in the interactive group (mean score 2.5 vs 2.1, difference = 0.4, 95% CI, 0.2-0.7, P = .001). Interactive genomic reports may improve physicians' ability to accurately assess genomic data and increase report-related satisfaction. Additional research in users' genomic needs and efforts to integrate interactive reports into electronic health records may facilitate the implementation of precision oncology.

Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

PubMed Central

2014-01-01

Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past experience of the construction of DRG systems for CABG patients demonstrates the variety of options available. It also highlights the importance of updating systems as frequently as possible, to incentivise best practice. PMID:24949279

Evaluating the construct of triage acuity against a set of reference vignettes developed via modified Delphi method.

PubMed

Twomey, Michèle; Wallis, Lee A; Myers, Jonathan E

2014-07-01

To evaluate the construct of triage acuity as measured by the South African Triage Scale (SATS) against a set of reference vignettes. A modified Delphi method was used to develop a set of reference vignettes. Delphi participants completed a 2-round consensus-building process, and independently assigned triage acuity ratings to 100 written vignettes unaware of the ratings given by others. Triage acuity ratings were summarised for all vignettes, and only those that reached 80% consensus during round 2 were included in the reference set. Triage ratings for the reference vignettes given by two independent experts using the SATS were compared with the ratings given by the international Delphi panel. Measures of sensitivity, specificity, associated percentages for over-triage/under-triage were used to evaluate the construct of triage acuity (as measured by the SATS) by examining the association between the ratings by the two experts and the international panel. On completion of the Delphi process, 42 of the 100 vignettes reached 80% consensus on their acuity rating and made up the reference set. On average, over all acuity levels, sensitivity was 74% (CI 64% to 82%), specificity 92% (CI 87% to 94%), under-triage occurred 14% (CI 8% to 23%) and over-triage 12% (CI 8% to 23%) of the time. The results of this study provide an alternative to evaluating triage scales against the construct of acuity as measured with the SATS. This method of using 80% consensus vignettes may, however, systematically bias the validity estimate towards better performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Genital Responses to Rape Vignettes Among Young Men: The Influence of Mood and Directed Attention.

PubMed

Lalumière, Martin L; Fairweather, Annabree; Harris, Grant T; Suschinsky, Kelly D; Seto, Michael C

2017-04-01

Although it is clear that men with a history of sexual assaults against women produce higher relative genital responses to rape vignettes in the laboratory than do men without such a history, it remains unclear what aspects of the vignettes are eliciting these responses, and whether the genital responses are affected by situational factors. The antisocial tendencies hypothesis states that many men are inhibited by cues of violence, suffering, and coercion in rape vignettes, but other men, particularly antisocial and sexually aggressive men, are not so inhibited. In this study, we investigated whether the hypothesized inhibition to rape vignettes among nonoffenders could be affected by manipulation of mood and directed attention. A total of 48 young men were exposed to audio-recorded vignettes describing mutually consenting and nonviolent sexual interactions, mutually consenting and violent sexual interactions, nonconsenting and violent sexual interactions, and nonsexual and nonviolent social interactions (within-subjects). Participants were randomly assigned to a mood manipulation designed to induce a happy, neutral, or sad mood (between-subjects). All were asked to pay attention to either sex words or violent words while listening to the vignettes (within-subjects). As is typically observed, genital responses were lower (inhibited) when vignettes included cues of violence or nonconsent. Both happy and sad mood inductions reduced this inhibition, so that men induced into a happy or sad mood showed greater relative responding to cues of violence or nonconsent compared with men in a neutral mood. The attention manipulation had no significant effect. Results suggest that genital responses to rape cues can be situationally influenced, but not necessarily as predicted by the antisocial tendencies hypothesis.

Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India.

PubMed

Atre, Sachin R; Kudale, Abhay M; Morankar, Sudhakar N; Rangan, Sheela G; Weiss, Mitchell G

2004-11-01

Gender-specific patterns of experience, meaning, and behaviour for tuberculosis (TB) require consideration to guide control programmes. To clarify concepts of gender, culture, and TB in a rural endemic population of Maharashtra, India, this study of 80 men and 80 women employed qualitative and quantitative methods of cultural epidemiology, using a locally adapted semi-structured Explanatory Model Interview Catalogue (EMIC) interviews are instruments for cultural epidemiological study of the distribution of illness-related experiences, meanings, and behaviours. This interview queried respondents without active disease about vignettes depicting a man and woman with typical features of TB. Emotional and social symptoms were frequently reported for both vignettes, but more often considered most distressing for the female vignette; specified problems included arranging marriages, social isolation, and inability to care for children and family. Job loss and reduced income were regarded most troubling for the male vignette. Men and women typically identified sexual experience as the cause of TB for opposite-sex vignettes. With wider access to information about TB, male respondents more frequently recommended allopathic doctors and specialty services. Discussion considers the practical significance of gender-specific cultural concepts of TB.

Sarah's birth. How the medicalisation of childbirth may be shaped in different settings: Vignette from a study of routine intervention in Jeddah, Saudi Arabia.

PubMed

Scamell, Mandie; Altaweli, Roa; McCourt, Christine

2017-02-01

The expansion of the medicalisation of childbirth has been described in the literature as being a global phenomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum. To illuminate the ways in which the medicalisation of birth may be understood and practised in different cultural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia. Ethnographic data collection methods, including participant observation and interviews. The data presented in this paper are drawn from ethnographic field notes collected during field work in Saudi Arabia, and informed by analysis of a wider set of field notes and interviews with professionals working in this context. While the medicalisation of care is a universal phenomenon, the ways in which the care of women is managed using routine medical intervention are framed by the local cultural context in which these practices take place. The ethnographic data presented in this paper shows the medicalisation of birth thesis to be incomplete. The evidence presented in this paper illustrates how local belief systems are not so much subsumed by the expansion of the bio-medical model of childbirth, rather they may actively facilitate a process of localised reinterpretation of such universalised and standardised practices. In this case, aspects of the social and cultural context of Jeddah operates to intensify the biomedical model at the expense of respectful maternity care. In this article, field note data on the birth of one Saudi Arabian woman is used as an illustration of how the medicalisation of childbirth has been appropriated and reinterpreted in Jeddah, Saudi Arabia. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The Quality of Psychotherapy Case Formulations: A Comparison of Expert, Experienced, and Novice Cognitive-Behavioral and Psychodynamic Therapists

ERIC Educational Resources Information Center

Eells, Tracy D.; Lombart, Kenneth G.; Kendjelic, Edward M.; Turner, L. Carolyn; Lucas, Cynthia P.

2005-01-01

Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided "think aloud" case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple…

[A case report on mobbing in a school child].

PubMed

Holtz, S

2012-08-01

Forty percent of the work of a paediatrician in private practice consists of counselling parents and children. There is a danger that behavioural symptoms are not taken seriously and brushed away with simple advices. This case vignette demonstrates that difficult and complex symptoms can be solved by using a concept-oriented approach.

Using Patient Case Video Vignettes to Improve Students’ Understanding of Cross-cultural Communication

PubMed Central

Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

2017-01-01

Objective. To develop, implement, and assess whether simulated patient case videos improve students’ understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students’ understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum. PMID:28496276

Influences on the perception of elder financial abuse among older adults in Southern California.

PubMed

Knight, Bob G; Kim, Seungyoun; Rastegar, Sarah; Jones, Scott; Jump, Victoria; Wong, Serena

2016-01-01

Under-reporting of elder financial abuse is partly due to failure of those around the victim to perceive the financial mistreatment as abuse. This study explored the effect of victim and perceiver factors on perception of elder financial abuse in the context of Routine Activity Theory (RAT). 488 older adults in Ventura County (CA) were surveyed about financial abuse using vignette method. In the study's Vignette 1, the amount of money taken, the type of frailty, and the relationship of perpetrator and victim were manipulated. In Vignette 2, the victim's age and relationship of perpetrator and victim were manipulated. Respondents' demographics (age, gender, education, and ethnicity) were collected. Logistic regression analyses revealed that children of the victim were least likely to be seen as committing abuse in both vignettes. In Vignette 1, there was an interaction of gender of respondent and the amount of money taken. In Vignette 2, non-Whites were less likely to perceive the signing over of the house as financial abuse. Respondents endorsed the concept of a special court with expertize in elder abuse as a way to increase the likelihood that they would report. Even though most financial abuse is perpetrated by family members, older adults are less likely to perceive a financial situation as abuse when it involves a child of the victim, thus making reporting and prevention less likely. The support for a specialty Elder Abuse Court (EAC) suggests that some reluctance to report is based on misgivings about punishing the perpetrator.

Slipping Anchor? Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity

ERIC Educational Resources Information Center

d'Uva, Teresa Bago; Lindeboom, Maarten; O'Donnell, Owen; van Doorslaer, Eddy

2011-01-01

We propose tests of the two assumptions under which anchoring vignettes identify heterogeneity in reporting of categorical evaluations. Systematic variation in the perceived difference between any two vignette states is sufficient to reject "vignette equivalence." "Response consistency"--the respondent uses the same response…

Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

PubMed

Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

2013-01-01

We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

PubMed Central

Pluye, Pierre; Grad, Roland M.; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

2013-01-01

PURPOSE We wanted to describe family physicians’ use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008–2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported. PMID:24218380

The Genomic Revolution and Beliefs about Essential Racial Differences: A Backdoor to Eugenics?

PubMed Central

Phelan, Jo C.; Link, Bruce G.; Feldman, Naumi M.

2014-01-01

Could the explosion of genetic research in recent decades affect our conceptions of race? In Backdoor to Eugenics, Duster argues that reports of specific racial differences in genetic bases of disease, in part because they are presented as objective facts whose social implications are not readily apparent, may heighten public belief in more pervasive racial differences. We tested this hypothesis with a multi-method study. A content analysis showed that news articles discussing racial differences in genetic bases of disease increased significantly between 1985 and 2008 and were significantly less likely than non–health-related articles about race and genetics to discuss social implications. A survey experiment conducted with a nationally representative sample of 559 adults found that a news-story vignette reporting a specific racial difference in genetic risk for heart attacks (the Backdoor Vignette) produced significantly greater belief in essential racial differences than did a vignette portraying race as a social construction or a no-vignette condition. The Backdoor Vignette produced beliefs in essential racial differences that were virtually identical to those produced by a vignette portraying race as a genetic reality. These results suggest that an unintended consequence of the genomic revolution may be the reinvigoration of age-old beliefs in essential racial differences. PMID:24855321

Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries.

PubMed

Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

2013-07-01

As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement.

Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries

PubMed Central

Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

2013-01-01

Aims As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. Methods and results National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Conclusions Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement. PMID:23364755

The Use of Music Therapy During the Treatment of Cancer Patients: A Collection of Evidence

PubMed Central

Boyde, Constance; Linden, Ulrike; Boehm, Katja

2012-01-01

Background: Music therapy is one of the oldest forms of creative art therapy and has been shown to have effects in different clinical and therapeutic settings, such as schizophrenia, pain, cardiovascular parameters, and dementia. This article provides an overview of some of the recent findings in this field and also reports two single case vignettes that offer insight into day-to-day applications of clinical music therapy. Material and Methods: For the collection of clinical studies of music therapy in oncology, the databases AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX were searched with the terms “Study OR Trial” AND “Music Therapy” AND “Cancer OR Oncolog$.” Studies were analyzed with respect to their design, setting and interventions, indications, patients, and outcomes. In addition, two case vignettes present the application of music therapy for a child with leukemia and an adult patient with breast cancer. Results: We found a total of 12 clinical studies conducted between 2001 and 2011 comprised of a total of 922 patients. Eight studies had a randomized controlled design, and four studies were conducted in the field of pediatric oncology. Studies reported heterogeneous results on short-term improvements in patients' mood and relaxation and reduced exhaustion and anxiety as well as in coping with the disease and cancer-related pain. Case descriptions showed similar effects in expressing emotions, opening up new goals, and turning the mind toward a healthy process and away form a disease-centered focus. Conclusion: The use of music therapy in the integrative treatment of cancer patients is a therapeutic option whose salutogenetic potential is shown in many case studies such as those presented here. Study results, however, did not draw a conclusive picture of the overall effect of music therapy. In addition to further clinical trials, the evidence mosaic should be complemented with qualitative studies, single case descriptions, and basic research. PMID:27257528

Clinical Vignettes Improve Performance in Anatomy Practical Assessment

ERIC Educational Resources Information Center

Ikah, December S. K.; Finn, Gabrielle M.; Swamy, Meenakshi; White, Pamela M.; McLachlan, John C.

2015-01-01

Although medical curricula now adopt an integrated teaching approach, this is not adequately reflected in assessment of anatomy knowledge and skills. In this study, we aimed to explore the impact of the addition of clinical vignette to item stems on students' performance in anatomy practical examinations. In this study, 129 undergraduate medical…

Using a Qualitative Vignette to Explore a Complex Public Health Issue.

PubMed

Jackson, Michaela; Harrison, Paul; Swinburn, Boyd; Lawrence, Mark

2015-10-01

This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique. © The Author(s) 2015.

Framing effect debiasing in medical decision making.

PubMed

Almashat, Sammy; Ayotte, Brian; Edelstein, Barry; Margrett, Jennifer

2008-04-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts. The present study investigated the effects of a debiasing procedure designed to prevent the framing effect for young adults who made decisions based on hypothetical medical decision-making vignettes. The debiasing technique involved participants listing advantages and disadvantages of each treatment prior to making a choice. One hundred and two undergraduate students read a set of three medical treatment vignettes that presented information in terms of different outcome probabilities under either debiasing or control conditions. The framing effect was demonstrated by the control group in two of the three vignettes. The debiasing group successfully avoided the framing effect for both of these vignettes. These results further support previous findings of the framing effect as well as an effective debiasing technique. This study improved upon previous framing debiasing studies by including a control group and personal medical scenarios, as well as demonstrating debiasing in a framing condition in which the framing effect was demonstrated without a debiasing procedure. The findings suggest a relatively simple manipulation may circumvent the use of decision-making heuristics in patients.

Case, Teacher and School Characteristics Influencing Teachers' Detection and Reporting of Child Physical Abuse and Neglect: Results from an Australian Survey

ERIC Educational Resources Information Center

Walsh, Kerryann; Bridgstock, Ruth; Farrell, Ann; Rassafiani, Mehdi; Schweitzer, Robert

2008-01-01

Objective: To identify the influence of multiple case, teacher and school characteristics on Australian primary school teachers' propensity to detect and report child physical abuse and neglect using vignettes as short hypothetical cases. Methods: A sample of 254 teachers completed a self-report questionnaire. They responded to a series of 32…

A Collection of JPME Operational Contract Support Case Studies and Vignettes

DTIC Science & Technology

2016-12-01

Contracting for goods and services in the contingency operational environment is a mission-enabling necessity; however, analyzing the strategic effects...choosing to contract for goods or services are largely ignored. This project explores the use of OCS in contingency environments, and the positive and...think of the costs literally, as tax dollars spent to enhance mission effectiveness. However, the less literal costs and the associated effects of

Understanding Attribution of Blame in Cases of Rape: An Analysis of Participant Gender, Type of Rape and Perceived Similarity to the Victim

ERIC Educational Resources Information Center

Grubb, Amy Rose; Harrower, Julie

2009-01-01

This study examined a variety of factors that may influence attributions towards rape victims. A total of 156 participants completed a questionnaire, which included a measure of attitudes towards rape victims and a vignette depicting one of three rape scenarios (a stranger rape, date rape and seduction rape). Participants rated the extent to which…

An assessment of the shared-decision model in parents of children with acute otitis media.

PubMed

Merenstein, Dan; Diener-West, Marie; Krist, Alex; Pinneger, Matthew; Cooper, Lisa A

2005-12-01

Medicine is shifting from a doctor-centered approach to a model entailing more shared decision-making. Many organizations now recommend a shared-decision approach to treating children with acute otitis media (AOM). Our primary objectives in this study were to assess (1) which style of decision-making on the physician's part would most effectively reduce parents' proclivity to use antibiotics for treatment of their child's AOM and (2) parental satisfaction with different doctor-patient decision-making styles. We conducted a cross-sectional survey to examine how parents respond to doctor-patient communication styles in 3 clinical vignettes that presented 2 versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were randomly assigned to receive 1 of 3 vignettes. The main predictor variable was the vignette assignment, and the main outcomes were (1) parent proclivity to use antibiotics and (2) parent ratings of care by the physician in the vignette. Using logistic regression, we adjusted for caregivers' age, gender, income, knowledge of antibiotics, decision-making preference, confidence in physician, and length of relationship with personal physician. Four hundred sixty-six parents met inclusion criteria, with a response rate of 94%. General characteristics were similar across vignette assignment groups. Parents who received the paternalistic-model vignettes were more likely to say that they would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9; 95% confidence interval: 2.3-10.6). This result remained statistically significant after adjustment for potential confounders. In addition, parents in the shared-decision groups were more satisfied (93% and 84%) than those in the paternalistic-model group (76%). To our knowledge, this is the first study to examine parent interest, acceptance, and satisfaction with the SDM. Our findings suggest that shared decision-making for AOM may lead to less antibiotic usage and higher levels of parental satisfaction. Although more studies are needed to examine how best to incorporate parents in the SDM, our study serves as an example of the potential benefit of this approach in pediatric medicine.

Using vignettes to explore work-based learning: Part 1.

PubMed

Wareing, Mark

This is the first of two articles exploring the use of vignettes as an alternative method of presenting the data arising from interviews. The interviews were carried out as part of research into work-based learning: both articles are based on findings from a hermeneutic phenomenological study into the lived experience of foundation degree mentors and their students-healthcare assistants undertaking a foundation degree in health and social care in order to become assistant practitioners. Part 1 presents a vignette of a notional workplace mentor (Staff Nurse Sophie) that describes her lived experience supporting two equally notional foundation degree students. Sophie's perspective will be a distillation of data arising from interviews with eight workplace mentors, all employed on acute wards within a large NHS hospital trust. The vignette attempts to demonstrate the role of the workplace mentor in the support of work-based learning, and the interprofessional factors that determine the landscape of workplace learning for foundation degree students. The potential of a vignette to assist in a deeper hermeneutic understanding of meanings arising from data will be explored, and the limitations of the approach considered.

Portraying mental illness and drug addiction as treatable health conditions: effects of a randomized experiment on stigma and discrimination.

PubMed

McGinty, Emma E; Goldman, Howard H; Pescosolido, Bernice; Barry, Colleen L

2015-02-01

Despite significant advances in treatment, stigma and discrimination toward persons with mental illness and drug addiction have remained constant in past decades. Prior work suggests that portraying other stigmatized health conditions (i.e., HIV/AIDS) as treatable can improve public attitudes toward those affected. Our study compared the effects of vignettes portraying persons with untreated and symptomatic versus successfully treated and asymptomatic mental illness and drug addiction on several dimensions of public attitudes about these conditions. We conducted a survey-embedded randomized experiment using a national sample (N = 3940) from an online panel. Respondents were randomly assigned to read one of ten vignettes. Vignette one was a control vignette, vignettes 2-5 portrayed individuals with untreated schizophrenia, depression, prescription pain medication addiction and heroin addiction, and vignettes 6-10 portrayed successfully treated individuals with the same conditions. After reading the randomly assigned vignette, respondents answered questions about their attitudes related to mental illness or drug addiction. Portrayals of untreated and symptomatic schizophrenia, depression, and heroin addiction heightened negative public attitudes toward persons with mental illness and drug addiction. In contrast, portrayals of successfully treated schizophrenia, prescription painkiller addiction, and heroin addiction led to less desire for social distance, greater belief in the effectiveness of treatment, and less willingness to discriminate against persons with these conditions. Portrayal of persons with successfully treated mental illness and drug addiction is a promising strategy for reducing stigma and discrimination toward persons with these conditions and improving public perceptions of treatment effectiveness. Copyright © 2014 Elsevier Ltd. All rights reserved.

Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

PubMed

Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

2017-06-22

The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta-algorithm illustrates a superordinate process that permanently keeps the entire patient in view. The meta-algorithm represents the back bone of the multimorbidity guideline of the German College of General Practitioners and Family Physicians. This article presents solely the development phase; the meta-algorithm needs to be piloted before it can be implemented. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Spontaneous labelling and stigma associated with clinical characteristics of peers 'at-risk' for psychosis.

PubMed

Anglin, Deidre M; Greenspoon, Michelle I; Lighty, Quenesha; Corcoran, Cheryl M; Yang, Lawrence H

2014-08-01

The public health benefits of utilizing an 'at-risk for psychosis' designation are tempered by concerns about stigma. It is therefore of interest to examine whether symptoms associated with this designation might spontaneously induce labels associated with a psychotic disorder, other non-psychotic disorders or non-psychiatric labels. This pilot study explored the labels associated with characteristics of 'high risk for psychosis' and the corresponding stigma level. A vignette describing an identical character, followed by a series of questions about stigmatizing attitudes towards the vignette character, was administered in the present investigation. The results indicated that even though most young people (59%) did not spontaneously label the vignette character with psychotic-like diagnostic labels, the single most frequent label provided was 'paranoid/a'. When such labelling, that is, strongly tied to psychosis, occurred, respondents exhibited stronger stigmatizing attributions of fear compared to those indicating non-psychiatric labels (e.g. 'weird'). These results suggest that the majority of respondents did not endorse diagnostic labels spontaneously, thus signaling that stigma in the majority of cases would not naturalistically be elicited. However, a segment of respondents evidenced stigma simply from behavioural changes manifested by individuals exhibiting signs of psychosis, independent of diagnosis. Implications for reducing any stigma associated with an 'at-risk for psychosis' designation are discussed. © 2013 Wiley Publishing Asia Pty Ltd.

Clinical management of musculoskeletal injuries in active children and youth.

PubMed

Mazer, Barbara; Shrier, Ian; Feldman, Debbie Ehrmann; Swaine, Bonnie; Majnemer, Annette; Kennedy, Eileen; Chilingaryan, Gevorg

2010-07-01

To describe how different health care specialists manage musculoskeletal injury in children and examine factors influencing return to play decisions. National survey. Secure Web site hosting online questionnaire. Medical doctors, physical therapists, and athletic therapists who were members of their respective sport medicine specialty organizations. Professional affiliation and the effect of the following factors were examined: pushy parent, cautious parent, protective equipment, previous injury, musculoskeletal maturity, game importance, position played, team versus individual sport, and time since injury. Recommendation of return to activity after common injuries seen in children and adolescents as described in 5 vignettes; consistency of responses across vignettes. The survey was completed by 464 respondents (34%). There were several differences between the professional groups in their recommendations to return to activity. Most factors studied did not tend to influence the decision to return to activity, although protective equipment often increased the response to return sooner. The number of participants who would return a child to activity sooner or later for each factor varied greatly across the 5 vignettes, except for pushy parent or cautious parent. Management practices of sport medicine clinicians vary according to profession, child, clinical factors, and sport-related factors. Decisions regarding return to play vary according to 5 specific characteristics of each clinical case. These findings help establish areas of consensus and disagreement in the management of children with injuries and safe return to physical activity.

Ageism and Gender among Social Work and Criminal Justice Students

ERIC Educational Resources Information Center

Kane, Michael N.

2006-01-01

Undergraduate social work and criminal justice students completed 1 of 4 vignettes that were identical with the exception of the age and gender of the vignette's subject. In each vignette, the subject interacted with an opposite-sex 24-year-old waiter or waitress. Following each vignette, respondents answered 20 items relating to the age, gender,…

The Effects of Vignette Placement on Attitudes toward Supporting Family Members

ERIC Educational Resources Information Center

Lau, Charles Q.; Seltzer, Judith A.; Bianchi, Suzanne M.

2016-01-01

Vignettes are useful for measuring norms and beliefs, but little is known about how vignette placement affects responses to subsequent attitude questions. We investigate how the placement of a vignette about parents and adult children living together affects answers to subsequent questions about family obligations in a survey of the U.S.…

A survey of the views and capabilities of community pharmacists in Western Australia regarding the rescheduling of selected oral antibiotics in a framework of pharmacist prescribing

PubMed Central

Sinkala, Fatima; Parsons, Richard; Sunderland, Bruce; Hoti, Kreshnik

2018-01-01

Background Antibiotic misuse in the community contributes to antimicrobial resistance. One way to address this may be by better utilizing community pharmacists’ skills in antibiotic prescribing. The aims of this study were to examine the level of support for “down-scheduling” selected antibiotics and to evaluate factors determining the appropriateness of community pharmacist prescribing for a limited range of infections, including their decision to refer to a doctor. Methods Self-administered questionnaires, including graded case vignette scenarios simulating real practice, were sent to Western Australian community pharmacists. In addition to descriptive statistics and chi-square testing, a General Estimating Equation (GEE) was used to identify factors associated with appropriateness of therapy and the decision to refer, for each of the seven vignettes. Results Of the 240 pharmacists surveyed, 90 (37.5%) responded, yielding 630 responses to seven different case vignettes. There was more than 60% respondent support for expanded prescribing (rescheduling) of commonly prescribed antibiotics. Overall 426/630 (67.6%) chose to treat the patient while the remaining 204/630 (32.4%) referred the patient to a doctor. Of those electing to treat, 380/426 (89.2%) opted to use oral antibiotics, with 293/380 (77.2%) treating with an appropriate selection and regimen. The GEE model indicated that pharmacists were more likely to prescribe inappropriately for conditions such as otitis media (p = 0.0060) and urinary tract infection in pregnancy (p < 0.0001) compared to more complex conditions. Over 80% of all pharmacists would refer the patient to a doctor following no improvement within 3 days, or within 24 h in the case of community acquired pneumonia. It was more common for younger pharmacists to refer the patient to a doctor (p = 0.0165). Discussion This study adds further insight into community pharmacy/pharmacist characteristics associated with appropriateness of oral antibiotic selection and the decision to refer to doctors. These findings require consideration in designing pharmacist over-the-counter prescribing models for oral antibiotics. PMID:29761047

A survey of the views and capabilities of community pharmacists in Western Australia regarding the rescheduling of selected oral antibiotics in a framework of pharmacist prescribing.

PubMed

Sinkala, Fatima; Parsons, Richard; Sunderland, Bruce; Hoti, Kreshnik; Czarniak, Petra

2018-01-01

Antibiotic misuse in the community contributes to antimicrobial resistance. One way to address this may be by better utilizing community pharmacists' skills in antibiotic prescribing. The aims of this study were to examine the level of support for "down-scheduling" selected antibiotics and to evaluate factors determining the appropriateness of community pharmacist prescribing for a limited range of infections, including their decision to refer to a doctor. Self-administered questionnaires, including graded case vignette scenarios simulating real practice, were sent to Western Australian community pharmacists. In addition to descriptive statistics and chi-square testing, a General Estimating Equation (GEE) was used to identify factors associated with appropriateness of therapy and the decision to refer, for each of the seven vignettes. Of the 240 pharmacists surveyed, 90 (37.5%) responded, yielding 630 responses to seven different case vignettes. There was more than 60% respondent support for expanded prescribing (rescheduling) of commonly prescribed antibiotics. Overall 426/630 (67.6%) chose to treat the patient while the remaining 204/630 (32.4%) referred the patient to a doctor. Of those electing to treat, 380/426 (89.2%) opted to use oral antibiotics, with 293/380 (77.2%) treating with an appropriate selection and regimen. The GEE model indicated that pharmacists were more likely to prescribe inappropriately for conditions such as otitis media ( p = 0.0060) and urinary tract infection in pregnancy ( p  < 0.0001) compared to more complex conditions. Over 80% of all pharmacists would refer the patient to a doctor following no improvement within 3 days, or within 24 h in the case of community acquired pneumonia. It was more common for younger pharmacists to refer the patient to a doctor ( p  = 0.0165). This study adds further insight into community pharmacy/pharmacist characteristics associated with appropriateness of oral antibiotic selection and the decision to refer to doctors. These findings require consideration in designing pharmacist over-the-counter prescribing models for oral antibiotics.

Machinima and Video-Based Soft-Skills Training for Frontline Healthcare Workers.

PubMed

Conkey, Curtis A; Bowers, Clint; Cannon-Bowers, Janis; Sanchez, Alicia

2013-02-01

Multimedia training methods have traditionally relied heavily on video-based technologies, and significant research has shown these to be very effective training tools. However, production of video is time and resource intensive. Machinima technologies are based on videogaming technology. Machinima technology allows videogame technology to be manipulated into unique scenarios based on entertainment or training and practice applications. Machinima is the converting of these unique scenarios into video vignettes that tell a story. These vignettes can be interconnected with branching points in much the same way that education videos are interconnected as vignettes between decision points. This study addressed the effectiveness of machinima-based soft-skills education using avatar actors versus the traditional video teaching application using human actors in the training of frontline healthcare workers. This research also investigated the difference between presence reactions when using avatar actor-produced video vignettes as compared with human actor-produced video vignettes. Results indicated that the difference in training and/or practice effectiveness is statistically insignificant for presence, interactivity, quality, and the skill of assertiveness. The skill of active listening presented a mixed result indicating the need for careful attention to detail in situations where body language and facial expressions are critical to communication. This study demonstrates that a significant opportunity exists for the exploitation of avatar actors in video-based instruction.

Issues in rural adolescent mental health in Australia.

PubMed

Boyd, Candice P; Aisbett, Damon L; Francis, Kristy; Kelly, Melinda; Newnham, Krystal; Newnham, Karyn

2006-01-01

The mental health of adolescents living in rural Australia has received little research attention. In this article, the extant literature on rural adolescent mental health in Australia is reviewed. Given the lack of literature on this topic, the review is centered on a vignette presented at the beginning of the article. The case represented by the vignette is that of a young Australian growing up in a rural area. The issues raised--including the nature of mental health issues for rural adolescents and barriers to seeking professional help--are then discussed in terms of the available literature. The article concludes with a future focus for research efforts in the area of rural adolescent mental health.

Staff Member Reactions to Same-Gender, Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities.

PubMed

Ahrendt, Andrew; Sprankle, Eric; Kuka, Alex; McPherson, Keagan

2017-01-01

The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers' approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults' perception of caregiver bias, as well as further investigation of caregivers' perceptions of older adults' sexual activity.

Accuracy of clinicians and models for estimating the probability that a pulmonary nodule is malignant.

PubMed

Balekian, Alex A; Silvestri, Gerard A; Simkovich, Suzanne M; Mestaz, Peter J; Sanders, Gillian D; Daniel, Jamie; Porcel, Jackie; Gould, Michael K

2013-12-01

Management of pulmonary nodules depends critically on the probability of malignancy. Models to estimate probability have been developed and validated, but most clinicians rely on judgment. The aim of this study was to compare the accuracy of clinical judgment with that of two prediction models. Physician participants reviewed up to five clinical vignettes, selected at random from a larger pool of 35 vignettes, all based on actual patients with lung nodules of known final diagnosis. Vignettes included clinical information and a representative slice from computed tomography. Clinicians estimated the probability of malignancy for each vignette. To examine agreement with models, we calculated intraclass correlation coefficients (ICC) and kappa statistics. To examine accuracy, we compared areas under the receiver operator characteristic curve (AUC). Thirty-six participants completed 179 vignettes, 47% of which described patients with malignant nodules. Agreement between participants and models was fair for the Mayo Clinic model (ICC, 0.37; 95% confidence interval [CI], 0.23-0.50) and moderate for the Veterans Affairs model (ICC, 0.46; 95% CI, 0.34-0.57). There was no difference in accuracy between participants (AUC, 0.70; 95% CI, 0.62-0.77) and the Mayo Clinic model (AUC, 0.71; 95% CI, 0.62-0.80; P = 0.90) or the Veterans Affairs model (AUC, 0.72; 95% CI, 0.64-0.80; P = 0.54). In this vignette-based study, clinical judgment and models appeared to have similar accuracy for lung nodule characterization, but agreement between judgment and the models was modest, suggesting that qualitative and quantitative approaches may provide complementary information.

Obstetrical Providers' Management of Chronic Pain in Pregnancy: A Vignette Study.

PubMed

Tucker Edmonds, Brownsyne; McKenzie, Fatima; Austgen, MacKenzie B; Ashburn-Nardo, Leslie; Matthias, Marianne S; Hirsh, Adam T

2017-05-01

Describe obstetrical providers' management of a hypothetical case on chronic pain in pregnancy and determine whether practices differ based on patient race. This was a self-administered survey at a clinical conference. Seventy-six obstetrician-gynecologists and one nurse practitioner were surveyed. A case-vignette described a pregnant patient presenting with worsening chronic lower back pain, requesting an opioid refill and increased dosage. We varied patient race (black/white) across two randomly assigned identical vignettes. Providers indicated their likelihood of prescribing opioids, drug testing, and referring on a 0 (definitely would not) to 10 (definitely would) scale; rated their suspicions/concerns about the patient on a 0-10 VAS scale; and ranked those concerns in order of importance. We calculated correlation coefficients, stratifying analyses by patient race. Providers were not inclined to refill the opioid prescription (median = 3.0) or increase the dose (median = 1.0). They were more likely to conduct urine drug tests on white than black patients ( P = 0.008) and more likely to suspect that white patients would divert the medication ( P =0.021). For white patients, providers' highest-ranked concern was the patient's risk of abuse/addiction, whereas, for black patients, it was harm to the fetus. Suspicion about symptom exaggeration was more closely related to decisions about refilling the opioid prescriptions and increasing the dose for black patients (r = -0.357, -0.439, respectively), whereas these decisions were more closely correlated with concerns about overdose for white patients (r = -0.406, -0.494, respectively). Provider suspicion and concerns may differ by patient race, which may relate to differences in pain treatment and testing. Further study is warranted to better understand how chronic pain is managed in pregnancy. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Using Vignettes To Build and Assess Teacher Understanding of Instructional Strategies

ERIC Educational Resources Information Center

Jeffries, Carolyn; Maeder, Dale W.

2005-01-01

In the last fifty years, the use of stories in education has included vignettes as an effective stimulus for discussion of real-life contexts and problems. However, vignettes have rarely been used as an assessment tool and there is no reported consensus on their definition and design. This article documents the use of vignettes as an effective…

Psychosis or Faith? Clinicians' Assessment of Religious Beliefs

ERIC Educational Resources Information Center

O'Connor, Shawn; Vandenberg, Brian

2005-01-01

This study investigated mental health professionals' assessment of the pathognomonic significance of religious beliefs. A total of 110 participants reviewed 3 vignettes depicting individuals possessing the religious beliefs associated with Catholicism, Mormonism, and Nation of Islam. The religious beliefs of the individuals in the vignettes were…

Supporting patients treated for prostate cancer: a video vignette study with an email-based educational program in general practice.

PubMed

Jiwa, Moyez; Halkett, Georgia; Meng, Xingqiong; Pillai, Vinita; Berg, Melissa; Shaw, Tim

2014-02-26

Men who have been treated for prostate cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following treatment. However, there is no evidence that such men are consistently advised by GPs and patients experience substantial unmet need for reassurance and advice. The intent of the study was to evaluate a brief, email-based educational program for GPs to manage standardized patients presenting with symptoms or side effects months or years after prostate cancer treatment. GPs viewed six pairs of video vignettes of actor-patients depicting men who had been treated for prostate cancer. The actor-patients presented problems that were attributable to the treatment of cancer. In Phase 1, GPs indicated their diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis. These responses were compared to the management decisions for those vignettes as recommended by a team of experts in prostate cancer. After Phase 1, all the GPs were invited to participate in an email-based education program (Spaced Education) focused on prostate cancer. Participants received feedback and could compare their progress and their performance with other participants in the study. In Phase 2, all GPs, regardless of whether they had completed the program, were invited to view another set of six video vignettes with men presenting similar problems to Phase 1. They again offered a diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis. In total, 64 general practitioners participated in the project, 57 GPs participated in Phase 1, and 45 in Phase 2. The Phase 1 education program was completed by 38 of the 57 (59%) participants. There were no significant differences in demographics between those who completed the program and those who did not. Factors determining whether management of cases was consistent with expert opinion were number of sessions worked per week (OR 0.78, 95% CI 0.67-0.90), site of clinical practice (remote practice, OR 2.25, 95% CI 1.01-5.03), number of patients seen per week (150 patients or more per week, OR 10.66, 95% CI 3.40-33.48), and type of case viewed. Completion of the Spaced Education did impact whether patient management was consistent with expert opinion (not completed, OR 0.88, 95% CI 0.5-1.56). The management of standardized patients by GPs was particularly unlikely to be consistent with expert opinion in the management of impotence and bony metastasis. There was no evidence from this standardized patient study that Spaced Education had an impact on the management of patients in this context. However, the program was not completed by all participants. Practitioners with a greater clinical load were more likely to manage cases as per expert opinion.

Rape Myths, Rape Scripts, and Common Rape Experiences of College Women: Differences in Perceptions of Women Who Have Been Raped.

PubMed

Hockett, Jericho M; Saucier, Donald A; Badke, Caitlyn

2016-03-01

Rape is prevalent at colleges. Although research suggests commonalities across many college women's rape experiences (e.g., perpetrators using multiple coercive strategies), vignettes used to assess rape perceptions often reflect false beliefs. Two studies varying a perpetrator's coercive tactics examine rape perceptions using vignettes reflecting rape myths, rape scripts, or many college women's common rape experiences. Participants perceive a woman who was raped more positively in vignettes reflecting common rape experiences versus those reflecting rape myths or scripts. Theoretical, educational, and research implications are discussed. © The Author(s) 2015.

A systematic review of utility values for chemotherapy-related adverse events.

PubMed

Shabaruddin, Fatiha H; Chen, Li-Chia; Elliott, Rachel A; Payne, Katherine

2013-04-01

Chemotherapy offers cancer patients the potential benefits of improved mortality and morbidity but may cause detrimental outcomes due to adverse drug events (ADEs), some of which requiring time-consuming, resource-intensive and costly clinical management. To appropriately assess chemotherapy agents in an economic evaluation, ADE-related parameters such as the incidence, (dis)utility and cost of ADEs should be reflected within the model parameters. To date, there has been no systematic summary of the existing literature that quantifies the utilities of ADEs due to healthcare interventions in general and chemotherapy treatments in particular. This review aimed to summarize the current evidence base of reported utility values for chemotherapy-related ADEs. A structured electronic search combining terms for utility, utility valuation methods and generic terms for cancer treatment was conducted in MEDLINE and EMBASE in June 2011. Inclusion criteria were: (1) elicitation of utility values for chemotherapy-related ADEs and (2) primary data. Two reviewers identified studies and extracted data independently. Any disagreements were resolved by a third reviewer. Eighteen studies met the inclusion criteria from the 853 abstracts initially identified, collectively reporting 218 utility values for chemotherapy-related ADEs. All 18 studies used short descriptions (vignettes) to obtain the utility values, with nine studies presenting the vignettes used in the valuation exercises. Of the 218 utility values, 178 were elicited using standard gamble (SG) or time trade-off (TTO) approaches, while 40 were elicited using visual analogue scales (VAS). There were 169 utility values of specific chemotherapy-related ADEs (with the top ten being anaemia [34 values], nausea and/or vomiting [32 values], neuropathy [21 values], neutropenia [12 values], diarrhoea [12 values], stomatitis [10 values], fatigue [8 values], alopecia [7 values], hand-foot syndrome [5 values] and skin reaction [5 values]) and 49 of non-specific chemotherapy-related adverse events. In most cases, it was difficult to directly compare the utility values as various definitions and study-specific vignettes were used for the ADEs of interest. This review was designed to provide an overall description of existing literature reporting utility values for chemotherapy-related ADEs. The findings were not exhaustive and were limited to publications that could be identified using the search strategy employed and those reported in the English language. This review identified wide ranges in the utility values reported for broad categories of specific chemotherapy-related ADEs. There were difficulties in comparing the values directly as various study-specific definitions were used for these ADEs and most studies did not make the vignettes used in the valuation exercises available. It is recommended that a basic minimum requirement be developed for the transparent reporting of study designs eliciting utility values, incorporating key criteria such as reporting how the vignettes were developed and presenting the vignettes used in the valuation tasks as well as valuing and reporting the utility values of the ADE-free base states. It is also recommended, in the future, for studies valuing the utilities of chemotherapy-related ADEs to define the ADEs according to the National Cancer Institute (NCI) definitions for chemotherapy-related ADEs as the use of the same definition across studies would ease the comparison and selection of utility values and make the overall inclusion of adverse events within economic models of chemotherapy agents much more straightforward.

Mental health literacy as a function of remoteness of residence: an Australian national study.

PubMed

Griffiths, Kathleen M; Christensen, Helen; Jorm, Anthony F

2009-03-27

Although there have been many population studies of mental health literacy, little is known about the mental health literacy of people who reside in rural areas. This study sought to determine the impact of remoteness on public knowledge of depression and schizophrenia. The mental health literacy of residents of major cities, inner regional, and outer-remote (including outer regional, remote, and very remote) regions were compared using data from a 2003-04 Australian national survey of the mental health literacy of 3998 adults. Measures included the perceived helpfulness of a range of professionals, non-professionals and interventions, and the causes, prognosis, and outcomes after treatment for four case vignettes describing depression, depression with suicidal ideation, early schizophrenia and chronic schizophrenia. Participant awareness of Australia's national depression initiative and depression in the media, their symptoms of depression and exposure to the conditions depicted in the vignettes were also compared. Mental health literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the disorders depicted in the suicidal ideation and chronic schizophrenia vignettes. They were also more likely to report having heard of Australia's national depression health promotion campaign. Conversely, they were less likely than major city residents to rate the evidence-based treatment of psychotherapy helpful for depression. Both inner regional and outer-remote residents were less likely to rate psychologists as helpful for depression alone. The rural groups were more likely to rate the non-evidence based interventions of drinking and painkillers as helpful for a depression vignette. In addition, outer-remote residents were more likely to identify the evidence based treatment of antipsychotics as harmful for early schizophrenia and less likely to endorse psychiatrists, psychologists, social workers and general practitioners as helpful for the condition. Mental health awareness campaigns in rural and remote regions may be most appropriately focused on communicating which interventions are effective for depression and schizophrenia and which mental health and other professionals are trained in the best-practice delivery and management of these. There is also a need to communicate to rural residents that alcohol and pain relievers are not an effective solution for depression.

Mental health literacy as a function of remoteness of residence: an Australian national study

PubMed Central

Griffiths, Kathleen M; Christensen, Helen; Jorm, Anthony F

2009-01-01

Background Although there have been many population studies of mental health literacy, little is known about the mental health literacy of people who reside in rural areas. This study sought to determine the impact of remoteness on public knowledge of depression and schizophrenia. Methods The mental health literacy of residents of major cities, inner regional, and outer-remote (including outer regional, remote, and very remote) regions were compared using data from a 2003–04 Australian national survey of the mental health literacy of 3998 adults. Measures included the perceived helpfulness of a range of professionals, non-professionals and interventions, and the causes, prognosis, and outcomes after treatment for four case vignettes describing depression, depression with suicidal ideation, early schizophrenia and chronic schizophrenia. Participant awareness of Australia's national depression initiative and depression in the media, their symptoms of depression and exposure to the conditions depicted in the vignettes were also compared. Results Mental health literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the disorders depicted in the suicidal ideation and chronic schizophrenia vignettes. They were also more likely to report having heard of Australia's national depression health promotion campaign. Conversely, they were less likely than major city residents to rate the evidence-based treatment of psychotherapy helpful for depression. Both inner regional and outer-remote residents were less likely to rate psychologists as helpful for depression alone. The rural groups were more likely to rate the non-evidence based interventions of drinking and painkillers as helpful for a depression vignette. In addition, outer-remote residents were more likely to identify the evidence based treatment of antipsychotics as harmful for early schizophrenia and less likely to endorse psychiatrists, psychologists, social workers and general practitioners as helpful for the condition. Conclusion Mental health awareness campaigns in rural and remote regions may be most appropriately focused on communicating which interventions are effective for depression and schizophrenia and which mental health and other professionals are trained in the best-practice delivery and management of these. There is also a need to communicate to rural residents that alcohol and pain relievers are not an effective solution for depression. PMID:19327161

Unconscious race and class bias: its association with decision making by trauma and acute care surgeons.

PubMed

Haider, Adil H; Schneider, Eric B; Sriram, N; Dossick, Deborah S; Scott, Valerie K; Swoboda, Sandra M; Losonczy, Lia; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Freischlag, Julie A; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A

2014-09-01

Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making. A prospective Web-based survey was administered to active members of the Eastern Association for the Surgery of Trauma. Participants completed nine clinical vignettes, each with three trauma/acute care surgery management questions. Race Implicit Association Test (IAT) and social class IAT assessments were completed by each participant. Multivariable, ordered logistic regression analysis was then used to determine whether implicit biases reflected on the IAT tests were associated with vignette responses. In total, 248 members of the Eastern Association for the Surgery of Trauma participated. Of these, 79% explicitly stated that they had no race preferences and 55% stated they had no social class preferences. However, 73.5% of the participants had IAT scores demonstrating an unconscious preference toward white persons; 90.7% demonstrated an implicit preference toward upper social class persons. Only 2 of 27 vignette-based clinical decisions were associated with patient race or social class on univariate analyses. Multivariable analyses revealed no relationship between IAT scores and vignette-based clinical assessments. Unconscious preferences for white and upper-class persons are prevalent among trauma and acute care surgeons. In this study, these biases were not statistically significantly associated with clinical decision making. Further study of the factors that may prevent implicit biases from influencing patient management is warranted. Epidemiologic study, level II.

Children's Beliefs about Parental Expectations for Emotional-Expressive Behavior Management.

ERIC Educational Resources Information Center

Saarni, Carolyn

The focus in the present study was on children's expectancies about how parents would respond to their children's genuine emotional-expressive displays, as sampled across seven different vignettes about parent-child interaction. The vignettes consisted of schematic cartoons and a verbal narrative. They contained "emotional displays" of…

Using vignettes to explore work-based learning: part 2.

PubMed

Wareing, Mark

This is the second of two articles exploring the use of vignettes as an alternative method of presenting the data arising from interviews. The interviews were carried out as part of research into work-based learning: both articles are based on findings from a hermeneutic phenomenological study into the lived experience of foundation degree mentors and their students-healthcare assistants undertaking a foundation degree in health and social care in order to become assistant practitioners. Part 2 presents a vignette of a notional assistant practitioner, Michelle, that describes her lived experience as a foundation degree student. Michelle's perspective is a distillation of data arising from interviews with 11 former foundation degree students. The vignette attempts to demonstrate the features of 'knowing' and 'becoming' in the practice of foundation degree students, and the impact that being a work-based learner has on students' perceptions of lifelong learning.

Patronizing the young: forms and evaluations.

PubMed

Giles, H; Williams, A

1994-01-01

Exploratory work indicated that Californian undergraduates were frequently, and irritatingly, patronized by older adults in a variety of ways. In a follow-up, using multidimensional scaling procedures, three distinct clusters representing young adults' own conceptions of patronizing speech emerged ("non-listening," "disapproving," and "parental"). In the main study, young adults were provided with a single vignette of a short conversation between an older and younger person. Eight versions of this vignette were devised independently varying elder's age (40- vs. 70-years) and speech style (neutral vs. non-listening vs. disapproving vs. parental). Participants were required to evaluate both vignette-targets. As expected, the patronizing elders were negatively perceived. An evaluative hierarchy differentiated between the three patronizing forms, and in ways that differed depending on the nature of the judgmental task. Content analyses of open-ended data also revealed interesting differences in interpretive responses to the various vignette conditions.

Evidence of More Immanent Justice Responding in Adults than Children: A Challenge to Traditional Developmental Theories

ERIC Educational Resources Information Center

Raman, Lakshmi; Winer, Gerald A.

2004-01-01

Three studies investigated developmental changes in immanent justice responding by asking participants to respond to vignettes in which a person's bad behaviour was followed by a negative consequence. Study 1 consisted of 152 sixth graders and 128 college students and presented participants with a vignette that examined the notion of bad people…

[Not quite the same: illness beliefs regarding burnout and depression among the general population].

PubMed

Bahlmann, Johannes; Schomerus, Georg; Angermeyer, Matthias C

2015-11-01

This study examined illness beliefs of the lay public associated with the diagnostic labels burnout and depression. Representative population survey in Germany 2011, using unlabelled case vignettes of a person suffering from depression. Following presentation of the vignette, respondents were asked openly how they would call the problem described. Agreement with various illness beliefs was elicited with Likert-scaled items. Seeing the problem as inherited predicted use of the label depression (OR 1.29, p < 0.001), while stress at work as a perceived cause was associated with use of the label burnout (OR 1.56, p < 0.001). Belief that the problem described resembled everyday experiences (belief in a symptom continuum) also predicted using the label burnout instead of depression (OR 1.31, p < 0.05). Although overlapping with beliefs about depression, the diagnostic label burnout is also associated with specific illness beliefs among the general public. © Georg Thieme Verlag KG Stuttgart · New York.

Mental states as part of countertransference responses in psychotherapists facing reports of traumatic events of mourning and sexual violence.

PubMed

Goldfeld, Patricia; Terra, Luciana; Abuchaim, Claudio; Sordi, Anne; Wiethaeuper, Daniela; Bouchard, Marc-Andrè; Mardini, Victor; Baumgardt, Rosana; Lauerman, Marta; Ceitlin, Lúcia Helena

2008-09-01

The study aims to compare the mental states and countertransference responses of 92 psychodynamically oriented psychotherapists, male and female, experienced and inexperienced, facing written reports of real patients who experienced traumatic events. Two vignettes were presented: one of a sexual violence, the other the sudden death of a significant person. The Mental States Rating System (MSRS; Bouchard, Picard, Audet, Brisson, & Carrier, 1998), the MSRS Self-Report (Goldfeld & Bouchard, 2004), and the Inventory of Countertransference Behavior (ICB; Friedman & Gelso, 2000) were used. Results showed that the mourning vignette led to more reflective responses (MSRS) and the rape case was associated with more negative countertransference reactions (ICB). Female participants were more reflective (MSRS); male therapists used less mentalized states (MSRS Self-Report) and expressed more negative reactions (ICB) for both scenarios. Experienced therapists showed more positive reactions on the ICB. The construct validity of the instruments is discussed in relation to the findings.

Development, preliminary usability and accuracy testing of the EBMT 'eGVHD App' to support GvHD assessment according to NIH criteria-a proof of concept.

PubMed

Schoemans, H; Goris, K; Durm, R V; Vanhoof, J; Wolff, D; Greinix, H; Pavletic, S; Lee, S J; Maertens, J; Geest, S D; Dobbels, F; Duarte, R F

2016-08-01

The EBMT Complications and Quality of Life Working Party has developed a computer-based algorithm, the 'eGVHD App', using a user-centered design process. Accuracy was tested using a quasi-experimental crossover design with four expert-reviewed case vignettes in a convenience sample of 28 clinical professionals. Perceived usefulness was evaluated by the technology acceptance model (TAM) and User satisfaction by the Post-Study System Usability Questionnaire (PSSUQ). User experience was positive, with a median of 6 TAM points (interquartile range: 1) and beneficial median total, and subscale PSSUQ scores. The initial standard practice assessment of the vignettes yielded 65% correct results for diagnosis and 45% for scoring. The 'eGVHD App' significantly increased diagnostic and scoring accuracy to 93% (+28%) and 88% (+43%), respectively (both P<0.05). The same trend was observed in the repeated analysis of case 2: accuracy improved by using the App (+31% for diagnosis and +39% for scoring), whereas performance tended to decrease once the App was taken away. The 'eGVHD App' could dramatically improve the quality of care and research as it increased the performance of the whole user group by about 30% at the first assessment and showed a trend for improvement of individual performance on repeated case evaluation.

Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment.

PubMed

Baker-Ericzén, Mary J; Jenkins, Melissa M; Park, Soojin; Garland, Ann F

2015-02-01

Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.

Analyze This! Thematic Analysis: Hostility, Attribution of Intent, and Interpersonal Perception Bias.

PubMed

Karadenizova, Zhana; Dahle, Klaus-Peter

2017-11-01

Research suggests that aggressive individuals exhibit a strong tendency to attribute hostile intent to the behavior of others when confronted with an ambiguous social situation. The vignettes method has become a standard procedure to assess hostile attributions. Vignettes represent incomplete ambiguous social stories, in which the subjects experience a negative outcome and are asked to attribute intent to the provocateur's action. This article explores the ways in which subjects perceive ambiguous social situations and other people's intentions, their tendency to refer negative outcome to oneself, and the components defining hostility in the interpersonal relationships. The sample consisted of male adolescent violent offenders ( N = 45) recruited from the Social Therapy Department of the German correctional facility for juvenile offenders in Berlin. All offenders were incarcerated for a violent or sexual crime and were currently undergoing individual and group psychotherapy. The five hypothetical vignettes used in this study were originally designed to assess hostile attributions in both institutional and noninstitutional social situations. Participants' responses were analyzed using thematic analysis. Thematic analysis revealed three key themes regarding the social perception-positive, negative, and neutral-and two themes regarding the components of hostility-provocateur-related personality features and relationship type. Although the vignettes were originally developed to detect hostility-prone perception bias, they seem to be able to reveal a wider set of different attributions of intent, both positive and negative. Thus, vignettes are not limited to assessment of hostility specifically. They much rather seem to be a measure which is sensitive to diverse attributions of intent in general. The diagnostic qualities of the vignettes, their area of application, limitations of the study, and future perspective are discussed.

The management of acute adverse effects of breast cancer treatment in general practice: a video-vignette study.

PubMed

Jiwa, Moyez; Long, Anne; Shaw, Tim; Pagey, Georgina; Halkett, Georgia; Pillai, Vinita; Meng, Xingqiong

2014-09-03

There has been a focus recently on the use of the Internet and email to deliver education interventions to general practitioners (GPs). The treatment of breast cancer may include surgery, radiotherapy, chemotherapy, and/or hormone treatment. These treatments may have acute adverse effects. GPs need more information on the diagnosis and management of specific adverse effects encountered immediately after cancer treatment. The goal was to evaluate an Internet-based educational program developed for GPs to advise patients with acute adverse effects following breast cancer treatment. During phase 1, participants viewed 6 video vignettes of actor-patients reporting 1 of 6 acute symptoms following surgery and chemotherapy and/or radiotherapy treatment. GPs indicated their diagnosis and proposed management through an online survey program. They received feedback about each scenario in the form of a specialist clinic letter, as if the patient had been seen at a specialist clinic after they had attended the GP. This letter incorporated extracts from local guidelines on the management of the symptoms presented. This feedback was sent to the GPs electronically on the same survey platform. In phase 2, all GPs were invited to manage similar cases as phase 1. Their proposed management was compared to the guidelines. McNemar test was used to compare data from phases 1 and 2, and logistic regression was used to explore the GP characteristics that were associated with inappropriate case management. A total of 50 GPs participated. Participants were younger and more likely to be female than other GPs in Australia. For 5 of 6 vignettes in phase 1, management was consistent with expert opinion in the minority of cases (6%-46%). Participant demographic characteristics had a variable effect on different management decisions in phase 1. The variables modeled explained 15%-28% of the differences observed. Diagnosis and management improved significantly in phase 2, especially for diarrhea, neutropenia, and seroma sample cases. The proportion of incorrect management responses was reduced to a minimum (25.3%-49.3%) in phase 2. There was evidence that providing feedback by experts on specific cases had an impact on GPs' knowledge about how to appropriately manage acute treatment adverse effects. This educational intervention could be targeted to support the implementation of shared care during cancer treatment.

The Management of Acute Adverse Effects of Breast Cancer Treatment in General Practice: A Video-Vignette Study

PubMed Central

Pagey, Georgina; Halkett, Georgia; Pillai, Vinita; Meng, Xingqiong

2014-01-01

Background There has been a focus recently on the use of the Internet and email to deliver education interventions to general practitioners (GPs). The treatment of breast cancer may include surgery, radiotherapy, chemotherapy, and/or hormone treatment. These treatments may have acute adverse effects. GPs need more information on the diagnosis and management of specific adverse effects encountered immediately after cancer treatment. Objective The goal was to evaluate an Internet-based educational program developed for GPs to advise patients with acute adverse effects following breast cancer treatment. Methods During phase 1, participants viewed 6 video vignettes of actor-patients reporting 1 of 6 acute symptoms following surgery and chemotherapy and/or radiotherapy treatment. GPs indicated their diagnosis and proposed management through an online survey program. They received feedback about each scenario in the form of a specialist clinic letter, as if the patient had been seen at a specialist clinic after they had attended the GP. This letter incorporated extracts from local guidelines on the management of the symptoms presented. This feedback was sent to the GPs electronically on the same survey platform. In phase 2, all GPs were invited to manage similar cases as phase 1. Their proposed management was compared to the guidelines. McNemar test was used to compare data from phases 1 and 2, and logistic regression was used to explore the GP characteristics that were associated with inappropriate case management. Results A total of 50 GPs participated. Participants were younger and more likely to be female than other GPs in Australia. For 5 of 6 vignettes in phase 1, management was consistent with expert opinion in the minority of cases (6%-46%). Participant demographic characteristics had a variable effect on different management decisions in phase 1. The variables modeled explained 15%-28% of the differences observed. Diagnosis and management improved significantly in phase 2, especially for diarrhea, neutropenia, and seroma sample cases. The proportion of incorrect management responses was reduced to a minimum (25.3%-49.3%) in phase 2. Conclusions There was evidence that providing feedback by experts on specific cases had an impact on GPs’ knowledge about how to appropriately manage acute treatment adverse effects. This educational intervention could be targeted to support the implementation of shared care during cancer treatment. PMID:25274131

The Development of Behavior Control Competency in Preadolescence: A Case Vignette

ERIC Educational Resources Information Center

Cooper, Atha J.; And Others

1972-01-01

The utility of a crisis intervention approach for helping preadolescents build competency in behavior control is demonstrated. The following dimensions are highlighted: immediacy of intervention, trust relationship, structural interventions, facilitating versus controlling, problem solving orientation, and mobilization of group membership…

Slipping Anchor? Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity

PubMed Central

d’Uva, Teresa Bago; Lindeboom, Maarten; O’Donnell, Owen; van Doorslaer, Eddy

2011-01-01

We propose tests of the two assumptions under which anchoring vignettes identify heterogeneity in reporting of categorical evaluations. Systematic variation in the perceived difference between any two vignette states is sufficient to reject vignette equivalence. Response consistency - the respondent uses the same response scale to evaluate the vignette and herself – is testable given sufficiently comprehensive objective indicators that independently identify response scales. Both assumptions are rejected for reporting of cognitive and physical functioning in a sample of older English individuals, although a weaker test resting on less stringent assumptions does not reject response consistency for cognition. PMID:22184479

US primary care physicians' opinions about conscientious refusal: a national vignette experiment.

PubMed

Brauer, Simon G; Yoon, John D; Curlin, Farr A

2016-02-01

Previous research has found that physicians are divided on whether they are obligated to provide a treatment to which they object and whether they should refer patients in such cases. The present study compares several possible scenarios in which a physician objects to a treatment that a patient requests, in order to better characterise physicians' beliefs about what responses are appropriate. We surveyed a nationally representative sample of 1504 US primary care physicians using an experimentally manipulated vignette in which a patient requests a clinical intervention to which the patient's physician objects. We used multivariate logistic regression models to determine how vignette and respondent characteristics affected respondent's judgements. Among eligible respondents, the response rate was 63% (896/1427). When faced with an objection to providing treatment, referring the patient was the action judged most appropriate (57% indicated it was appropriate), while few physicians thought it appropriate to provide treatment despite one's objection (15%). The most religious physicians were more likely than the least religious physicians to support refusing to accommodate the patient's request (38% vs 22%, OR=1.75; 95% CI 1.06 to 2.86). This study indicates that US physicians believe it is inappropriate to provide an intervention that violates one's personal or professional standards. Referring seems to be physicians' preferred way of responding to requests for interventions to which physicians object. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Are Cantonese-speakers really descriptivists? Revisiting cross-cultural semantics.

PubMed

Lam, Barry

2010-05-01

In an article in Cognition [Machery, E., Mallon, R., Nichols, S., & Stich, S. (2004). Semantics cross-cultural style. Cognition, 92, B1-B12] present data which purports to show that East Asian Cantonese-speakers tend to have descriptivist intuitions about the referents of proper names, while Western English-speakers tend to have causal-historical intuitions about proper names. Machery et al. take this finding to support the view that some intuitions, the universality of which they claim is central to philosophical theories, vary according to cultural background. Machery et al. conclude from their findings that the philosophical methodology of consulting intuitions about hypothetical cases is flawed vis a vis the goal of determining truths about some philosophical domains like philosophical semantics. In the following study, three new vignettes in English were given to Western native English-speakers, and Cantonese translations were given to native Cantonese-speaking immigrants from a Cantonese community in Southern California. For all three vignettes, questions were given to elicit intuitions about the referent of a proper name and the truth-value of an uttered sentence containing a proper name. The results from this study reveal that East Asian Cantonese-speakers do not differ from Western English-speakers in ways that support Machery et al.'s conclusions. This new data concerning the intuitions of Cantonese-speakers raises questions about whether cross-cultural variation in answers to questions on certain vignettes reveal genuine differences in intuitions, or whether such differences stem from non-intuitional differences, such as differences in linguistic competence. Copyright 2009 Elsevier B.V. All rights reserved.

Model Minority Stereotype: Influence on Perceived Mental Health Needs of Asian Americans.

PubMed

Cheng, Alice W; Chang, Janet; O'Brien, Janine; Budgazad, Marc S; Tsai, Jack

2017-06-01

This study examined the influence of the model minority stereotype on the perceived mental health functioning of Asian Americans. It was hypothesized that college students would perceive Asian Americans as having fewer mental health problems and clinical symptoms than Whites due to the model minority stereotype. Four hundred and twenty-five undergraduate students from a predominately White college campus in the American northeast were randomly exposed to one of four conditions: (1) a clinical vignette describing a White college student suffering from adjustment disorder; (2) the same vignette describing an Asian American college student; (3) a newspaper article describing a success story of Whites and the White clinical vignette; (4) the same newspaper article and clinical vignette describing an Asian American. Following exposure to one of the conditions, participants completed a memory recall task and measures of colorblindness, attitudes towards Asian Americans, attitudes towards out-group members, and perceived mental health functioning. Participants exposed to the vignettes primed with the positive/model minority stereotype perceived the target regardless of race/ethnicity as having better mental health functioning and less clinical symptoms than the condition without the stereotype. Additionally, the stereotype primer was found to be a modest predictor for the perception of mental health functioning in Asian American vignettes. Results shed light on the impact of the model minority stereotype on the misperception of Asian Americans' mental health status, contributing to the invisibility or neglect of this minority group's mental health needs.

Working with Parents of Aggressive Children: Clinical Vignettes.

ERIC Educational Resources Information Center

Mordock, John B.

1988-01-01

Seven brief clinical vignettes are presented, illustrating principles of intervention with parents of aggressive children. The vignettes describe family relationships; parents' feelings toward counselors, especially anger; counseling techniques; actions taken by counselors; and outcomes of treatment. (JDD)

The use of vignettes to empower effective responses to attempted sexual assault.

PubMed

Allen, Kaylie T; Meadows, Elizabeth A

2017-01-01

Women assertively resisting sexual aggression have the best chances of avoiding completed rape. Especially with acquaintances, there are significant social and psychological barriers to resistance. Novel vignettes depicting acquaintance rape were designed to enhance self-efficacy, reduce unrealistic optimism, and empower assertive resistance. The data were collected using a Web-based survey of 449 female college students from multiple universities in August-October 2014. Between-subjects mixed-methods design. Participants were randomly assigned to read one of four vignettes and complete self-report measures of personal vulnerability, self-efficacy, and beliefs and intention about resistance. Although vignettes did not impact self-efficacy, one vignette enhanced perceived controllability and decreased unrealistic optimism. Women who read about completed acquaintance rape described intention to use physically assertive responses at double the rate of women reading about successful resistance. As low-cost, easily disseminated materials, vignettes about sexual assault may enhance campus prevention efforts.

Therapist Directiveness and Client Reactance in the Administration of Homework in Therapy with College Students

ERIC Educational Resources Information Center

Branagan, William Tyler; Swanbrow Becker, Martin A.

2018-01-01

The present study used an analog design with three vignettes portraying homework administrations at three levels of therapist directiveness (low, medium, and high) and the Therapeutic Reactance Scale to measure participant reactance. Participants (N = 436) read the vignettes and completed the Homework Completion Scale (HCS), Counseling…

Does Major Matter? Considering the Implications of Collecting Vignette Data from Our Students

ERIC Educational Resources Information Center

Collett, Jessica L.; Childs, Ellen

2009-01-01

Social psychologists in both sociology and psychology commonly use vignettes to gauge how people might respond in a given situation. Research subjects in such studies, like those in other experiments, are often undergraduates, surveyed or recruited in classes. While there has been significant attention to the generalizability of students'…

Effects of Age Expectations on Oncology Social Workers' Clinical Judgment

ERIC Educational Resources Information Center

Conlon, Annemarie; Choi, Namkee G.

2014-01-01

Objective: This study examined the influence of oncology social workers' expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the patent's age…

An Exploratory Study of Digital Video Editing as a Tool for Teacher Preparation

ERIC Educational Resources Information Center

Calandra, Brendan; Gurvitch, Rachel; Lund, Jacalyn

2008-01-01

The authors' purpose was to examine teacher candidates' perspectives of successful teaching through personalized video vignettes. Furthermore, the authors were interested in how participants' written reflections might change as a result of creating these vignettes. This research used mixed-methods within the context of an exploratory multi-case…

Knowledge of ghostwriting and financial conflicts-of-interest reduces the perceived credibility of biomedical research

PubMed Central

2011-01-01

Background While the impact of conflicts-of-interest (COI) is of increasing concern in academic medicine, there is little research on the reaction of practicing clinicians to the disclosure of such conflicts. We developed two research vignettes presenting a fictional antidepressant medication study, one in which the principal investigator had no COI and another in which there were multiple COI disclosed. We confirmed the face validity of the COI vignette through consultation with experts. Hospital-based clinicians were randomly assigned to read one of these two vignettes and then administered a credibility scale. Findings Perceived credibility ratings were much lower in the COI group, with a difference of 11.00 points (31.42%) on the credibility scale total as calculated through the Mann-Whitney U test (95% CI = 6.99 - 15.00, p < .001). Clinicians in the COI group were also less likely to recommend the antidepressant medication discussed in the vignette (Odds Ratio = 0.163, 95% CI = .03 = 0.875). Conclusions In this study, increased disclosure of COI resulted in lower credibility ratings. PMID:21281504

Blueberry Pancakes, Please.

ERIC Educational Resources Information Center

Leana, Frank C.

1994-01-01

Describes three case vignettes of college freshmen who are unhappy with their choice of schools early in their freshman years. Considers problems in dormitory living, academic pressures, and interpersonal problems. Discusses change in the campus environment in recent decades and the need for adult involvement in campus life. (NB)

Drug reimbursement and GPs' prescribing decisions: a randomized case-vignette study about the pharmacotherapy of obesity associated with type 2 diabetes: how GPs react to drug reimbursement.

PubMed

Verger, Pierre; Rolland, Sophie; Paraponaris, Alain; Bouvenot, Julien; Ventelou, Bruno

2010-08-01

This study sought to identify the effect of drug reimbursability--a decision made in France by the National Authority for Health--on physicians' prescribing practices for a diet drug such as rimonabant, approved for obese or overweight patients with type-2 diabetes. A cross-sectional survey of French general practitioners (GPs) presented a case-vignette about a patient for whom this drug is indicated in two alternative versions, differing only in its reimbursability, to two separate randomized subsamples of GPs in early 2007, before any decision was made about reimbursement. The results indicate that (i) more than 20% of GPs in private practice would be willing to prescribe a non-reimbursed diet drug for patients with obesity complicated by type 2 diabetes; (ii) the number of GPs willing to prescribe it would increase by 47.6% if the drug were reimbursed, and (iii) such a drug would be adopted at a higher rate by GPs who have regular contacts with pharmaceutical sales representatives. In France, unlike most other countries, drug reimbursement status is a signal of quality. However, our results suggest that a significant proportion of GPs would spontaneously adopt anti-obesity drugs even if they were not reimbursed. Decisions about reimbursement of pharmaceutical products should be made taking into account that reimbursement is likely to intensify prescription.

Specialist palliative care nurses' management of the needs of patients with depression.

PubMed

Hayes, Jessica Elizabeth; Hart, Bethne; Phillips, Jane

2017-06-02

Depression is an important condition to consider if we are to optimise the care outcomes for patients with palliative care needs. Depression has a high incidence in palliative patients, with up to 15% diagnosed with major depression and 37% expressing some form of depressive symptoms ( O'Connor et al, 2010 ). The challenge is to ensure that palliative care patients with depression are identified in a timely manner and that their depression is effectively managed. To examine how Australian specialist inpatient palliative care nurses perceive, assess and respond to depression in a patient case study. This descriptive pilot study is a replication of a United States study by Little et al (2005) , exploring contemporary Australian specialist palliative care nurses' screening, assessment and management of depression in people with a progressive life-limiting illness. A survey titled 'Specialist palliative care nurses managing patients with complex care needs' questioned the nursing assessment, knowledge and clinical care priorities related to a case vignette of a patient demonstrating signs of depression. A total of 33 nurses completed this survey. Less than half (39.4%) of the participants identified depression as a major issue arising from the case vignette. Depression screening tools were not widely known. Functionality assessments measuring activities of daily living were the most recognised and widely used tools by participants. This small sample pilot study demonstrated that specialist palliative care nurses are still not confident in their screening and responding to a patient with depression. The available evidenced based depression screening tools were unfamiliar to these nurses and not widely used which can result in depression remaining undetected and undermanaged. The connections between physical health and mental health need stronger recognition and response within nursing care of palliative patients.

[Compulsive buying disorder: a review and a case vignette].

PubMed

Tavares, Hermano; Lobo, Daniela Sabbatini S; Fuentes, Daniel; Black, Donald W

2008-05-01

Compulsive buying disorder was first described as a psychiatric syndrome in the early twentieth century. Its classification remains elusive, and investigators have debated its potential relationship to mood, substance use, obsessive-compulsive, and impulse control disorders. The objective of this study is to present a review of compulsive buying disorder and present a case vignette. Two databases were reviewed (Medline and PsycINFO) in search for articles published in the last 40 years. Selected terms included oniomania, compulsive buying, and compulsive shopping. Other relevant articles were also identified through reference lists. Compulsive buying disorder is a prevalent and chronic condition that is found worldwide, sharing commonalities with impulse control disorders. In clinical samples, women make up more than 80% of subjects. Its etiology is unknown, but neurobiologic and genetic mechanisms have been proposed. The disorder is highly comorbid with mood, substance use, eating and impulse control disorders. Treatment recommendations derived from the literature and clinical experience suggest that problem shoppers can benefit from psychosocial interventions. Cognitive-behavioral group models appear promising. Medication trials have reported mixed results. The identification and treatment of psychiatric comorbidity is also a key aspect of treatment. In order to determine the validity of compulsive buying disorder, future work should focus on psychopathology and neurobiological findings unique to the syndrome.

How College Students' Conceptions of Newton's Second and Third Laws Change through Watching Interactive Video Vignettes: A Mixed Methods Study

ERIC Educational Resources Information Center

Engelman, Jonathan

2016-01-01

Changing student conceptions in physics is a difficult process and has been a topic of research for many years. The purpose of this study was to understand what prompted students to change or not change their incorrect conceptions of Newtons Second or Third Laws in response to an intervention, Interactive Video Vignettes (IVVs), designed to…

Passing the Rod: Similarities between Parents' and Children's Orientations toward Physical Punishment.

ERIC Educational Resources Information Center

Holden, George W.; And Others

This study examined the correspondence between parents' and children's orientations toward the use of physical punishment. A series of vignettes concerning child misbehavior was shown to children and their parents. Subjects were asked to assess the likelihood of their responding to the situation shown by spanking the child in the vignette.…

3-D Computer Animation vs. Live-Action Video: Differences in Viewers' Response to Instructional Vignettes

ERIC Educational Resources Information Center

Smith, Dennie; McLaughlin, Tim; Brown, Irving

2012-01-01

This study explored computer animation vignettes as a replacement for live-action video scenarios of classroom behavior situations previously used as an instructional resource in teacher education courses in classroom management strategies. The focus of the research was to determine if the embedded behavioral information perceived in a live-action…

Psychometric Properties of Virtual Reality Vignette Performance Measures: A Novel Approach for Assessing Adolescents' Social Competency Skills

ERIC Educational Resources Information Center

Paschall, Mallie J.; Fishbein, Diana H.; Hubal, Robert C.; Eldreth, Diana

2005-01-01

This study examined the psychometric properties of performance measures for three novel, interactive virtual reality vignette exercises developed to assess social competency skills of at-risk adolescents. Performance data were collected from 117 African-American male 15-17 year olds. Data for 18 performance measures were obtained, based on…

Sixth Graders' Conflict Resolution in Role Plays with a Peer, Parent, and Teacher

ERIC Educational Resources Information Center

Borbely, Christina J.; Graber, Julia A.; Nichols, Tracy; Brooks-Gunn, Jeanne; Botvin, Gilbert J.

2005-01-01

This study used conflict resolution role play vignettes and self-report surveys of 450 New York City 6th graders to examine associations between adolescents' conflict resolution efficacy and social skills. Vignettes covered 3 social contexts, conflict with a peer (disagreement over activities), with a parent (raise in allowance), and with a…

The Detrimental Effects of Adolescents' Chronic Loneliness on Motivation and Emotion Regulation in Social Situations.

PubMed

Vanhalst, Janne; Luyckx, Koen; Van Petegem, Stijn; Soenens, Bart

2018-01-01

In adolescence, when establishing and maintaining satisfying social relationships is a key developmental task, chronic loneliness is related to a host of negative outcomes. This study aimed at examining motivational and regulatory factors related to chronic loneliness. Specifically, this study investigated chronically lonely adolescents' responses to hypothetical vignettes of social inclusion and exclusion, thereby focusing on (a) adolescents' willingness and motivation to approach social inclusion and (b) emotion regulation strategies to deal with social exclusion. A total of 730 adolescents (Mage = 15.43 years, 72% female) participated in this four-wave study with annual loneliness assessments and hypothetical vignettes of social inclusion and exclusion at the final wave. After each social inclusion vignette, participants rated their willingness to accept the invitation for social inclusion and five types of motivation to approach the situation. After each social exclusion vignette, participants rated nine cognitive emotion regulation strategies. Compared to individuals following other trajectories, chronically lonely adolescents were less likely to accept invitations for social inclusion and the quality of their motivation for accepting such invitations was lower. Further, they were more likely to employ maladaptive emotion regulation strategies. In sum, this study adds significantly to understanding the motivational and regulatory processes that differentiate chronically lonely adolescents from adolescents following other trajectories.

Case vignettes of movement disorders.

PubMed

Yung, C Y

1983-08-01

This paper reports five movement disorders cases to serve as a basis for discussion of the problems encountered in the clinical management of these cases, and the pathophysiological mechanisms involved in these disorders as presented. Case 1 is a description of the subjective experience of a patient with acute orofacial dystonia from promethazine. Case 2 is the use of clonazepam is post-head injury tics. Case 3 is the complication from discontinuation of haloperidol and benztropine mesylate treatment. Case 4 is myoclonus in subacute sclerosing Panencephalitis, and Case 5 is rebound tremor from withdrawal of a beta-adrenergic blocker.

Psychodrama: A Creative Approach for Addressing Parallel Process in Group Supervision

ERIC Educational Resources Information Center

Hinkle, Michelle Gimenez

2008-01-01

This article provides a model for using psychodrama to address issues of parallel process during group supervision. Information on how to utilize the specific concepts and techniques of psychodrama in relation to group supervision is discussed. A case vignette of the model is provided.

A Cognitive Perspective in the Treatment of Incarcerated Clients.

ERIC Educational Resources Information Center

Walsh, Thomas C.

1990-01-01

Proposes a cognitive therapy model as a workable approach in treating incarcerated clients. Reviews principal components and techniques of cognitive theory. Uses case vignettes to illustrate application of this approach. Delineates key features of cognitive model which relate to treatment of incarcerated population. (Author/ABL)

CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation.

PubMed

Ramchandani, Neesha; Johnson, Kim; Cullen, Karen; Hamm, Terri; Bisordi, Jean; Sullivan-Bolyai, Susan

2017-02-01

Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators' (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching-learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.

Perceived impact of socially anxious behaviors on individuals' lives in Western and East Asian countries.

PubMed

Rapee, Ronald M; Kim, Jinkwan; Wang, Jianping; Liu, Xinghua; Hofmann, Stefan G; Chen, Junwen; Oh, Kyung Ya; Bögels, Susan M; Arman, Soroor; Heinrichs, Nina; Alden, Lynn E

2011-09-01

The current study compared the predicted social and career impact of socially withdrawn and reticent behaviors among participants from Western and East Asian countries. Three hundred sixty-one college students from 5 Western countries and 455 students from 3 East Asian countries read hypothetical vignettes describing socially withdrawn and shy behaviors versus socially outgoing and confident behaviors. Participants then answered questions following each vignette indicating the extent to which they would expect the subject of the vignette to be socially liked and to succeed in their career. Participants also completed measures of their own social anxiety and quality of life. The results indicated significant vignette-by-country interactions in that the difference in perceived social and career impact between shy and outgoing vignettes was smaller among participants from East Asian countries than from Western countries. In addition, significant negative correlations were shown between personal level of shyness and experienced quality of life for participants from both groups of countries, but the size of this relationship was greater for participants from Western than East Asian countries. The results point to the more negative impact of withdrawn and socially reticent behaviors for people from Western countries relative to those from East Asia. Copyright © 2011. Published by Elsevier Ltd.

Estimation of post-test probabilities by residents: Bayesian reasoning versus heuristics?

PubMed

Hall, Stacey; Phang, Sen Han; Schaefer, Jeffrey P; Ghali, William; Wright, Bruce; McLaughlin, Kevin

2014-08-01

Although the process of diagnosing invariably begins with a heuristic, we encourage our learners to support their diagnoses by analytical cognitive processes, such as Bayesian reasoning, in an attempt to mitigate the effects of heuristics on diagnosing. There are, however, limited data on the use ± impact of Bayesian reasoning on the accuracy of disease probability estimates. In this study our objective was to explore whether Internal Medicine residents use a Bayesian process to estimate disease probabilities by comparing their disease probability estimates to literature-derived Bayesian post-test probabilities. We gave 35 Internal Medicine residents four clinical vignettes in the form of a referral letter and asked them to estimate the post-test probability of the target condition in each case. We then compared these to literature-derived probabilities. For each vignette the estimated probability was significantly different from the literature-derived probability. For the two cases with low literature-derived probability our participants significantly overestimated the probability of these target conditions being the correct diagnosis, whereas for the two cases with high literature-derived probability the estimated probability was significantly lower than the calculated value. Our results suggest that residents generate inaccurate post-test probability estimates. Possible explanations for this include ineffective application of Bayesian reasoning, attribute substitution whereby a complex cognitive task is replaced by an easier one (e.g., a heuristic), or systematic rater bias, such as central tendency bias. Further studies are needed to identify the reasons for inaccuracy of disease probability estimates and to explore ways of improving accuracy.

Using simulation to test critical thinking skills of nursing students.

PubMed

Johannsson, S L; Wertenberger, D H

1996-10-01

The purpose of this pilot study was to evaluate the effectiveness of using simulations to test critical thinking ability of nursing students. Nine medical and surgical videotaped vignettes were selected from the critical thinking component of the Performance Based Development System (PBDS). Pathology, difficulty rating and the obviousness of cues varied between vignettes. Each student was rated as acceptable, partially acceptable or unacceptable in their ability to identify a problem and provide appropriate nursing interventions with rationale for each vignette. A paper and pencil exercise and interviews were used to validate findings obtained from the video simulations. The pros and cons of using video simulations to assess critical thinking abilities of nursing students are discussed.

The Power of the Right Vignette

ERIC Educational Resources Information Center

Darvin, Jacqueline

2017-01-01

Cultural Political Vignettes (CPVs) are hypothetical situations involving ethical or social dilemmas presented to students in the form of brief vignettes. They help students consider and discuss questions about ethics, society, and responsibility, and develop both skills (like critical thinking) and dispositions (like empathy) needed to be a…

Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports.

PubMed

Akuthota, Venu; Chou, Larry H; Drake, David F; Nadler, Scott F; Toledo, Santiago D

2004-03-01

This self-directed learning module discusses classic topics and highlights new advances in this area. This article discusses upper-limb sports injuries as part of a section of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on shoulder and elbow pain in the athlete. To discuss shoulder and elbow overuse injuries in sports.

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

PubMed Central

2012-01-01

Background The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds. Results When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making. PMID:23114289

Abandoning Colorblind Practice in School Counseling

ERIC Educational Resources Information Center

Smith, Lance C.; Geroski, Anne M.; Tyler, Katie B.

2014-01-01

Drawing from three case vignettes and the extant literature, the authors seek to identify, problematize, and expand the discussion on colorblind approaches to diversity within the practice of school counseling. The authors discuss how such an approach to working with students from under-represented groups subtly blames the victim, limits the…

Empowering Ethnically and Racially Diverse Clients through Prejudice Reduction: Suggestions and Strategies for Counselors.

ERIC Educational Resources Information Center

Sandhu, Daya Singh; Brown, Sherlon Pack

1996-01-01

Focuses on the persistent problems of prejudice in multicultural societies. Various theories of prejudice and other psychological, social, and political factors that contribute to prejudice are discussed. Demonstrates several counseling theories and techniques as applied to case vignettes dealing with prejudice and racism. (Author/KW)

Cerebral Venous Thrombosis after Intravenous Immunoglobulin Therapy in Immune Thrombocytopenic Purpura

PubMed Central

James, Joe; Shiji, P. V.; Radhakrishnan, Chandni

2017-01-01

A common misconception is that immune thrombocytopenic purpura (ITP) causes only bleeding diathesis. From this case vignette of a young male with ITP who had cerebral venous thrombosis, we highlight the importance of considering venous thrombosis in such patients when they present with focal cerebral signs. PMID:29307971

Use of standardized patients to assess quality of tuberculosis care: a pilot, cross-sectional study

PubMed Central

Das, Jishnu; Kwan, Ada; Daniels, Ben; Satyanarayana, Srinath; Subbaraman, Ramnath; Bergkvist, Sofi; Das, Ranendra K.; Das, Veena; Pai, Madhukar

2015-01-01

SUMMARY Background Existing studies on quality of tuberculosis care mostly reflect knowledge, not actual practice. Methods We conducted a validation study on the use of standardized patients (SPs) for assessing quality of TB care. Four cases, two for presumed TB and one each for confirmed TB and suspected MDR-TB, were presented by 17 SPs, with 250 SP interactions among 100 consenting providers in Delhi, including qualified (29%), alternative medicine (40%) and informal providers (31%). Validation criteria were: (1) negligible risk and ability to avoid adverse events for providers and SPs; (2) low detection rates of SPs by providers, and (3) data accuracy across SPs and audio verification of SP recall. We used medical vignettes to assess provider knowledge for presumed TB. Correct case management was benchmarked using Standards for TB Care in India (STCI). Findings SPs were deployed with low detection rates (4.7% of 232 interactions), high correlation of recall with audio recordings (r=0.63; 95% CI: 0.53 – 0.79), and no safety concerns. Average consultation length was 6 minutes with 6.2 questions/exams completed, representing 35% (95% confidence interval [CI]: 33%–38%) of essential checklist items. Across all cases, only 52 of 250 (21%; 95% CI: 16%–26%) were correctly managed. Correct management was higher among MBBS doctors (adjusted OR=2.41, 95% CI: 1.17–4.93) as compared to all others. Provider knowledge in the vignettes was markedly more consistent with STCI than their practice. Interpretation The SP methodology can be successfully implemented to assess TB care. Our data suggest a big gap between provider knowledge and practice. PMID:26268690

Clinical Decision-Making in Community Children’s Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment

PubMed Central

Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

2014-01-01

Background Mental health professionals’ decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective The present study explored the role of prior training in evidence-based treatments on clinicians’ assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Methods Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog “think aloud” method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. Results MANOVA results were significant for EBT training status such that EBT trained clinicians’ displayed cognitive processes more closely aligned with “expert” decision-makers and non-EBT trained clinicians’ decision processes were more similar to “novice” decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. Conclusion This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians’ decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice. PMID:25892901

Preschoolers' Problem-Solving in Sexually Abusive and Non-Sexual Situations.

ERIC Educational Resources Information Center

Grober, Jacqueline S.; And Others

This study examined the relation of social situation variables and children's gender to children's social problem solving ability in potentially unsafe situations. A total of 62 preschoolers (mean age 4.4 years) were shown a series of four vignettes. In two vignettes, an adult or a child asked a second child to cross a street. In two other…

Using Video Vignettes of Historical Episodes for Promoting Pre-Service Teachers' Ideas about the Nature of Science

ERIC Educational Resources Information Center

Cakmakci, Gultekin

2017-01-01

This study used video vignettes of historical episodes from documentary films as a context and instructional tool to promote pre-service science teachers' (PSTs) conceptions of the nature of science (NOS). The participants received explicit-reflective NOS instruction, and were introduced to techniques to be able to use scenes from documentary…

Web-based multimedia vignettes in advanced community pharmacy practice experiences.

PubMed

Flowers, Schwanda K; Vanderbush, Ross E; Hastings, Jan K; West, Donna

2010-04-12

To evaluate the effectiveness of Web-based multimedia vignettes on complex drug administration techniques to augment the training of pharmacy students in advanced community pharmacy practice experiences. During the orientation for a community APPE, students were randomly assigned to either a study group or control group After they began their APPE, students in the study group were given an Internet address to access multimedia vignettes which they were required to watch to augment their training and standardize their counseling of patients in the use of inhalers and ear and eye drops. A 12-item questionnaire was administered to students in both groups at the orientation and again on the last day of the APPE to evaluate their knowledge of counseling patients in the use of inhalers and ear and eye drops. The control group did not experience any improvement in their counseling knowledge of the research topics during their month-long experience. Students in the intervention group scored higher on their postintervention test than students in the control group (p < 0.001). Student learning outcomes from experiential training can be improved through the use of Web-based multimedia instructional vignettes.

Association of unconscious race and social class bias with vignette-based clinical assessments by medical students.

PubMed

Haider, Adil H; Sexton, Janel; Sriram, N; Cooper, Lisa A; Efron, David T; Swoboda, Sandra; Villegas, Cassandra V; Haut, Elliott R; Bonds, Morgan; Pronovost, Peter J; Lipsett, Pamela A; Freischlag, Julie A; Cornwell, Edward E

2011-09-07

Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes. A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students' explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences. Association of scores on an established IAT for race and a novel IAT for social class with vignette responses. Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%-75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%-90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was -0.49 (95% CI, -1.00 to 0.03) and for social class, the coefficient was -0.04 (95% CI, -0.50 to 0.41). Adjusted odds ratios for other vignettes ranged from 0.69 to 3.03 per unit change in IAT score, but none were statistically significant. Analysis stratified by vignette patient race or class status yielded similarly negative results. Tests for interactions between patient race or class status and student IAT D scores in predicting clinical assessments were not statistically significant. The majority of first-year medical students at a single school had IAT scores consistent with implicit preference for white persons and possibly for those in the upper class. However, overall vignette-based clinical assessments were not associated with patient race or occupation, and no association existed between implicit preferences and the assessments.

Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students

PubMed Central

Haider, Adil H.; Sexton, Janel; Sriram, N.; Cooper, Lisa A.; Efron, David T.; Swoboda, Sandra; Villegas, Cassandra V.; Haut, Elliott R.; Bonds, Morgan; Pronovost, Peter J.; Lipsett, Pamela A.; Freischlag, Julie A.; Cornwell, Edward E.

2012-01-01

Context Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. Objective To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes. Design, Setting, and Participants A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students’ explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences. Main Outcome Measures Association of scores on an established IAT for race and a novel IAT for social class with vignette responses. Results Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%–75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%–90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was −0.49 (95% CI, −1.00 to 0.03) and for social class, the coefficient was −0.04 (95% CI, −0.50 to 0.41). Adjusted odds ratios for other vignettes ranged from 0.69 to 3.03 per unit change in IAT score, but none were statistically significant. Analysis stratified by vignette patient race or class status yielded similarly negative results. Tests for interactions between patient race or class status and student IAT D scores in predicting clinical assessments were not statistically significant. Conclusions The majority of first-year medical students at a single school had IAT scores consistent with implicit preference for white persons and possibly for those in the upper class. However, overall vignette-based clinical assessments were not associated with patient race or occupation, and no association existed between implicit preferences and the assessments. PMID:21900134

First Equals Most Important? Order Effects in Vignette-Based Measurement

ERIC Educational Resources Information Center

Auspurg, Katrin; Jäckle, Annette

2017-01-01

To measure what determines people's attitudes, definitions, or decisions, surveys increasingly ask respondents to judge vignettes. A vignette typically describes a hypothetical situation or object as having various attributes (dimensions). In factorial surveys, the values (levels) of dimensions are experimentally varied, so that their impact on…

[Characteristics of interactions between mentally ill parents and their young children].

PubMed

Deneke, Christiane; Lüders, Bettina

2003-03-01

Disturbed parent infant interactions are frequently seen in cases of parental mental illness. They are indicating possible risks of the infant's development. Regular and illness-specific patterns are not found. Therefore the interaction has to be observed and classified in each individual case to recognize the relevance of the parental illness to the child. Different interaction patterns and their impact on the child's development are described and illustrated by case vignettes. The importance of preventive intervention is highlighted.

Beliefs About Help Seeking for Mental Disorders: Findings From a Mental Health Literacy Study in Singapore.

PubMed

Picco, Louisa; Abdin, Edimansyah; Chong, Siow Ann; Pang, Shirlene; Vaingankar, Janhavi A; Sagayadevan, Vathsala; Kwok, Kian Woon; Subramaniam, Mythily

2016-11-01

This study investigated beliefs about help seeking, treatment options, and expected outcomes for alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD), and schizophrenia, by using a vignette-based approach. The Mind Matters study was a comprehensive, population-based, cross-sectional survey conducted among Singapore residents (N=3,006) ages 18 to 65 to establish the level of mental health literacy. Questions were asked about whom the person in the vignette should seek help from, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. "Talk to family or friends" was the most common source of help recommended for alcohol abuse (30.1%), depression (54.2%), and schizophrenia (21.5%), and "see a doctor or general practitioner" was the most recommended for dementia (53.8%) and OCD (26.8%). Help-seeking preferences were significantly associated with age, gender, ethnicity, and income and with having a personal experience of or knowing someone with a mental disorder similar to that described in the vignette. Respondents rated seeing a psychiatrist as the most helpful intervention (88.4%) and dealing with the problem on his or her own as the most harmful (64.6%). Most respondents (79.3%) indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. Most respondents recommended seeking help for mental disorders from informal sources, such as family and friends. Targeted intervention strategies to improve mental health literacy related to help seeking, treatment beliefs, and effectiveness of evidence-based treatments are needed in Singapore.

Comparing Vignette Instruction and Assessment Tasks to Classroom Observations and Reflections

ERIC Educational Resources Information Center

Jeffries, Carolyn; Maeder, Dale W.

2011-01-01

The growing body of research on the use of vignettes in teacher education courses suggests that vignette-based instruction and assessment tasks may represent a viable alternative to traditional forms of scaffolded instruction and reflective essays following classroom observations, thereby creating a bridge between college and K-12 classrooms for…

Using Anchoring Vignettes to Adjust Self-Reported Personality: A Comparison Between Countries

PubMed Central

Weiss, Selina; Roberts, Richard D.

2018-01-01

Data from self-report tools cannot be readily compared between cultures due to culturally specific ways of using a response scale. As such, anchoring vignettes have been proposed as a suitable methodology for correcting against this difference. We developed anchoring vignettes for the Big Five Inventory-44 (BFI-44) to supplement its Likert-type response options. Based on two samples (Rwanda: n = 423; Philippines: n = 143), we evaluated the psychometric properties of the measure both before and after applying the anchoring vignette adjustment. Results show that adjusted scores had better measurement properties, including improved reliability and a more orthogonal correlational structure, relative to scores based on the original Likert scale. Correlations of the Big Five Personality Factors with life satisfaction were essentially unchanged after the vignette-adjustment while correlations with counterproductive were noticeably lower. Overall, these changed findings suggest that the use of anchoring vignette methodology improves the cross-cultural comparability of self-reported personality, a finding of potential interest to the field of global workforce research and development as well as educational policymakers. PMID:29593621

The spectrum of psychosis in multiple sclerosis: a clinical case series

PubMed Central

Gilberthorpe, Thomas G; O’Connell, Kara E; Carolan, Alison; Silber, Eli; Brex, Peter A; Sibtain, Naomi A; David, Anthony S

2017-01-01

Psychosis in the context of multiple sclerosis (MS) has previously been reported as a rare occurrence. However, recent epidemiological studies have found prevalence rates of psychosis in MS that are two to three times higher than those in the general population. Untreated psychosis in patients with MS can adversely impact on adherence to MS medication, levels of disability, and quality of life. This retrospective case series describes the spectrum of psychotic disorders occurring in association with MS using demographic, clinical, and neuroimaging data. In the discussion, we highlight the particular diagnostic and treatment challenges that such disorders can pose for clinicians and through our case vignettes provide examples of potential interventions for this complex patient population. PMID:28203081

Anchoring Vignettes in EQ-5D-5L Questionnaire: Validation of a New Instrument.

PubMed

Azzolina, Danila; Minto, Clara; Boschetto, Stefania; Martinato, Matteo; Bauce, Barbara; Iliceto, Sabino; Gregori, Dario

2017-01-01

Health Related Quality of Life (HRQoL) is an indicator of patient's physical, psychological and social life. HRQoL is influenced by experience, beliefs, perceptions and expectations, and measures subjective perspective of the patient himself. EQ-5D-5L and SF-12 questionnaires are validated instruments useful to measure HRQoL, increasingly administered in electronic formats. The main purpose is to evaluate the feasibility of anchoring vignettes for the EQ-5D-5L questionnaire, with the aim to improve intergroup comparability of responses among different subjects. A comparison with SF-12 questionnaire is carried out. This is a cross-sectional study conducted at the ambulatories of cardiology of the University Hospital of Padova, in Italy. Thirty-eight subjects with a diagnosis of cardiovascular disease or at risk of cardiovascular disease were enrolled. A factorial analysis has been performed to assess the convergent validity of EQ-5D-5L questionnaire compared to Sf-12. Moreover, a compound Hierarchical Ordered Probit (Chopit) model has been estimated to evaluate if the questionnaire form affects the subjective evaluation process in order to compare EQ-5D-5L with and without vignettes. Correlation and factor analysis demonstrate that EQ_5D questionnaire is coherent with SF-12 in paper format. Chopit model estimation shows that questionnaire format does not affect the subjective question interpretation. Moreover, in a parametric model including vignettes, education attainment, disease severity, and gender are predictors of HRQoL status. The EQ-5D including vignettes in electronic format seems to be a valid tool to measure HRQoL as compared to EQ-5D without vignettes in paper format and to SF-12 questionnaire.

Conceptions of mental illness: attitudes of mental health professionals and the general public.

PubMed

Stuber, Jennifer P; Rocha, Anita; Christian, Ann; Link, Bruce G

2014-04-01

The authors compared attitudes of the U.S. general public and of mental health professionals about the competence and perceived dangerousness of people with mental health problems and the desire for social distance from them. Factors related to negative attitudes and the desire for social distance also were examined. Vignettes describing individuals meeting DSM-IV criteria for major depression and schizophrenia were included in the 2006 General Social Survey (GSS) and a 2009 study of mental health professionals, and responses were descriptively compared (GSS, N=397 responses to depression vignette, N=373 responses to schizophrenia vignette; 731 mental health professionals responded to both vignettes). Regression analyses examined whether demographic and provider characteristics were associated with perceptions of less competence and perceived dangerousness of the vignette character and with respondents' desire for social distance. Compared with the American public, mental health professionals had significantly more positive attitudes toward people with mental health problems. However, some providers' conceptions about the dangerousness of people with schizophrenia and provider desire for social distance from clients in work and personal situations were concerning. Younger age, self-identifying as non-Hispanic white, being female, having at least a four-year college degree, being familiar with mental illness, and certain job titles and more years of experience in the mental health field were predictive of more positive conceptions. Although mental health professionals held more positive attitudes than the general public about people with mental health problems, strong stereotypes persisted in both groups, especially concerning schizophrenia. This study identified several demographic and provider characteristics that can inform intervention strategies in both groups.

College students' perceptions of peers with autism spectrum disorder.

PubMed

Matthews, Nicole L; Ly, Agnes R; Goldberg, Wendy A

2015-01-01

Little is known about peer attitudes toward college students with autism spectrum disorder (ASD). Affective, behavioral, and cognitive attitudes toward vignette characters displaying behaviors characteristic of ASD were examined among 224 four-year university students who were randomly assigned to one of three labeling conditions for the primary vignette characters: high functioning autism (HFA), typical college student, or no label. Students in the HFA label condition reported more positive behavioral and cognitive attitudes toward the vignette characters than students in the no label condition. Male students and students with lower scores on the Broad Autism Phenotype Questionnaire reported more positive attitudes across study conditions. These experimental results suggest that knowledge of a diagnosis might improve attitudes toward college students with ASD.

Knowledge of binge eating disorder: a cross-sectional survey of physicians in the United States.

PubMed

Supina, Dylan; Herman, Barry K; Frye, Carla B; Shillington, Alicia C

2016-01-01

Binge eating disorder (BED)--now a designated disorder in the DSM-5--is the most prevalent eating disorder (ED), affecting 2-3% of the US population. This survey of US physicians assesses how BED is diagnosed, treated and referred. Internists, family practitioners, obstetrics/gynecologist (OB/GYNs) and psychiatrists were randomly selected from a nationally-representative panel. Participants completed an online survey and reviewed case vignettes consistent with DSM-5-defined BED, then answered questions to elicit whether they would assess for psychiatric conditions including EDs. Those reporting they would screen and who correctly identified BED in vignettes received additional questions about BED diagnosis, treatment, and referral patterns. Of 278 physicians surveyed, 96% were board-certified and 87% had practiced >10 years. 23% were psychiatrists, 27% family practitioners, 31% internists and 19% OB/GYNs. 92% were 'somewhat likely' to screen for ED after reviewing DSM-5-consistent vignettes. 206 (74%) correctly identified BED. Of these, 33% and 68% reported they proactively screen eating habits for all patients and obese patients, respectively. 10% reported not screening eating habits even in the presence of ED symptoms. Fewer than half reported using DSM criteria in Diagnosing BED, and 56 (27%) did not recognize BED to be a discreet ED. Although ED awareness is improving, understanding BED as a distinct ED is lacking, which may result in low rates of screening and diagnosis. This study illustrates how taking a complete patient history (including probing BED characteristics) may be an effective first-line strategy for clinicians to facilitate optimal care for these patients.

Negative attributions towards people with substance use disorders in South Africa: variation across substances and by gender.

PubMed

Sorsdahl, Katherine; Stein, Dan J; Myers, Bronwyn

2012-08-07

Little research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution. A convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents' attitudes towards the specific cases were investigated. Respondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less "dangerous" than the alcohol vignette. Respondents were more likely to offer "help" to women who use alcohol, but more likely to suggest "coercion into treatment" for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances. The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.

Recognizing mania in children and adolescents-age does not matter, but decreased need for sleep does.

PubMed

Meyer, Thomas D; Fuhr, Kristina; Hautzinger, Martin; Schlarb, Angelika A

2011-01-01

The diagnosis of pediatric bipolar disorders is a controversial topic. If this is mainly due to a bias against a diagnosis in younger children, then just changing the information about the age of a patient should influence the likelihood of a diagnosis despite otherwise identical symptoms. Therefore, we designed a study to test if the age of a patient will influence diagnostic decisions. We further attempted to replicate an earlier result with regard to "decreased need for sleep" as a salient symptom for mania. We randomly sent 1 of 4 case vignettes describing a person with current mania to child/adolescents psychiatrists in Germany. This vignette was systematically varied with respect to age of the patient (6 vs 16 years) and the presence/absence of decreased need for sleep but always included sufficient criteria to diagnose a mania. One hundred sixteen responded and, overall, 63.8% of the respondents diagnosed a bipolar disorder in the person described in the vignette. Although age did not affect the likelihood of a bipolar diagnosis, the presence of decreased need for sleep did increase its likelihood. Furthermore, the number of core symptoms identified by the clinicians was closely linked to the likelihood of assigning a bipolar diagnosis. Certain symptoms such as the decreased need for sleep, and also elated mood and grandiosity, seem to be salient for some clinicians and influence their diagnoses. Biological age of the patient, however, does not seem to cause a systematic bias against a diagnosis of bipolar disorder in children. Copyright © 2011 Elsevier Inc. All rights reserved.

Explicit-Reflective Teaching Nature of Science as Embedded within the Science Topic: Interactive Historical Vignettes Technique

ERIC Educational Resources Information Center

Nur, Erdogan Melek; Fitnat, Koseoglu

2015-01-01

It is obvious that more extensive work is needed in developing historical materials that address nature of science (NOS) concepts that will be implemented by teachers. Owing to the importance of meeting this need, research problem of this study is to design historical vignettes focused on the concept of chemical equilibrium which lies at the heart…

The Influence of Length of Marriage and Fidelity Status on Perception of Marital Rape

ERIC Educational Resources Information Center

Munge, Bethany A.; Pomerantz, Andrew M.; Pettibone, Jonathan C.; Falconer, Jameca W.

2007-01-01

To what extent does the length of the marriage or the wife's faithfulness to the husband influence the perception of responsibility or trauma in marital rape? In the current study, each participant was presented with one of four marital rape vignettes. The vignettes varied only in the length of the marriage (3 years or 15 years) and the fidelity…

Children's Event Reports: Factors Affecting Responses to Repeated Questions in Vignette Scenarios and Event Recall Interviews

ERIC Educational Resources Information Center

Howie, Pauline; Nash, Laura; Kurukulasuriya, Nadezhda; Bowman, Alison

2012-01-01

When adults repeat questions, children often give inconsistent answers. This study aimed to test the claim that these inconsistencies occur because children infer that their first answer was unsatisfactory, and that the adult expects them to change their answer. Children aged 4, 6, and 8 years (N= 134) were asked about vignettes in which an adult…

A case study of effective practice in mathematics teaching and learning informed by Valsiner's zone theory

NASA Astrophysics Data System (ADS)

Geiger, Vince; Anderson, Judy; Hurrell, Derek

2017-02-01

The characteristics that typify an effective teacher of mathematics and the environments that support effective teaching practices have been a long-term focus of educational research. In this article we report on an aspect of a larger study that investigated `best practice' in mathematics teaching and learning across all Australian states and territories. A case study from one Australian state was developed from data collected via classroom observations and semi-structured interviews with school leaders and teachers and analysed using Valsiner's zone theory. A finding of the study is that `successful' practice is strongly tied to school context and the cultural practices that have been developed by school leaders and teachers to optimise student learning opportunities. We illustrate such an alignment of school culture and practice through a vignette based on a case of one `successful' school.

Therapists' perspectives on optimal treatment for pathological narcissism.

PubMed

Kealy, David; Goodman, Geoff; Rasmussen, Brian; Weideman, Rene; Ogrodniczuk, John S

2017-01-01

This study used Q methodology to explore clinicians' perspectives regarding optimal psychotherapy process in the treatment of pathological narcissism, a syndrome of impaired self-regulation. Participants were 34 psychotherapists of various disciplines and theoretical orientations who reviewed 3 clinical vignettes portraying hypothetical cases of grandiose narcissism, vulnerable narcissism, and panic disorder without pathological narcissism. Participants then used the Psychotherapy Process Q set, a 100-item Q-sort instrument, to indicate their views regarding optimal therapy process for each hypothetical case. By-person principal components analysis with varimax rotation was conducted on all 102 Q-sorts, revealing 4 components representing clinicians' perspectives on ideal therapy processes for narcissistic and non-narcissistic patients. These perspectives were then analyzed regarding their relationship to established therapy models. The first component represented an introspective, relationally oriented therapy process and was strongly correlated with established psychodynamic treatments. The second component, most frequently endorsed for the panic disorder vignette, consisted of a cognitive and alliance-building approach that correlated strongly with expert-rated cognitive-behavioral therapy. The third and fourth components involved therapy processes focused on the challenging interpersonal behaviors associated with narcissistic vulnerability and grandiosity, respectively. The perspectives on therapy processes that emerged in this study reflect different points of emphasis in the treatment of pathological narcissism, and may serve as prototypes of therapist-generated approaches to patients suffering from this issue. The findings suggest several areas for further empirical inquiry regarding psychotherapy with this population. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Public Stigma towards Older Adults with Depression: Findings from the São Paulo-Manaus Elderly in Primary Care Study

PubMed Central

Kester, Rachel; Braga, Patrícia Emília; Peluso, Érica T. P.; Blay, Sérgio L.; R. Menezes, Paulo; E. Ribeiro, Euler

2016-01-01

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment. PMID:27352293

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997.

PubMed

Uhlenhuth, E H; Balter, M B; Ban, T A; Yang, K

1999-01-01

To assemble expert clinical experience and judgment regarding the treatment of anxiety disorders in a systematic, quantitative manner, particularly with respect to changes during the preceding five years. A panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997. This report focuses on the experts' responses to questions about therapeutic options relevant to seven vignettes describing typical cases of different anxiety disorders. The preferred initial treatment strategy in 1992 was a combination of medication with a psychological therapy for all vignettes except simple phobia, where a psychological procedure alone was favored. There was little change in 1997, primarily some decrease in the choice of psychological therapy and some increase in the choice of medication for social phobia. Experts recommending a medication in 1992 most often chose as first-line treatment a benzodiazepine anxiolytic (BZ) for panic disorder (PD), generalized anxiety disorder (GAD), simple phobia, and adjustment disorder. They recommended a beta-blocker most often for social phobia and a tricyclic anti-depressant (TCA) for agoraphobia and obsessive-compulsive disorder (OCD). Nearly a fourth chose a combination of medications, usually a TCA plus a BZ. In 1997, the expert panel's most frequent recommendation for agoraphobia, PD, and OCD changed to a specific serotonin reuptake inhibitor (SSRI); and they also recommended these compounds more often for GAD, social phobia, and simple phobia. Fewer experts chose BZs or TCAs. However, in 1997 many again chose a combination of medications, often a BZ plus a SSRI, so that, overall, there was only a small decline in recommendations for BZs. As second-line medications (1997 only), the experts recommended SSRIs most often for most vignettes, but a TCA for PD and GAD. Recommendations for a combination of medications rose substantially for most vignettes, usually a BZ plus an antidepressant. Combined cognitive-behavioral therapy plus medication was highly favored by the experts as the initial treatment strategy for anxiety disorders. During the preceding five years, SSRIs displaced older antidepressants as the experts' first-line choices for the pharmacotherapy of anxiety disorders. In case of an unsatisfactory response, the experts' second-line choices more often were an older antidepressant or a combination of an antidepressant plus a BZ. According to the experts' judgements, the BZs, especially combined with an antidepressant, remain mainstays of pharmacotherapy for anxiety disorders.

Ageism and Intervention: What Social Work Students Believe about Treating People Differently Because of Age

ERIC Educational Resources Information Center

Kane, Michael

2004-01-01

BSW and MSW students randomly completed one of two vignettes that were identical with the exception of the age of the vignette's subject. Following the vignette, respondents responded to 16 bio-psycho-social assessment and intervention items relating to health, illness, aging, and death. The multivariate analysis of variance was significant…

Ageism and Intervention: What Social Work Students Believe about Treating People Differently because of Age

ERIC Educational Resources Information Center

Kane, Michael N.

2004-01-01

BSW and MSW students randomly completed one of two vignettes that were identical with the exception of the age of the vignette's subject. Following the vignette, respondents responded to 16 bio-psycho-social assessment and intervention items relating to health, illness, aging, and death. The multivariate analysis of variance was significant…

Effects of Race and Precipitating Event on Suicide versus Nonsuicide Death Classification in a College Sample

ERIC Educational Resources Information Center

Walker, Rheeda L.; Flowers, Kelci C.

2011-01-01

Race group differences in suicide death classification in a sample of 109 Black and White university students were examined. Participants were randomly assigned to read three vignettes for which the vignette subjects' race (only) varied. The vignettes each described a circumstance (terminal illness, academic failure, or relationship difficulties)…

Acceptance and Commitment Therapy (ACT) as a Career Counselling Strategy

ERIC Educational Resources Information Center

Hoare, P. Nancey; McIlveen, Peter; Hamilton, Nadine

2012-01-01

Acceptance and commitment therapy (ACT) has potential to contribute to career counselling. In this paper, the theoretical tenets of ACT and a selection of its counselling techniques are overviewed along with a descriptive case vignette. There is limited empirical research into ACT's application in career counselling. Accordingly, a research agenda…

Pharmacological Management of Bipolar Disorder in a Youth with Diabetes

ERIC Educational Resources Information Center

DelBello, Melissa P.; Correll, Christoph U.; Carlson, Gabrielle A.; Carlson, Harold E.; Kratochvil, Christopher J.

2007-01-01

In this article, four clinicians respond to the following case vignette: A 12-year-old girl with insulin-dependent diabetes presents for treatment of her newly diagnosed bipolar disorder. How would you address the bipolar disorder pharmacologically, and how would the presence of diabetes affect your selection of medication and clinical management?

The Difference That Differences Make: Adolescent Diversity and Its Deregulation.

ERIC Educational Resources Information Center

Levine, Melvin D.

This document discusses the differences in maturity of late adolescents, aged 16 to 21, and how lack of readiness by some adolescents has a major impact upon communities and upon the individual. The document illustrates the tension between individuation and regulation with five vignettes of actual cases. Sources of variation, including biological…

Affect Regulation, Mirror Neurons, and the Third Hand: Formulating Mindful Empathic Art Interventions

ERIC Educational Resources Information Center

Franklin, Michael

2010-01-01

Visual empathy through empathic art interventions are discussed in this article with respect to attachment theory; recent research on the mirror neuron system; art, empathy, and mindfulness; and an artistic strategy for crafting third-hand interventions (Kramer, 1986). A case vignette demonstrates the art therapist's applied use of visual art…

Classification Trees for Quality Control Processes in Automated Constructed Response Scoring.

ERIC Educational Resources Information Center

Williamson, David M.; Hone, Anne S.; Miller, Susan; Bejar, Isaac I.

As the automated scoring of constructed responses reaches operational status, the issue of monitoring the scoring process becomes a primary concern, particularly when the goal is to have automated scoring operate completely unassisted by humans. Using a vignette from the Architectural Registration Examination and data for 326 cases with both human…

Clinical Approach to the Heavy Cannabis User in the Age of Medical Marijuana.

PubMed

Cermak, Timmen L

2016-01-01

This article begins with a case vignette exemplifying the common clinical problem of heavy marijuana users. The epidemiology and basic science underlying cannabis dependence is outlined, followed by clinical strategies for basing a therapeutic alliance on known research findings and using motivational interviewing to deal with typical patterns of denial.

Development of cognitive processing and judgments of knowledge in medical students: Analysis of progress test results.

PubMed

Cecilio-Fernandes, Dario; Kerdijk, Wouter; Jaarsma, A D Debbie C; Tio, René A

2016-11-01

Beside acquiring knowledge, medical students should also develop the ability to apply and reflect on it, requiring higher-order cognitive processing. Ideally, students should have reached higher-order cognitive processing when they enter the clinical program. Whether this is the case, is unknown. We investigated students' cognitive processing, and awareness of their knowledge during medical school. Data were gathered from 347 first-year preclinical and 196 first-year clinical students concerning the 2008 and 2011 Dutch progress tests. Questions were classified based upon Bloom's taxonomy: "simple questions" requiring lower and "vignette questions" requiring higher-order cognitive processing. Subsequently, we compared students' performance and awareness of their knowledge in 2008 to that in 2011 for each question type. Students' performance on each type of question increased as students progressed. Preclinical and first-year clinical students performed better on simple questions than on vignette questions. Third-year clinical students performed better on vignette questions than on simple questions. The accuracy of students' judgment of knowledge decreased over time. The progress test is a useful tool to assess students' cognitive processing and awareness of their knowledge. At the end of medical school, students achieved higher-order cognitive processing but their awareness of their knowledge had decreased.

The more information, the more negative stigma towards schizophrenia: Brazilian general population and psychiatrists compared.

PubMed

Loch, Alexandre Andrade; Hengartner, Michael Pascal; Guarniero, Francisco Bevilacqua; Lawson, Fabio Lorea; Wang, Yuan-Pang; Gattaz, Wagner Farid; Rössler, Wulf

2013-02-28

Findings on stigmatizing attitudes toward individuals with schizophrenia have been inconsistent in comparisons between mental health professionals and members of the general public. In this regard, it is important to obtain data from understudied sociocultural settings, and to examine how attitudes toward mental illness vary in such settings. Nationwide samples of 1015 general population individuals and 1414 psychiatrists from Brazil were recruited between 2009 and 2010. Respondents from the general population were asked to identify an unlabeled schizophrenia case vignette. Psychiatrists were instructed to consider "someone with stabilized schizophrenia". Stereotypes, perceived prejudice and social distance were assessed. For the general population, stigma determinants replicated findings from the literature. The level of the vignette's identification constituted an important correlate. For psychiatrists, determinants correlated in the opposite direction. When both samples were compared, psychiatrists showed the highest scores in stereotypes and perceived prejudice; for the general population, the better they recognized the vignette, the higher they scored in those dimensions. Psychiatrists reported the lowest social distance scores compared with members of the general population. Knowledge about schizophrenia thus constituted an important determinant of stigma; consequently, factors influencing stigma should be further investigated in the general population and in psychiatrists as well. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.

PubMed

Schmidt, H G; Van Gog, Tamara; Schuit, Stephanie Ce; Van den Berge, Kees; Van Daele, Paul L; Bueving, Herman; Van der Zee, Tim; Van den Broek, Walter W; Van Saase, Jan L; Mamede, Sílvia

2017-01-01

Literature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of the present experiment was to study the effect of such difficult patients' behaviours on doctors' diagnostic performance. We created six vignettes in which patients were depicted as difficult (displaying distressing behaviours) or neutral. Three clinical cases were deemed to be diagnostically simple and three deemed diagnostically complex. Sixty-three family practice residents were asked to evaluate the vignettes and make the patient's diagnosis quickly and then through deliberate reflection. In addition, amount of time needed to arrive at a diagnosis was measured. Finally, the participants rated the patient's likability. Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than for neutral patients (0.54 vs 0.64; p=0.017). Overall diagnostic accuracy was higher for simple than for complex cases. Deliberate reflection upon the case improved initial diagnostic, regardless of case complexity and of patient behaviours (0.60 vs 0.68, p=0.002). Amount of time needed to diagnose the case was similar regardless of the patient's behaviour. Finally, average likability ratings were lower for difficult than for neutral-patient cases. Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

School Superintendents' Perceptions of Ethically Just Responses to a Teacher Sexting Vignette: Severity of Administrator Response, Superintendent Personality, and Offender Gender and Race

ERIC Educational Resources Information Center

Adams, Michael W.

2012-01-01

This study focused on the perceived ethics of the decisions superintendents make in response to a situation with a teacher that was value-laden, potentially volatile, and potentially affected by the teachers' gender or ethnicity. Superintendents (N = 123) each read one of 12 versions of a vignette depicting a sexting incident between a…

All framing effects are not created equal: Low convergent validity between two classic measurements of framing

PubMed Central

Zhen, Shanshan; Yu, Rongjun

2016-01-01

Human risk-taking attitudes can be influenced by two logically equivalent but descriptively different frames, termed the framing effect. The classic hypothetical vignette-based task (Asian disease problem) and a recently developed reward-based gambling task have been widely used to assess individual differences in the framing effect. Previous studies treat framing bias as a stable trait that has genetic basis. However, these two paradigms differ in terms of task domain (loss vs. gain) and task context (vignette-based vs. reward-based) and the convergent validity of these measurements remains unknown. Here, we developed a vignette-based task and a gambling task in both gain and loss domains and tested correlations of the framing effect among these tasks in 159 young adults. Our results revealed no significant correlation between the vignette-based task in the loss domain and the gambling task in the gain domain, indicating low convergent validity. The current findings raise the question of how to measure the framing effect precisely, especially in individual difference studies using large samples and expensive neuroscience methods. Our results suggest that the framing effect is influenced by both task domain and task context and future research should be cautious about the operationalization of the framing effect. PMID:27436680

All framing effects are not created equal: Low convergent validity between two classic measurements of framing.

PubMed

Zhen, Shanshan; Yu, Rongjun

2016-07-20

Human risk-taking attitudes can be influenced by two logically equivalent but descriptively different frames, termed the framing effect. The classic hypothetical vignette-based task (Asian disease problem) and a recently developed reward-based gambling task have been widely used to assess individual differences in the framing effect. Previous studies treat framing bias as a stable trait that has genetic basis. However, these two paradigms differ in terms of task domain (loss vs. gain) and task context (vignette-based vs. reward-based) and the convergent validity of these measurements remains unknown. Here, we developed a vignette-based task and a gambling task in both gain and loss domains and tested correlations of the framing effect among these tasks in 159 young adults. Our results revealed no significant correlation between the vignette-based task in the loss domain and the gambling task in the gain domain, indicating low convergent validity. The current findings raise the question of how to measure the framing effect precisely, especially in individual difference studies using large samples and expensive neuroscience methods. Our results suggest that the framing effect is influenced by both task domain and task context and future research should be cautious about the operationalization of the framing effect.

"I Have Just Understood It from the Story …": Using Vignettes in Educational Research to Investigate Cultural Tolerance

ERIC Educational Resources Information Center

Al Sadi, Fatma H.; Basit, Tehmina N.

2017-01-01

The vignettes approach has emerged as a popular tool in quantitative and qualitative research. It has proven to be particularly effective in measuring sensitive topics. This paper focuses on the construction and validation process of questionnaire-based vignettes, which were used as an instrument to examine Omani secondary school girls' cultural…

Community beliefs about treatments and outcomes of mental disorders: a mental health literacy survey in a rural area of Maharashtra, India.

PubMed

Kermode, M; Bowen, K; Arole, S; Joag, K; Jorm, A F

2009-07-01

Mental health remains a neglected issue in most developing countries, especially in rural areas where access to effective mental health services is limited. The integration of mental health into primary health care is being promoted as a strategy to address this problem. Consequently, there is an urgent need to enhance mental health awareness among communities, and to provide mental health training for primary healthcare staff. In order to do this effectively, it is important to understand and take account of local views on mental health and illness. As such, a mental health literacy (MHL) assessment was undertaken in a poor, rural area of Maharashtra, India to inform the development of a mental health training programme. A cross-sectional MHL survey was undertaken in late 2007. Data were collected from 240 systematically sampled community members and 60 purposively sampled village health workers (VHWs) using an interviewer-administered questionnaire. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked to name the problems, and to identify the treatments and people that were most likely to be helpful (or otherwise), and the likely outcomes for people with such problems. Most participants recognized that the people in the vignettes were experiencing a mental health problem. 'Depression' was the most common label for the problems experienced in the depression vignette, and 'a mind/brain problem' was the most common label in the case of the psychosis vignette. Socio-economic interventions provided by family, friends and neighbours were considered to be most helpful. Local VHWs and doctors were also viewed as potentially helpful, but psychiatrists less so. Approximately half of the sample thought that dealing with the problem alone would be helpful. Special diets, tonics, appetite stimulants and sleeping pills were also strongly endorsed, but awareness of psychiatric medications was negligible. The findings from this study highlight the need to enhance MHL in this community. Additionally, there is a need to build the capacity of the primary healthcare staff, including the VHWs, so that they are equipped to provide an effective local response for people experiencing mental health problems.

Standardisation of information submitted to an endpoint committee for cause of death assignment in a cancer screening trial – lessons learnt from CAP (Cluster randomised triAl of PSA testing for Prostate cancer).

PubMed

Williams, Naomi J; Hill, Elizabeth M; Ng, Siaw Yein; Martin, Richard M; Metcalfe, Chris; Donovan, Jenny L; Evans, Simon; Hughes, Laura J; Davies, Charlotte F; Hamdy, Freddie C; Neal, David E; Turner, Emma L

2015-01-23

In cancer screening trials where the primary outcome is target cancer-specific mortality, the unbiased determination of underlying cause of death (UCD) is crucial. To minimise bias, the UCD should be independently verified by expert reviewers, blinded to death certificate data and trial arm. We investigated whether standardising the information submitted for UCD assignment in a population-based randomised controlled trial of prostate-specific antigen (PSA) testing for prostate cancer reduced the reviewers' ability to correctly guess the trial arm. Over 550 General Practitioner (GP) practices (>415,000 men aged 50-69 years) were cluster-randomised to PSA testing (intervention arm) or the National Health Service (NHS) prostate cancer risk management programme (control arm) between 2001 and 2007. Assignment of UCD was by independent reviews of researcher-written clinical vignettes that masked trial arm and death certificate information. A period of time after the process began (the initial phase), we analysed whether the reviewers could correctly identify trial arm from the vignettes, and the reasons for their choice. This feedback led to further standardisation of information (second phase), after which we re-assessed the extent of correct identification of trial arm. 1099 assessments of 509 vignettes were completed by January 2014. In the initial phase (n = 510 assessments), reviewers were unsure of trial arm in 33% of intervention and 30% of control arm assessments and were influenced by symptoms at diagnosis, PSA test result and study-specific criteria. In the second phase (n = 589), the respective proportions of uncertainty were 45% and 48%. The percentage of cases whereby reviewers were unable to determine the trial arm was greater following the standardisation of information provided in the vignettes. The chances of a correct guess and an incorrect guess were equalised in each arm, following further standardisation. It is possible to mask trial arm from cause of death reviewers, by using their feedback to standardise the information submitted to them. ISRCTN92187251.

How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India.

PubMed

Panda, Bhuputra; Pati, Sanghamitra; Nallala, Srinivas; Chauhan, Abhimanyu S; Anasuya, Anita; Som, Meena; Zodpey, Sanjay

2015-01-01

Routine immunization (RI) is a key child survival intervention. Ensuring acceptable standards of RI service delivery is critical for optimal outcomes. Accumulated evidences suggest that 'supportive supervision' improves the quality of health care services in general. During 2009-2010, the Government of Odisha and UNICEF jointly piloted this strategy in four districts to improve RI program outcomes. The present study aims to assess the effect of this strategy on improvement of skills and practices at immunization session sites. A quasi-experimental 'post-test only' study design was adopted to compare the opinion and practices of frontline health workers and their supervisors in four intervention districts (IDs) with two control districts (CDs). Altogether, we interviewed 111 supervisor-supervisee (health worker) pairs using semi-structured interview schedules and case vignettes. We also directly observed health workers' practices during immunization sessions at 111 sites. Data were analyzed with SPSS version 16.0. The mean knowledge score of supervisors in CDs was significantly higher than in intervention groups. Variegated responses were obtained on case vignettes. The control group performed better in solving certain hypothetically asked problems, whereas the intervention group scored better in others. Health workers in IDs gave a lower rating to their respective supervisors' knowledge, skill, and frequency of supervision. Logistics and vaccine availability were better in CDs. Notwithstanding other limitations, supportive supervision may not have independent effects on improving the quality of immunization services. Addressing systemic issues, such as the availability of essential logistics, supply chain management, timely indenting, and financial resources, could complement the supportive supervision strategy in improving immunization service delivery.

Preferences for cancer investigation: a vignette-based study of primary-care attendees.

PubMed

Banks, Jonathan; Hollinghurst, Sandra; Bigwood, Lin; Peters, Tim J; Walter, Fiona M; Hamilton, Willie

2014-02-01

The UK lags behind many European countries in terms of cancer survival. Initiatives to address this disparity have focused on barriers to presentation, symptom recognition, and referral for specialist investigation. Selection of patients for further investigation has come under particular scrutiny, although preferences for referral thresholds in the UK population have not been studied. We investigated preferences for diagnostic testing for colorectal, lung, and pancreatic cancers in primary-care attendees. In a vignette-based study, researchers recruited individuals aged at least 40 years attending 26 general practices in three areas of England between Dec 6, 2011, and Aug 1, 2012. Participants completed up to three of 12 vignettes (four for each of lung, pancreatic, and colorectal cancers), which were randomly assigned. The vignettes outlined a set of symptoms, the risk that these symptoms might indicate cancer (1%, 2%, 5%, or 10%), the relevant testing process, probable treatment, possible alternative diagnoses, and prognosis if cancer were identified. Participants were asked whether they would opt for diagnostic testing on the basis of the information in the vignette. 3469 participants completed 6930 vignettes. 3052 individuals (88%) opted for investigation in their first vignette. We recorded no strong evidence that participants were more likely to opt for investigation with a 1% increase in risk of cancer (odds ratio [OR] 1·02, 95% CI 0·99-1·06; p=0·189), although the association between risk and opting for investigation was strong when colorectal cancer was analysed alone (1·08, 1·03-1·13; p=0·0001). In multivariable analysis, age had an effect in all three cancer models: participants aged 60-69 years were significantly more likely to opt for investigation than were those aged 40-59 years, and those aged 70 years or older were less likely. Other variables associated with increased likelihood of opting for investigation were shorter travel times to testing centre (colorectal and lung cancers), a family history of cancer (colorectal and lung cancers), and higher household income (colorectal and pancreatic cancers). Participants in our sample expressed a clear preference for diagnostic testing at all risk levels, and individuals want to be tested at risk levels well below those stipulated by UK guidelines. This willingness should be considered during design of cancer pathways, particularly in primary care. The public engagement with our study should encourage general practitioners to involve patients in referral decision making. The National Institute for Health Research Programme Grants for Applied Research programme. Copyright © 2014 Banks et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

Paranoid personality disorder and the schizophrenia spectrum-Where to draw the line?

PubMed

Birkeland, Søren Fryd

2013-08-01

By means of a case vignette, this study explores the clinical intersection between paranoid personality disorder and other schizophrenia-spectrum illness. Even though the patient described had paramount signs of a paranoid personality disorder and was diagnosed as such, psychopathological symptoms extended considerably beyond the common concept and diagnostic criteria of the disorder. Management strategies included psychopharmacological and non-pharmacological interventions, yet psychosocial functioning permanently appeared defective. While there is a persistent need for an opportunity to distinguish the characteristic syndromal pattern of paranoid personality attributes, the case exemplifies the challenges associated with classifying some largely suspicious and distrustful eccentrics within the schizophrenia spectrum. Copyright © 2013 John Wiley & Sons, Ltd.

End-of-life practices at a Lebanese hospital: courage or knowledge?

PubMed

Gebara, Jouhayna; Tashjian, Hera

2006-10-01

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.

Perception of Physical Child Abuse Among Parents and Professionals in a French Emergency Department.

PubMed

Bailhache, Marion; Alioum, Ahmadou; Salmi, Louis-Rachid

2017-04-01

France has not prohibited all forms of corporal punishment, and the point at which an act is regarded as physical abuse is not clearly determined. The aim of our study was to compare perception of a caregiver's violent behavior toward his child by professionals and parents in an emergency department and determine characteristics associated with that perception. A cross-sectional study was conducted from November 2013 to October 2014 in the emergency department of the pediatric university hospital in Bordeaux, France. An anonymous self-administered questionnaire, including vignettes describing hypothetical situations of violent interaction between a parent and child, and items related to sociodemographic and family characteristics, was administered to professionals and parents. Vignettes included varying child's age and behavior, frequency of caregiver's behavior, hitting with/without an object, and targeted child's body part. Violent behavior was restricted to hitting for reasons of feasibility. Respondents were asked to rate the acceptability of situations on a 100-mm visual analog scale. Analyses were multivariate mixed Poisson regressions. A total of 1,001 participants assessed the vignettes. Participants were predominantly females (64%), married or living with a partner (87%), with a median age of 34 years. Professionals assessed vignettes as acceptable significantly more than parents (mean rating 2.8 times higher; p < .001). For both professionals and parents, all vignette characteristics were significantly associated with acceptability. Parents who had a child below 1 year old, those who had visited an emergency department many times in the past year, and those who had fewer children were less tolerant. Such findings indicate the need for additional research to better appreciate consequences and severity of violent behavior toward children, and the need to educate parents and professionals.

Conceptions of Mental Illness: Attitudes of Mental Health Professionals and the General Public

PubMed Central

Stuber, Jennifer P.; Rocha, Anita; Christian, Ann; Link, Bruce G.

2014-01-01

Objectives The authors compared attitudes of the U.S. general public and of mental health professionals about the competence and perceived dangerousness of people with mental health problems and the desire for social distance from them. Factors related to negative attitudes and the desire for social distance also were examined. Methods Vignettes describing individuals meeting DSM-IV criteria for major depression and schizophrenia were included in the 2006 General Social Survey (GSS) and a 2009 study of mental health professionals, and responses were descriptively compared (GSS, N=397 responses to depression vignette, N=373 responses to schizophrenia vignette; 731 mental health professionals responded to both vignettes). Regression analyses examined whether demographic and provider characteristics were associated with perceptions of less competence and perceived dangerousness of the vignette character and with respondents’ desire for social distance. Results Compared with the American public, mental health professionals had significantly more positive attitudes toward people with mental health problems. However, some providers’ conceptions about the dangerousness of people with schizophrenia and provider desire for social distance from clients in work and personal situations were concerning. Younger age, self-identifying as non-Hispanic white, being female, having at least a four-year college degree, being familiar with mental illness, and certain job titles and more years of experience in the mental health field were predictive of more positive conceptions. Conclusions Although mental health professionals held more positive attitudes than the general public about people with mental health problems, strong stereotypes persisted in both groups, especially concerning schizophrenia. This study identified several demographic and provider characteristics that can inform intervention strategies in both groups. PMID:24430508

Cognitive models of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

PubMed

Earnst, K S; Marson, D C; Harrell, L E

2000-08-01

To investigate measures of patient cognitive abilities as predictors of physician judgments of medical treatment consent capacity (competency) in patients with Alzheimer's disease (AD). Predictor models of legal standards (LS) and personal competency judgments were developed for each study physician using independent neuropsychological test measures and logistic regression analyses. A university medical center. Five physicians with experience assessing the competency of AD patients were recruited to make competency judgments of videotaped vignettes from 10 older controls and 21 patients with AD (10 with mild and 11 with moderate dementia). The 31 patient and control videotapes of performance on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI) were rated by the five physicians. The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Each study physician viewed each vignette videotape individually, made judgments of competent or incompetent under each of the LS, and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis and neuropsychological test performance. Stepwise logistic regression was conducted to identify cognitive predictors of each physician's LS and personal competency judgments for Vignette A using the full sample (n = 31). Classification logistic regression analysis was used to determine how well these cognitive predictor models classified each physician's competency judgments for Vignette A. These classification models were then cross-validated using physician's Vignette B judgments. Cognitive predictor models for Vignette A competency judgments differed across individual physicians, and were related to difficulty of LS and to incompetency outcome rates across LS for AD patients. Measures of semantic knowledge and receptive language predicted judgments under less difficult LS of evidencing a treatment choice (LS1) and making the reasonable treatment choice (LS2). Measures of semantic knowledge, short-term verbal recall, and simple reasoning ability predicted judgments under more difficult and clinically relevant LS of appreciating consequences of a treatment choice (LS3), providing rational reasons for a treatment choice (LS4), and understanding the treatment situation and choices (LSS). Cognitive models for physicians' personal competency judgments were virtually identical to their respective models for LS5 judgments. For AD patients, shortterm memory predictors were associated with high incompetency outcome rates (over 70%), a simple reasoning measure was associated with moderately high incompetency outcome rates (60-70%), and a semantic knowledge measure was associated with lower incompetency outcome rates (30-60%). Overall, single predictor models were relatively robust, correctly classifying an average of 83% of physician judgments for Vignette A and 80% of judgments for Vignette B. Multiple cognitive functions predicted physicians' LS and personal competency judgments. Declines in semantic knowledge, short-term verbal recall, and simple reasoning ability predicted physicians' judgments on the three most difficult and clinically most relevant LS (LS3-LS5), as well as their personal competency judgments. Our findings suggest that clinical assessment of competency should include evaluation of semantic knowledge, verbal recall, and simple reasoning abilities.

Physicians' perception of alternative displays of clinical research evidence for clinical decision support - A study with case vignettes.

PubMed

Slager, Stacey L; Weir, Charlene R; Kim, Heejun; Mostafa, Javed; Del Fiol, Guilherme

2017-07-01

To design alternate information displays that present summaries of clinical trial results to clinicians to support decision-making; and to compare the displays according to efficacy and acceptability. A 6-between (information display presentation order) by 3-within (display type) factorial design. Two alternate displays were designed based on Information Foraging theory: a narrative summary that reduces the content to a few sentences; and a table format that structures the display according to the PICO (Population, Intervention, Comparison, Outcome) framework. The designs were compared with the summary display format available in PubMed. Physicians were asked to review five clinical studies retrieved for a case vignette; and were presented with the three display formats. Participants were asked to rate their experience with each of the information displays according to a Likert scale questionnaire. Twenty physicians completed the study. Overall, participants rated the table display more highly than either the text summary or PubMed's summary format (5.9vs. 5.4vs. 3.9 on a scale between 1 [strongly disagree] and 7 [strongly agree]). Usefulness ratings of seven pieces of information, i.e. patient population, patient age range, sample size, study arm, primary outcome, results of primary outcome, and conclusion, were high (average across all items=4.71 on a 1 to 5 scale, with 1=not at all useful and 5=very useful). Study arm, primary outcome, and conclusion scored the highest (4.9, 4.85, and 4.85 respectively). Participants suggested additional details such as rate of adverse effects. The table format reduced physicians' perceived cognitive effort when quickly reviewing clinical trial information and was more favorably received by physicians than the narrative summary or PubMed's summary format display. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study.

PubMed

Das, Jishnu; Kwan, Ada; Daniels, Benjamin; Satyanarayana, Srinath; Subbaraman, Ramnath; Bergkvist, Sofi; Das, Ranendra K; Das, Veena; Pai, Madhukar

2015-11-01

Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients. We did a pilot, cross-sectional validation study of a convenience sample of consenting private health-care providers in low-income and middle-income areas of Delhi, India. We recruited standardised patients in apparently good health from the local community to present four cases (two of presumed tuberculosis and one each of confirmed tuberculosis and suspected multidrug-resistant tuberculosis) to a randomly allocated health-care provider. The key objective was to validate the standardised-patient method using three criteria: negligible risk and ability to avoid adverse events for providers and standardised patients, low detection rates of standardised patients by providers, and data accuracy across standardised patients and audio verification of standardised-patient recall. We also used medical vignettes to assess providers' knowledge of presumed tuberculosis. Correct case management was benchmarked using Standards for Tuberculosis Care in India (STCI). Between Feb 2, and March 28, 2014, we recruited and trained 17 standardised patients who had 250 interactions with 100 health-care providers, 29 of whom were qualified in allopathic medicine (ie, they had a Bachelor of Medicine & Surgery [MBBS] degree), 40 of whom practised alternative medicine, and 31 of whom were informal health-care providers with few or no qualifications. The interactions took place between April 1, and April 23, 2014. The proportion of detected standardised patients was low (11 [5%] detected out of 232 interactions among providers who completed the follow-up survey), and standardised patients' recall correlated highly with audio recordings (r=0·63 [95% CI 0·53-0·79]), with no safety concerns reported. The mean consultation length was 6 min (95% CI 5·5-6·6) with a mean of 6·18 (5·72-6·64) questions or examinations completed, representing 35% (33-38) of essential checklist items. Across all cases, only 52 (21% [16-26]) of 250 were correctly managed. Correct management was higher among MBBS-qualified doctors than other types of health-care provider (adjusted odds ratio 2·41 [95% CI 1·17-4·93]; p=0·0166). Of the 69 providers who completed the vignette, knowledge in the vignettes was more consistent with STCI than their actual clinical practice-eg, 50 (73%) ordered a chest radiograph or sputum test during the vignette compared with seven (10%) during the standardised-patient interaction; OR 0·04 (95% CI 0·02-0·11); p<0·0001. Standardised patients can be successfully implemented to assess tuberculosis care. Our data suggest a big gap between private provider knowledge and practice. Additional work is needed to substantiate our pilot data, understand the know-do gap in provider behaviour, and to identify the best approach to measure and improve the quality of tuberculosis care in India. Grand Challenges Canada, the Bill & Melinda Gates Foundation, Knowledge for Change Program, and the World Bank Development Research Group. Copyright © 2015 Elsevier Ltd. All rights reserved.

Caroline Crachami, the Sicilian Fairy: a case of bird-headed dwarfism.

PubMed

Bondeson, J

1992-09-15

One of the most remarkable cases of extreme dwarfism on record is Caroline Crachami, the Sicilian Fairy. She was born in 1815, and was taken to London to be exhibited for money in 1824. Due to her proportional dwarfism, severe intrauterine growth retardation, and typical "bird-headed" profile, Caroline Crachami has by some been diagnosed as a case of the autosomal recessive Seckel syndrome. In this historical vignette, the Sicilian Fairy's life and death are presented in some detail using new material, and the problem of her correct diagnosis is discussed.

Introducing the concept of modern depression in Japan; an international case vignette survey.

PubMed

Kato, Takahiro A; Shinfuku, Naotaka; Fujisawa, Daisuke; Tateno, Masaru; Ishida, Tetsuya; Akiyama, Tsuyoshi; Sartorius, Norman; Teo, Alan R; Choi, Tae Young; Wand, Anne P F; Balhara, Yatan Pal Singh; Chang, Jane Pei-Chen; Chang, Rita Yuan-Feng; Shadloo, Behrang; Ahmed, Helal Uddin; Lerthattasilp, Tiraya; Umene-Nakano, Wakako; Horikawa, Hideki; Matsumoto, Ryohei; Kuga, Hironori; Tanaka, Masuo; Kanba, Shigenobu

2011-12-01

Japanese psychiatrists have increasingly reported patients with depression that does not seem to fit the criteria of the ICD-10 and the DSM-IV, and which has recently been called modern type depression (MTD). We explored whether MTD is frequently seen in Japan and also in other countries, and if so, how patients with MTD are diagnosed and treated. The questionnaires, with two case vignettes (traditional type depression (TTD) and MTD), were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated their opinions about each case's prevalence in their country, etiology, diagnosis, suicide risk, and treatment using Likert scales. Out of 247 responses (123 from Japan and 124 from other countries), two hundred thirty-nine valid responses were received. MTD was recognized in all participating countries, and especially in urban areas. Generally, the factor of personality was regarded as the most probable cause of MTD. Whereas about 90% of Japanese psychiatrists applied the ICD/DSM criteria to TTD, only about 60% applied the criteria to MTD. Our results indicate that Japan's MTD seems to be occurring in many other countries, and that the present ICD/DSM criteria may not be sufficient to diagnose MTD. Therefore, it could be an important candidate for a new international diagnostic criterion as a subtype of depression. A clear diagnostic framework and consensus on the interventions to treat MTD would be valuable. Further clinical, psychopathological and international epidemiological studies are needed to confirm our preliminary findings of MTD. Copyright © 2011 Elsevier B.V. All rights reserved.

Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems - Systematic review.

PubMed

Takasaki, Hiroshi; Okuyama, Kousuke; Rosedale, Richard

2017-02-01

Mechanical Diagnosis and Therapy (MDT) is used in the treatment of extremity problems. Classifying clinical problems is one method of providing effective treatment to a target population. Classification reliability is a key factor to determine the precise clinical problem and to direct an appropriate intervention. To explore inter-examiner reliability of the MDT classification for extremity problems in three reliability designs: 1) vignette reliability using surveys with patient vignettes, 2) concurrent reliability, where multiple assessors decide a classification by observing someone's assessment, 3) successive reliability, where multiple assessors independently assess the same patient at different times. Systematic review with data synthesis in a quantitative format. Agreement of MDT subgroups was examined using the Kappa value, with the operational definition of acceptable reliability set at ≥ 0.6. The level of evidence was determined considering the methodological quality of the studies. Six studies were included and all studies met the criteria for high quality. Kappa values for the vignette reliability design (five studies) were ≥ 0.7. There was data from two cohorts in one study for the concurrent reliability design and the Kappa values ranged from 0.45 to 1.0. Kappa values for the successive reliability design (data from three cohorts in one study) were < 0.6. The current review found strong evidence of acceptable inter-examiner reliability of MDT classification for extremity problems in the vignette reliability design, limited evidence of acceptable reliability in the concurrent reliability design and unacceptable reliability in the successive reliability design. Copyright © 2017 Elsevier Ltd. All rights reserved.

Teachers' Assumptions Regarding the Severity, Causes, and Outcomes of Behavioral Problems in Preschoolers: Implications for Referral.

ERIC Educational Resources Information Center

Walker, Elaine; And Others

1984-01-01

Asked preschool teachers (N=100) to rate severity, long-term outcome, stability, and importance of constitutional and environmental determinants for case vignettes describing three syndromes: aggression, hyperactivity, and withdrawal, and to judge the need for referral. Results indicated little evidence of sex bias in teachers' evaluations of the…

Understanding Family Roles and Ethics in Working with First-Generation College Students and Their Families

ERIC Educational Resources Information Center

Hartig, Nadine; Steigerwald, Fran

2007-01-01

This article examines the family roles and ethics of first-generation college students and their families through discussion of a case vignette. London's family roles applied to first-generation college students are discussed. Narrative therapy practices and an ethical model that examines the value process of counselors are explored as possible…

Extended School Year: Legal and Practical Considerations for Educators

ERIC Educational Resources Information Center

Burke, Meghan M.; Decker, Janet R.

2017-01-01

This article clarifies what extended school year (ESY) is and who is eligible for it. It also describes, how it looks different for individual students, where and when it can be provided, and how to determine whether students are eligible. To illustrate common challenges in determining ESY, vignettes are provided based on four students' cases.…

A Sikh Perspective on Life-Stress: Implications for Counselling

ERIC Educational Resources Information Center

Sandhu, Jaswinder Singh

2005-01-01

This paper presents the Sikh life-stress model as a culture-specific intervention. The paper looks at the Sikh world-view, from which it delineates the Sikh perspective on life-stress. It further outlines a framework for incorporating the Sikh life-stress model into the Western counselling context, and concludes with a case vignette to demonstrate…

You Don't Know What You Don't Know: Choices for School Administrators When Crisis Hits

ERIC Educational Resources Information Center

Low, Lori L.

2008-01-01

School leaders carry great responsibility when a crisis occurs. Understanding the significance and use of school crisis teams is vitally important and often unknowingly overlooked. This article examines the crucial role of school leaders when a crisis event occurs. Through combining existing research, case vignettes of actual events, and…

Large-Scale Evaluation of Quality of Care in 6 Countries of Eastern Europe and Central Asia Using Clinical Performance and Value Vignettes.

PubMed

Peabody, John W; DeMaria, Lisa; Smith, Owen; Hoth, Angela; Dragoti, Edmond; Luck, Jeff

2017-09-27

A significant determinant of population health outcomes is the quality of care provided for noncommunicable diseases, obstetric, and pediatric care. We present results on clinical practice quality in these areas as measured among nearly 4,000 providers working at more than 1,000 facilities in 6 Eastern European and Central Asian countries. This study was conducted between March 2011 and April 2013 in Albania, Armenia, Georgia, Kazakhstan, Kirov Province in Russia, and Tajikistan. Using a probability proportional-to-size sampling technique, based on number of hospital beds, we randomly selected within each country 42 hospitals and their associated primary health care clinics. Physicians and midwives within each clinical area of interest were randomly selected from each hospital and clinic and asked how they would care for simulated patients using Clinical Performance and Value (CPV) vignettes. Facility administrators were also asked to complete a facility survey to collect structural measures of quality. CPV vignettes were scored on a scale of 0% to 100% for each provider. We used descriptive statistics and t tests to identify significant differences in CPV scores between hospitals and clinics and rural vs. urban facilities, and ANOVA to identify significant differences in CPV scores across countries. We found that quality of care, as concurrently measured by performance on CPV vignettes, was generally poor and widely variable within and between countries. Providers in Kirov Province, Russia, had the highest overall performance, with an average score of 70.8%, while providers in Albania and Tajikistan had the lowest average score, each at 50.8%. The CPV vignettes with the lowest scores were for multiple noncommunicable disease risk factors and birth asphyxia. A considerable proportion (11%) of providers performed well on the CPV vignettes, regardless of country, facility, or structural resources available to them. Countries of Eastern Europe and Central Asia are challenged by poor performance as measured by clinical care vignettes, but there is potential for provision of high-quality care by a sizable proportion of providers. Large-scale assessments of quality of care have been hampered by the lack of effective measurement tools that provide generalizable and reliable results across diverse economic, cultural, and social settings. The feasibility of quality measurement using CPV vignettes in these 6 countries and the ability to combine results with individual feedback could significantly enhance strategies to improve quality of care, and ultimately population health. © Peabody et al.

Online Interactive Video Vignettes (IVVs)

NASA Astrophysics Data System (ADS)

Laws, Priscilla

2016-03-01

Interest in on-line learning is increasing rapidly. A few years ago members of the LivePhoto Physics Group1 received collaborative NSF Grants2 to create short, single-topic, on-line activities that invite introductory physics students to make individual predictions about a phenomenon and test them though video observations or analysis. Each Vignette is designed for web delivery as: (1) an ungraded homework assignment or (2) an exercise to prepare for a class or tutorial session. Sample IVVs are available at the ComPadre website http://www.compadre.org/ivv/. Portions of Vignettes on mechanics topics including Projectile Motion, Circular Motion, the Bullet-Block phenomenon, and Newton's Third Law will be presented. Those attending this talk will be asked to guess what predictions students are likely to make about phenomena in various IVVs. These predictions can be compared to those made by students who completed Vignettes. Finally, research on the impact of Vignettes on student learning and attitudes will be discussed. Co-PI Robert Teese, Rochester Institute of Technology.

Public perceptions toward mental illness in Japan.

PubMed

Kasahara-Kiritani, Mami; Matoba, Tomoko; Kikuzawa, Saeko; Sakano, Junko; Sugiyama, Katsumi; Yamaki, Chikako; Mochizuki, Mieko; Yamazaki, Yoshihiko

2018-05-16

The purpose was to characterize public perceptions in Japan of mental illness and how they related to stigma-related attitudes for the same. Data were obtained using a vignette survey conducted as a part of the Stigma in Global Context - Mental Health Study and contained a nationally representative sample (n = 994). The survey was conducted using a multi-mode approach (face-to-face interviews, the drop-off-and-pick-up, postal collection) from September to December 2006, with a multi-stage probability sample of Japanese residents aged 18-64 years. Respondents were randomly assigned one of four vignette conditions that described psychiatric disorders meeting the diagnostic criteria for schizophrenia and major depressive disorder (one vignette for each gender exhibiting each diagnosis). We compared respondents' stigma-related attitudes and perceptions toward mental illness between vignettes. Over 80% of Japanese participants believed that depressive disorder or schizophrenia could be cured via treatment. However, Japanese people still had relatively strong vigilance and denial of competency toward schizophrenia. Participants expressed the belief that mental illnesses are curable, but stigma toward people with schizophrenia was still relatively strong. Copyright © 2018 Elsevier B.V. All rights reserved.

A Randomized Trial Testing the Impact of Narrative Vignettes vs. Guideline Summaries on Provider Response to a Professional Organization Clinical Policy for Safe Opioid Prescribing

PubMed Central

Meisel, Zachary F.; Metlay, Joshua P.; Sinnenberg, Lauren; Kilaru, Austin S.; Grossestreuer, Anne; Barg, Frances K.; Shofer, Frances S.; Rhodes, Karin V.; Perrone, Jeanmarie

2016-01-01

Background Clinical guidelines are known to be underused by practitioners. In response to the challenges of treating pain amidst a prescription opioid epidemic, the American College of Emergency Physicians published an evidence-based clinical policy for opioid prescribing in 2012. Evidence-based narratives, an effective method of communicating health information in a variety of settings, offer a novel strategy for disseminating guidelines to physicians and engaging providers with clinical evidence. Objectives To compare whether narrative vignettes embedded in the American College of Emergency Physician (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared to traditional summary text. Methods A prospective randomized controlled study, entitled Stories to Promote Information using Narrative (SPIN) trial, was performed. Derived from qualitative interviews with 61 ACEP physicians, 4 narrative vignettes were selected and refined, using a consensus panel of clinical and implementation experts. All ACEP members were then block randomized by state of residence to receive alternative versions of a daily emailed newsletter for a total of 24 days during a 9 week period. Narrative newsletters contained a selection of vignettes that referenced opioid prescription dilemmas. Control newsletters contained a selection of descriptive text about the clinical policy using similar length and appearance to the narrative vignettes. Embedded in the newsletters were web links to the complete vignette or traditional summary text, as well as additional links to the full ACEP clinical policy and a website providing assistance with prescription drug monitoring program enrollment. The newsletters were otherwise identical. Outcomes measured were the percentage of subjects who visited any of the web pages that contained additional guideline related information and the odds of any unique physician visiting these web pages during the study. Results 27,592 physicians were randomized and 21,226 received the newsletter during the study period. When counting each physician once over the study period, there were 509 unique visitors in the narrative group and 173 unique visitors in the control group (4.8% vs. 1.6%, difference 3.2% 95%CI 2.7%-3.7%). There were 744 gross visits from the e-newsletter to any of the three web pages in the narrative group compared to 248 in the control group (7.0% vs. 2.3%, OR 3.2 (95% CI 2.7-3.6). Over the course of the study, the odds ratio of any physician in the narrative group visiting one of the three informational web sites compared to the control group was 3.1 (95% CI 2.6-3.6). Conclusion Among a national sample of emergency physicians, narrative vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions. PMID:27133392

Learning Happens: 30 Video Vignettes of Babies and Toddlers Learning School Readiness Skills through Everyday Interactions. [DVD and Guide

ERIC Educational Resources Information Center

Lerner, Claire; Parlakian, Rebecca

2007-01-01

This DVD (duration: 1 hour 53 seconds) features 30 video vignettes that show parents and children--aged birth to 3 years--interacting during everyday play and routines. These vignettes, some in English and some in Spanish, are designed to be tools for professionals to use both in direct work with families and for training other early child…

Using clinical vignettes to assess doctors' and medical students' ability to identify sociocultural factors affecting health and health care.

PubMed

Hudelson, Patricia; Perron, N Junod; Perneger, Thomas

2011-01-01

Methods are needed for assessing clinicians' cultural knowledge frameworks. We used a mail survey containing four short clinical vignettes to explore respondents' ability to identify sociocultural factors affecting health and health care. Participants included 299 physicians working at the University Hospitals of Geneva, 156 private physicians, and all 134 local medical students in their clinical years. Twenty-one sociocultural "domains" were identified through inductive coding of responses. For each vignette, we obtained the sum of codes as a measure of the respondent's awareness of sociocultural factors that might affect care in this particular situation. As internal consistency was reasonably high (0.68), we computed a single total score as the sum of responses given to all four vignettes. Reponses correlated with factors that might be expected to impact clinicians' awareness of sociocultural factors affecting care. Medical students, females, respondents who had received cultural competence training, those with greater interest in caring for immigrant patients, and those with high self-assessed skills at exploring psychosocial and migration-related issues scored higher on the vignettes. Brief clinical vignettes appear to be a relevant and feasible method for exploring physicians' knowledge of social and cultural factors affecting health and health care.

Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians.

PubMed

Raptis, Stavroula; Chen, Jia Ning; Saposnik, Florencia; Pelyavskyy, Roman; Liuni, Andrew; Saposnik, Gustavo

2017-01-01

Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. To evaluate the association between family physicians' risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08-27.85). Physicians' willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03-0.86). Physicians' aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed.

Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians

PubMed Central

Saposnik, Florencia; Pelyavskyy, Roman; Liuni, Andrew; Saposnik, Gustavo

2017-01-01

Background Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. Objectives To evaluate the association between family physicians’ risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Methods Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Results Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08–27.85). Physicians’ willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03–0.86). Conclusion Physicians’ aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed. PMID:28979101

Referring patients to specialists: A structured vignette survey of Australian and British GPs

PubMed Central

Jiwa, Moyez; Gordon, Michael; Arnet, Hayley; Ee, Hooi; Bulsara, Max; Colwell, Brigitte

2008-01-01

Background In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral. Methods A self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the data Results We received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents. 1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently. Conclusion GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies. PMID:18194578

The Effect of Message Content and Clinical Outcome on Patients' Perception of Physician Compassion: A Randomized Controlled Trial.

PubMed

Tanco, Kimberson; Azhar, Ahsan; Rhondali, Wadih; Rodriguez-Nunez, Alfredo; Liu, Diane; Wu, Jimin; Baile, Walter; Bruera, Eduardo

2018-03-01

In a previous randomized crossover study, patients perceived a physician delivering a more optimistic message (MO) as more compassionate and professional. However, the impact of the clinical outcome of the patient on patient's perception of physician's level of compassion and professionalism has not been previously studied. Our aim was to determine if the reported clinical outcome modified the patient's perception of physician compassion, professionalism, impression, and preference for physician. One hundred twenty-eight advanced cancer patients in an outpatient Supportive Care Center were randomized to complete validated questionnaires about patients' perception of physician's level of compassion, professionalism, impression, and preference of physician for themselves and their family after watching scripted videos depicting a physician delivering an MO versus a less optimistic (LO) message followed by a clinical vignette depicting a worse outcome. Median age was 61 years and 55% were female. There was no difference in compassion score after the vignette in the MO and LO groups. However, there were significantly worse overall impression and professionalism scores in both the MO and LO groups after the vignette. In the MO group, preference for the physician for themselves and their family significantly decreased after the vignette. Seeing a worse clinical outcome did not change the patients' appraisal of an inappropriately optimistic physician. However, it reduced the overall impression of both physicians that conveyed an MO or an LO message and it also resulted in less likelihood of choosing the MO physician for themselves and their family. The study found that a patient's perception of a physician's compassion did not change after reading a vignette describing a negative clinical outcome, regardless of whether the physician had given a more or a less optimistic message to the patient. However, the results suggested that patients perceived worse professionalism and overall physician impression scores for both more and less optimistic physicians and lower likelihood to choose the more optimistic physician for themselves and their family. © AlphaMed Press 2017.

Nursing home nurses' and community-dwelling older adults' reported knowledge, attitudes, and behavior toward antibiotic use.

PubMed

Kistler, Christine E; Beeber, Anna; Becker-Dreps, Sylvia; Ward, Kimberly; Meade, Megan; Ross, Brittany; Sloane, Philip D

2017-01-01

Antibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated. To understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall. Of 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement "by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic", while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette. While a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.

Knowledge gaps in the diagnosis and management of patients with tropical diseases presenting to Canadian emergency departments: are the gaps being met?

PubMed

Meshkat, Nazanin; Misra, Shikha; Hunchak, Cheryl; Cleiman, Paula; Khan, Yasmin; Puchalski Ritchie, Lisa M

2014-11-01

We conducted a needs assessment to identify knowledge gaps in the management of tropical diseases by Canadian emergency physicians and identify available, related continuing medical education (CME) resources. A literature review was conducted to summarize challenges in the management of commonly encountered tropical diseases. An anonymous online survey was administered to Canadian emergency physicians using the Canadian Association of Emergency Physicians survey deployment service in July and August 2012. The survey identified self-reported gaps in knowledge and assessed knowledge using case-based vignettes. A list of CME resources was generated from a review of major academic emergency medicine journals, online cases, and conference topics from emergency medicine associations during 2010-2011. Two independent reviewers assessed the relevance of the resources; differences were resolved by consensus. From 635 citations, 47 articles were selected for full review; the majority (66%) were retrospective chart reviews, few (10.6%) had an emergency medicine focus, and fewer still were Canadian (8.5%). In total, 1,128 surveys were distributed, and 296 (27%) participants were included in the study. Most respondents reported "no" (52.4%) or "some" (45.9%) training in tropical medicine. Most (69.9%) rated their comfort in managing patients with tropical diseases as "low." Few (11.1%) respondents reported a tropical disease being misdiagnosed or mismanaged; 44.1% indicated malaria. The perceived need for further training was high (76.7%). Conference workshops were the most highly requested CME modality, followed by case studies and podcasts. Correct answers to case vignettes ranged from 30.7 to 58.4%. Although 2,038 CME titles were extracted from extensive searches, only 6 were deemed relevant. Most Canadian emergency physicians have had minimal training in tropical diseases, reported a low comfort level in their management, and identified a high need for CME opportunities, which are lacking.

Cultural influences on stigmatization of problem gambling: East Asian and Caucasian canadians.

PubMed

Dhillon, Jasmin; Horch, Jenny D; Hodgins, David C

2011-12-01

Cultural influences on problem gambling stigma were examined using a between subject vignette study design. Students of East Asian (n = 64) and Caucasian (n = 50) ancestry recruited from a Canadian University rated a vignette describing either an East Asian problem gambler or a Caucasian problem gambler on a measure of attitudinal social distance. In accordance with the hypothesis, a factorial ANOVA revealed that East Asian Canadians stigmatize problem gambling more than Caucasian Canadians. Moreover, East Asian participants stigmatized the East Asian individual described in the vignette more than they did the Caucasian individual. Individuals with gambling problems were generally not perceived as being dangerous. However, participants who perceived problem gambling as a dangerous condition wanted more social distance than those who did not perceive individuals with a gambling problem as dangerous.

Influence of Social Class Perceptions on Attributions among Mental Health Practitioners

PubMed Central

Thomposon, Mindi; Diestelmann, Jacob; Cole, Odessa; Keller, Abiola; Minami, Takuya

2018-01-01

Objective A vignette-based study assessed the influence of social class attributions toward a hypothetical client’s difficulty. Method 188 licensed mental health professionals who were recruited through professional listservs completed an online survey after reviewing one of two versions of a vignette describing a hypothetical client that varied based on social class cues. Results As expected, this sample of licensed mental health practitioners detected social class differences based on the descriptors of the hypothetical client across the two vignettes. These perceived social class differences, however, did not impact participants’ attributions toward the client for causing or solving her problems, level of GAF score ascribed to the client, or willingness to work with the client. Conclusions There was no evidence that participants differentially ascribed attributions based on social class. Implications and directions for future research are provided. PMID:24499284

Self-compassion, pain, and breaking a social contract.

PubMed

Purdie, Fiona; Morley, Stephen

2015-11-01

Self-compassion is the ability to respond to one's failures, shortcomings, and difficulties with kindness and openness rather than criticism. This study, which might be regarded as a proof-of-concept study, aimed to establish whether self-compassion is associated with expected emotional responses and the likelihood of responding with problem solving, support seeking, distraction, avoidance, rumination, or catastrophizing to unpleasant self-relevant events occurring in 3 social contexts. Sixty chronic pain patients were presented with 6 vignettes describing scenes in which the principal actor transgressed a social contract with negative interpersonal consequences. Vignettes represented 2 dimensions: (1) whether pain or a nonpain factor interrupted the fulfillment of the contract and (2) variation in the social setting (work, peer, and family). The Self-Compassion Scale was the covariate in the analysis. Higher levels of self-compassion were associated with significantly lower negative affect and lower reported likelihood of avoidance, catastrophizing, and rumination. Self-compassion did not interact with pain vs nonpain factor. Work-related vignettes were rated as more emotional and more likely to be associated with avoidance, catastrophizing, and rumination and less likelihood of problem solving. The findings suggest that self-compassion warrants further investigation in the chronic pain population both regarding the extent of its influence as a trait and in terms of the potential to enhance chronic pain patients' ability to be self-compassionate, with a view to its therapeutic utility in enhancing psychological well-being and adjustment. Limitations regarding the possible criterion contamination and the generalizability of vignette studies are discussed.

Access to resources shapes maternal decision making: evidence from a factorial vignette experiment.

PubMed

Kushnick, Geoff

2013-01-01

The central assumption of behavioral ecology is that natural selection has shaped individuals with the capacity to make decisions that balance the fitness costs and benefits of behavior. A number of factors shape the fitness costs and benefits of maternal care, but we lack a clear understanding how they, taken together, play a role in the decision-making process. In animal studies, the use of experimental methods has allowed for the tight control of these factors. Standard experimentation is inappropriate in human behavioral ecology, but vignette experiments may solve the problem. I used a confounded factorial vignette experiment to gather 640 third-party judgments about the maternal care decisions of hypothetical women and their children from 40 female karo Batak respondents in rural Indonesia. This allowed me to test hypotheses derived from parental investment theory about the relative importance of five binary factors in shaping maternal care decisions with regard to two distinct scenarios. As predicted, access to resources--measured as the ability of a woman to provide food for her children--led to increased care. A handful of other factors conformed to prediction, but they were inconsistent across scenarios. The results suggest that mothers may use simple heuristics, rather than a full accounting for costs and benefits, to make decisions about maternal care. Vignettes have become a standard tool for studying decision making, but have made only modest inroads to evolutionarily informed studies of human behavior.

Public attitudes towards people with depression in times of uncertainty: results from three population surveys in Germany.

PubMed

Angermeyer, Matthias C; Matschinger, Herbert; Schomerus, Georg

2013-09-01

The recent increase of so-called precarious work conditions plus the current financial crisis have led to a growing sense of uncertainty among the public. This may have repercussions on attitudes towards people with mental illness. Particularly, the public may have become more reluctant to support access to work for these people. In 1990, 2001 and 2011, population surveys were conducted in the "old" states of Germany, using the same sampling procedure, interview mode and measures. Within the context of a fully structured interview respondents were presented a case-vignette depicting a person with symptoms of depression. They were then asked how willing they would be to accept the person in the vignette in various social relationships. While the German public's unwillingness to recommend an individual with depression for a job remained unchanged during the 1990s, it increased significantly during the subsequent decade. By contrast, in all other social relationships studied, no increase of the desire for social distance could be observed during this time period. The trend towards withholding access to jobs was most pronounced among employed respondents. The results of our study underline the importance of macro-social factors for the discrimination of people with mental illness.

Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.

PubMed

Kuehlmeyer, Katja; Racine, Eric; Palmour, Nicole; Hoster, Eva; Borasio, Gian Domenico; Jox, Ralf J

2012-10-01

Diagnosis and decisions on life-sustaining treatment (LST) in disorders of consciousness, such as the vegetative state (VS) and the minimally conscious state (MCS), are challenging for neurologists. The locked-in syndrome (LiS) is sometimes confounded with these disorders by less experienced physicians. We aimed to investigate (1) the application of diagnostic knowledge, (2) attitudes concerning limitations of LST, and (3) further challenging aspects in the care of patients. A vignette-based online survey with a randomized presentation of a VS, MCS, or LiS case scenario was conducted among members of the German Society for Neurology. A sample of 503 neurologists participated (response rate 16.4%). An accurate diagnosis was given by 86% of the participants. The LiS case was diagnosed more accurately (94%) than the VS case (79%) and the MCS case (87%, p < 0.001). Limiting LST for the patient was considered by 92, 91, and 84% of the participants who accurately diagnosed the VS, LiS, and MCS case (p = 0.09). Overall, most participants agreed with limiting cardiopulmonary resuscitation; a minority considered limiting artificial nutrition and hydration. Neurologists regarded the estimation of the prognosis and determination of the patients' wishes as most challenging. The majority of German neurologists accurately applied the diagnostic categories VS, MCS, and LiS to case vignettes. Their attitudes were mostly in favor of limiting life-sustaining treatment and slightly differed for MCS as compared to VS and LiS. Attitudes toward LST strongly differed according to circumstances (e.g., patient's will opposed treatment) and treatment measures.

Psychometric properties of virtual reality vignette performance measures: a novel approach for assessing adolescents' social competency skills.

PubMed

Paschall, Mallie J; Fishbein, Diana H; Hubal, Robert C; Eldreth, Diana

2005-02-01

This study examined the psychometric properties of performance measures for three novel, interactive virtual reality vignette exercises developed to assess social competency skills of at-risk adolescents. Performance data were collected from 117 African-American male 15-17 year olds. Data for 18 performance measures were obtained, based on adolescents' interaction with a provocative virtual teenage character. Twelve of the 18 performance measures loaded on two factors corresponding to emotional control and interpersonal communication skills, providing support for their factorial validity. The internal reliability coefficients for the two multi-item measures were 0.88 and 0.91, respectively. Additional analyses with established measures of three psychosocial factors (beliefs supporting aggression, aggressive conflict-resolution style and hostility) and behavioral criteria (e.g., self-reported behavioral misconduct and drug use) provided limited support for the construct and criterion-related validity of the performance measures. Study findings suggest that the virtual reality vignette exercises may represent a promising approach for assessing adolescents' social competency skills.

Mental health literacy about schizophrenia and depression: a survey among Chinese caregivers of patients with mental disorder.

PubMed

Chen, Shubao; Wu, Qiuxia; Qi, Chang; Deng, Huiqiong; Wang, Xuyi; He, Haoyu; Long, Jiang; Xiong, Yifan; Liu, Tieqiao

2017-03-09

To investigate the knowledge of schizophrenia and depression among caregivers of patients with mental disorder in China. A convenience sample of 402 caregivers at the Department of Psychiatry of a general hospital in China was investigated (response rate 95.7%), using vignettes based investigation methodology. The number of caregivers using the term "depression" to describe the depression vignette was 43.6%, which was significantly higher than the number of caregivers using the term "schizophrenia" to describe the schizophrenia one (28.5%). A high percentage of caregivers believed that "psychiatrist", "psychologist" and "close family members" would be helpful, and the top three most helpful interventions were "becoming more physically active", "getting out and learning more" and "receiving psychotherapy". The number of caregivers endorsed "antipsychotics" and "antidepressants" as helpful for the schizophrenia and the depression vignettes were 82.0 and 80.7%, respectively. Regarding the causes of mental illness, items related to psychosocial factors, including "daily problems" and "work or financial problems", and "weakness of character" were highly rated, with half considered genetic or chemical imbalance causes. Caregivers expressed a high knowledge about treatments and interventions of mental disorders. But there are still some areas, particularly regarding the recognition and causes of mental disorders, that are in need of improvement. This is particularly the case for schizophrenia.

Competence of birth attendants at providing emergency obstetric care under India’s JSY conditional cash transfer program for institutional delivery: an assessment using case vignettes in Madhya Pradesh province

PubMed Central

2014-01-01

Background Access to emergency obstetric care by competent staff can reduce maternal mortality. India has launched the Janani Suraksha Yojana (JSY) conditional cash transfer program to promote institutional births. During implementation of the JSY, India witnessed a steep increase in the proportion of institutional deliveries-from 40% in 2004 to 73% in 2012. However, maternal mortality reduction follows a secular trend. Competent management of complications, when women deliver in facilities under the JSY, is essential for reduction in maternal mortality and therefore to a successful program outcome. We investigate, using clinical vignettes, whether birth attendants at institutions under the program are competent at providing appropriate care for obstetric complications. Methods A facility based cross-sectional study was conducted in three districts of Madhya Pradesh (MP) province. Written case vignettes for two obstetric complications, hemorrhage and eclampsia, were administered to 233 birth attendant nurses at 73 JSY facilities. Their competence at (a) initial assessment, (b) diagnosis, and (c) making decisions on appropriate first-line care for these complications was scored. Results The mean emergency obstetric care (EmOC) competence score was 5.4 (median = 5) on a total score of 20, and 75% of participants scored below 35% of the maximum score. The overall score, although poor, was marginally higher in respondents with Skilled Birth Attendant (SBA) training, those with general nursing and midwifery qualifications, those at higher facility levels, and those conducting >30 deliveries a month. In all, 14% of respondents were competent at assessment, 58% were competent at making a correct clinical diagnosis, and 20% were competent at providing first-line care. Conclusions Birth attendants in the JSY facilities have low competence at EmOC provision. Hence, births in the JSY program cannot be considered to have access to competent EmOC. Urgent efforts are required to effectively increase the competence of birth attendants at managing obstetric complications in order to translate large gains in coverage of institutional delivery services under JSY into reductions in maternal mortality in Madhya Pradesh, India. PMID:24885817

Beauty and the Eye of the Beholder: Gender and Attractiveness Affect Judgments in Teacher Sex Offense Cases.

PubMed

Mackelprang, Emily; Becker, Judith V

2017-06-01

The present study investigated the effects of gender and attractiveness on judgments of bail requirements, incarceration, and sex offender registration lengths, and attitudes toward offenders and victims in a teacher-student sexual perpetration scenario. Researchers presented 432 undergraduate students at a large southwestern university with one of four vignettes detailing a sexual relationship between a 35-year-old teacher and a 14-year-old student. Vignettes varied by both attractiveness and gender of the offender (using heterosexual offender-victim dyads). Results indicate that both gender and attractiveness affect judgments of sex offenders; specifically, female sexual offenders were viewed more leniently and judged less punitively than male sexual offenders. Although attractive female sexual offenders were given particularly lenient treatment, attractiveness did not affect judgments toward male sex offenders. In addition, although male and female participants tended to rate male offenders similarly, male participants were more lenient toward female offenders than were female participants. Finally, post hoc analyses revealed that, for many variables, unattractive female sexual offenders may not be viewed differently from male sexual offenders. These results have serious implications for the legal system, sex offender management, and societal views regarding male and female sexual offenders and their victims.

Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.

PubMed

Meyer, Ashley N D; Thompson, Pamela J; Khanna, Arushi; Desai, Samir; Mathews, Benji K; Yousef, Elham; Kusnoor, Anita V; Singh, Hardeep

2018-04-20

Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)'s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app's usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework. Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app's potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges. A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions.

Variations in Identification of Healthcare-Associated Infections

PubMed Central

Keller, Sara C.; Linkin, Darren R.; Fishman, Neil O.; Lautenbach, Ebbing

2014-01-01

OBJECTIVE Little is known about whether those performing healthcare-associated infection (HAI) surveillance vary in their interpretations of HAI definitions developed by the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). Our primary objective was to characterize variations in these interpretations using clinical vignettes. We also describe predictors of variation in responses. DESIGN Cross-sectional study. SETTING United States. PARTICIPANTS A sample of US-based members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. METHODS Respondents assessed whether each of 6 clinical vignettes met criteria for an NHSN-defined HAI. Individual- and institutional-level data were also gathered. RESULTS Surveys were distributed to 143 SHEA Research Network members from 126 hospitals. In total, 113 responses were obtained, representing at least 61 unique hospitals (30 respondents did not identify a hospital); 79.2% (84 of 106 nonmissing responses) were infection preventionists, and 79.4% (81 of 102 nonmissing responses) worked at academic hospitals. Among the 6 vignettes, the proportion of respondents correctly characterizing the vignettes was as low as 27.3%. Combining all 6 vignettes, the mean percentage of correct responses was 61.1% (95% confidence interval, 57.7%–63.8%). Percentage of correct responses was associated with presence of a clinical background (ie, nursing or physician degrees) but not with hospital size or infection prevention and control department characteristics. CONCLUSIONS Substantial heterogeneity exists in the application of HAI definitions in this survey of infection preventionists and hospital epidemiologists. Our data suggest a need to better clarify these definitions, especially when comparing HAI rates across institutions. PMID:23739071

Factors Influencing Labeling Nonconsensual Sex as Sexual Assault.

PubMed

Yndo, Monica C; Zawacki, Tina

2017-03-01

The current study examined the effects of physical attractiveness and sexual interest cues on men's sexual perceptions of women and whether increases in sexual perceptions of a woman would lead to decreases in labeling of subsequent nonconsensual sex as sexual assault. Two hundred thirty-three male college students ( M age = 19.17, SD = 1.22) read a vignette describing a hypothetical social interaction between a man and a woman; within the vignette, the female character's physical attractiveness (attractive vs. less attractive) and the degree to which the female character behaved interested in the male character (uninterested vs. ambiguous) were manipulated. The vignette ends with the male character physically forcing sexual intercourse with the female character. After reading the vignette, participants' labeling of the nonconsensual sex as sexual assault was addressed. Participants' perceptions of the female character's sexual interest in the male character prior to the nonconsensual sex was assessed as a dependent variable during stopping points in the vignette, prior to sexual assault. Both physical attractiveness and interest cues had a significant positive influence on men's perception of the female character as sexually interested. In addition, perceptions of sexual interest had a direct negative effect on sexual assault labeling. These results indicate that increases in physical attractiveness and interest cues increase perceptions of sexual interest, in turn decreasing the labeling of nonconsensual sex as sexual assault. This experimental research contributes to the literature on misperception of sexual interest and sexual assault labeling. These findings provide implications for intervention programs and for forensic issues related to sexual assault.

Evolution of a Journal: Outing Some Ghosts from the Closet

ERIC Educational Resources Information Center

McDermott, John F.

2004-01-01

In this article, the author seeks to review the history of The Journal of The American Academy of Child and Adolescent Psychiatry, it's many changes and struggles. Some would maintain that in its early years, the JAACAP was filled with clinically useful case vignettes. But then, their story goes, it took a sharp turn to the left, and now is packed…

Levels of Emotional Awareness: a model for conceptualizing and measuring emotion-centered structural change.

PubMed

Subic-Wrana, Claudia; Beutel, Manfred E; Garfield, David A S; Lane, Richard D

2011-04-01

The need to establish the efficacy of psychoanalytic long-term treatments has promoted efforts to operationalize psychic structure and structural change as key elements of psychoanalytic treatments and their outcomes. Current, promising measures of structural change, however, require extensive interviews and rater training. The purpose of this paper is to present the theory and measurement of Levels of Emotional Awareness (LEA) and to illustrate its use based on clinical case vignettes. The LEA model lays out a developmental trajectory of affective processing, akin to Piaget's theory of sensory-cognitive development, from implicit to explicit processing. Unlike other current assessments of psychic structure (Scales of Psychological Capacities, Reflective Functioning, Operationalized Psychodynamic Diagnostics) requiring intensive rater and interviewer training, it is easily assessed based on a self-report performance test. The LEA model conceptualizes a basic psychological capacity, affect processing. As we will illustrate using two case vignettes, by operationalizing implicit and explicit modes of affect processing, it provides a clinical measure of emotional awareness that is highly pertinent to the ongoing psychoanalytic debate on the nature and mechanisms of structural change. Copyright © 2011 Institute of Psychoanalysis.

Physician Surveys to Assess Customary Care in Medical Malpractice Cases

PubMed Central

Hartz, Arthur; Lucas, Joshua; Cramm, Timothy; Green, Michael; Bentler, Suzanne; Ely, John; Wolfe, Steven; James, Paul

2002-01-01

OBJECTIVE Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care. DESIGN Seven physician surveys of mutually exclusive groups of randomly selected physicians. SETTING Iowa. PARTICIPANTS Community and academic primary care physicians and relevant specialists. INTERVENTIONS Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case. MEASUREMENTS AND MAIN RESULTS Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor. CONCLUSIONS Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may provide more information about customary practice or standard of care than the opinion of a single physician expert. PMID:12133145

Using short vignettes to disentangle perceived capability from motivation: a test using walking and resistance training behaviors.

PubMed

Rhodes, Ryan E; Williams, David M; Mistry, Chetan D

2016-07-01

Self-efficacy is arguably the strongest correlate of physical activity, yet some researchers suggest this is because the construct confounds ability with motivation. We examine a more circumscribed construct, called perceived capability (PC), meant to measure ability but not motivation and propose that the construct will not be related to unskilled physical activities but may be linked to skilled behaviors. The purpose of this paper was to examine whether a PC construct can be stripped of motivation using a vignette approach in both walking and resistance training behaviors. Participants were a random sample of 248 university students, who were then randomly assigned to either answer resistance training or walking behavior questions. Both groups completed a PC measure and reasons for their answer before and after reading a vignette that clarified the phrasing of capability to a literal use of the term. PC was significantly (p < .01) higher post- compared to pre-vignette and the differences were greater (p < .01) for walking than for resistance training. PC had significantly (p < .01) smaller correlations with intention and self-reported behavior post-disambiguation, which resulted in a null relationship with walking but a small correlation with resistance training behavior. When PC was combined with intention to predict behavior, however, there was no significant (p > .05) difference in the amount of variance explained pre- to post-vignette. Thought listing showed that participants did not report capability barriers to walking and over half of the sample construed capability as motivation/other priorities pre-vignette. The findings support use of a vignette approach for researchers who wish to disentangle the assessment of PC from motivation while creating no overall loss in explained variance of physical activity.

Habitual Cognitive Reappraisal Was Negatively Related to Perceived Immorality in the Harm and Fairness Domains

PubMed Central

Li, Zhongquan; Wu, Xiaoyuan; Zhang, Lisong; Zhang, Ziyuan

2017-01-01

Emotion plays an important role in moral judgment, and people always use emotion regulation strategies to modulate emotion, consciously or unconsciously. Previous studies had investigated only the relationship between emotion regulation strategies and moral judgment in the Harm domain, and revealed divergent results. Based on Moral Foundations Theory, the present study extended the investigation into moral judgment in all five moral domains and used a set of standardized moral vignettes. Two hundred and six college students filled in the Emotion Regulation Questionnaire and completed emotional ratings and moral judgment on moral vignettes from Moral Foundations Vignettes. Correlation analysis indicated that habitual cognitive reappraisal was negatively related to immorality rating in Harm, Fairness, and Loyalty domains. Regression analysis revealed that after controlling the effect of other variables, cognitive reappraisal negatively predicted immorality ratings in the Harm and Fairness domains. Further mediation analysis showed that emotional valence only partially explained the association between cognitive reappraisal and moral judgment in Harm area. Some other factors beyond emotional valence were suggested for future studies. PMID:29075229

Habitual Cognitive Reappraisal Was Negatively Related to Perceived Immorality in the Harm and Fairness Domains.

PubMed

Li, Zhongquan; Wu, Xiaoyuan; Zhang, Lisong; Zhang, Ziyuan

2017-01-01

Emotion plays an important role in moral judgment, and people always use emotion regulation strategies to modulate emotion, consciously or unconsciously. Previous studies had investigated only the relationship between emotion regulation strategies and moral judgment in the Harm domain, and revealed divergent results. Based on Moral Foundations Theory, the present study extended the investigation into moral judgment in all five moral domains and used a set of standardized moral vignettes. Two hundred and six college students filled in the Emotion Regulation Questionnaire and completed emotional ratings and moral judgment on moral vignettes from Moral Foundations Vignettes. Correlation analysis indicated that habitual cognitive reappraisal was negatively related to immorality rating in Harm, Fairness, and Loyalty domains. Regression analysis revealed that after controlling the effect of other variables, cognitive reappraisal negatively predicted immorality ratings in the Harm and Fairness domains. Further mediation analysis showed that emotional valence only partially explained the association between cognitive reappraisal and moral judgment in Harm area. Some other factors beyond emotional valence were suggested for future studies.

Does a web-based feedback training program result in improved reliability in clinicians' ratings of the Global Assessment of Functioning (GAF) Scale?

PubMed

Støre-Valen, Jakob; Ryum, Truls; Pedersen, Geir A F; Pripp, Are H; Jose, Paul E; Karterud, Sigmund

2015-09-01

The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician's deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree. (c) 2015 APA, all rights reserved.

Euthanasia or physician-assisted suicide? A survey from the Netherlands.

PubMed

Kouwenhoven, Pauline S C; van Thiel, Ghislaine J M W; Raijmakers, Natasja J H; Rietjens, Judith A C; van der Heide, Agnes; van Delden, Johannes J M

2014-03-01

Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. To study physicians' experiences and attitudes concerning the choice between euthanasia and PAS. A questionnaire including vignettes was sent to a random sample of 1955 Dutch general practitioners, elderly care physicians and medical specialists. In total, 793 physicians (41%) participated. There was no clear preference for euthanasia (36%) or PAS (34%). Two thirds of physicians thought that PAS underlines the autonomy and responsibility of the patient and considered this a reason to choose PAS. Reasons for not choosing PAS were expected practical problems. A minority (22%) discussed the possibility of PAS with their patient in case of a request for assistance in dying. Patients receiving PAS more often experienced psychosocial suffering in comparison with patients receiving euthanasia. In vignettes of patients with a request for assistance in dying due to psychosocial suffering, physicians agreed more often with the performance of PAS than with euthanasia. Dutch physicians perceive a difference between euthanasia and PAS. Although they believe PAS underlines patient autonomy and responsibility, the option of PAS is rarely discussed with the patient. The more psychosocial in nature the patient's suffering, the more physicians choose PAS. In these cases, PAS seems to fulfil physicians' preferences to emphasize patient autonomy and responsibility. Expected technical problems and unfamiliarity with PAS also play a role. Paradoxically, the choice for PAS is predominantly a physician's one.

Awareness of ethical issues in medical education: an interactive teach-the-teacher course.

PubMed

Chiapponi, Costanza; Dimitriadis, Konstantinos; Özgül, Gülümser; Siebeck, Robert G; Siebeck, Matthias

2016-01-01

We conducted an international, interdisciplinary teach-the-teacher course to sensitize physicians from different countries to ethical issues in medical education. The purpose of this study was to assess the effects of this course. Before and after participating in a short session on ethical issues in medical education, 97 physicians from different countries in Africa, Asia, and Europe completed a self-assessment questionnaire on their competence and interest in this field. The short session consisted of working in small groups to identify, analyze and discuss ethical dilemmas described in case vignettes adapted from published examples or written by medical students. In addition to the questionnaire, we conducted a large-group experience to explore four basic orientations of participants in ethical thinking: relativism, intentionalism, consequentialism, and absolutism. We found a significant self-perceived increase in the participants' ability to identify and describe ethical issues and students' dilemmas, in their knowledge about these issues and teaching professionalism, and in their ability to describe both students' perspectives and teachers' and students' behaviors. In addition, participants' feeling of understanding their own culturally learned patterns of determining what is right and wrong increased after taking part in the course. The four contrasting basic ethical orientations showed no significant differences between participants regarding nationality, age, or gender. Ethics of education is an important issue for medical teachers. Teachers' self-perceived competence can be increased by working on case vignettes in small groups.

Awareness of ethical issues in medical education: an interactive teach-the-teacher course

PubMed Central

Chiapponi, Costanza; Dimitriadis, Konstantinos; Özgül, Gülümser; Siebeck, Robert G.; Siebeck, Matthias

2016-01-01

Purpose: We conducted an international, interdisciplinary teach-the-teacher course to sensitize physicians from different countries to ethical issues in medical education. The purpose of this study was to assess the effects of this course. Method: Before and after participating in a short session on ethical issues in medical education, 97 physicians from different countries in Africa, Asia, and Europe completed a self-assessment questionnaire on their competence and interest in this field. The short session consisted of working in small groups to identify, analyze and discuss ethical dilemmas described in case vignettes adapted from published examples or written by medical students. In addition to the questionnaire, we conducted a large-group experience to explore four basic orientations of participants in ethical thinking: relativism, intentionalism, consequentialism, and absolutism. Results: We found a significant self-perceived increase in the participants’ ability to identify and describe ethical issues and students’ dilemmas, in their knowledge about these issues and teaching professionalism, and in their ability to describe both students’ perspectives and teachers’ and students’ behaviors. In addition, participants’ feeling of understanding their own culturally learned patterns of determining what is right and wrong increased after taking part in the course. The four contrasting basic ethical orientations showed no significant differences between participants regarding nationality, age, or gender. Conclusion: Ethics of education is an important issue for medical teachers. Teachers’ self-perceived competence can be increased by working on case vignettes in small groups. PMID:27275510

Co-production in practice: how people with assisted living needs can help design and evolve technologies and services.

PubMed

Wherton, Joseph; Sugarhood, Paul; Procter, Rob; Hinder, Sue; Greenhalgh, Trisha

2015-05-26

The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of 'care closer to home' is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants' perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual's wider social support network. Finally, the service must support a high degree of information sharing and coordination. The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use.

Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes.

PubMed

Verghese, Abraham; Charlton, Blake; Kassirer, Jerome P; Ramsey, Meghan; Ioannidis, John P A

2015-12-01

Oversights in the physical examination are a type of medical error not easily studied by chart review. They may be a major contributor to missed or delayed diagnosis, unnecessary exposure to contrast and radiation, incorrect treatment, and other adverse consequences. Our purpose was to collect vignettes of physical examination oversights and to capture the diversity of their characteristics and consequences. A cross-sectional study using an 11-question qualitative survey for physicians was distributed electronically, with data collected from February to June of 2011. The participants were all physicians responding to e-mail or social media invitations to complete the survey. There were no limitations on geography, specialty, or practice setting. Of the 208 reported vignettes that met inclusion criteria, the oversight was caused by a failure to perform the physical examination in 63%; 14% reported that the correct physical examination sign was elicited but misinterpreted, whereas 11% reported that the relevant sign was missed or not sought. Consequence of the physical examination inadequacy included missed or delayed diagnosis in 76% of cases, incorrect diagnosis in 27%, unnecessary treatment in 18%, no or delayed treatment in 42%, unnecessary diagnostic cost in 25%, unnecessary exposure to radiation or contrast in 17%, and complications caused by treatments in 4%. The mode of the number of physicians missing the finding was 2, but many oversights were missed by many physicians. Most oversights took up to 5 days to identify, but 66 took longer. Special attention and skill in examining the skin and its appendages, as well as the abdomen, groin, and genitourinary area could reduce the reported oversights by half. Physical examination inadequacies are a preventable source of medical error, and adverse events are caused mostly by failure to perform the relevant examination. Copyright © 2015 Elsevier Inc. All rights reserved.

The physiological correlates of children's emotions in contexts of moral transgression.

PubMed

Malti, Tina; Colasante, Tyler; Zuffianò, Antonio; de Bruine, Marieke

2016-02-01

Heightened attention to sociomoral conflicts and arousal at the prospect of committing moral transgressions are thought to increase the likelihood of negatively valenced moral emotions (NVMEs; e.g., guilt) in children. Here, we tested this biphasic model of moral emotions with a psychophysiological framework. For a series of vignettes depicting moral transgressions, 5- and 8-year-olds (N=138) were asked to anticipate their emotions as hypothetical victimizers. Their responses were coded for the presence and intensity of NVMEs. In addition, their heart rate (HR) was calculated for three intervals of interest: a baseline period, the presentation of vignettes, and the anticipation of emotions following vignettes. We used multilevel modeling to examine how change in children's HR across these intervals related to the intensity of their NVMEs. Those who experienced greater HR deceleration from baseline to vignettes and greater acceleration from vignettes to anticipated emotions reported more intense NVMEs. We discuss the potential attention- and arousal-related processes behind children's physiological reactivity and anticipated emotions in contexts of moral transgression. Copyright © 2015 Elsevier Inc. All rights reserved.

Temporo-parietal junction activity in theory-of-mind tasks: falseness, beliefs, or attention.

PubMed

Aichhorn, Markus; Perner, Josef; Weiss, Benjamin; Kronbichler, Martin; Staffen, Wolfgang; Ladurner, Gunther

2009-06-01

By combining the false belief (FB) and photo (PH) vignettes to identify theory-of-mind areas with the false sign (FS) vignettes, we re-establish the functional asymmetry between the left and right temporo-parietal junction (TPJ). The right TPJ (TPJ-R) is specially sensitive to processing belief information, whereas the left TPJ (TPJ-L) is equally responsible for FBs as well as FSs. Measuring BOLD at two time points in each vignette, at the time the FB-inducing information (or lack of information) is presented and at the time the test question is processed, made clear that the FB is processed spontaneously as soon as the relevant information is presented and not on demand for answering the question in contrast to extant behavioral data. Finally, a fourth, true belief vignette (TB) required teleological reasoning, that is, prediction of a rational action without any doubts being raised about the adequacy of the actor's information about reality. Activation by this vignette supported claims that the TPJ-R is activated by TBs as well as FBs.

Mammographers’ Perception of Women’s Breast Cancer Risk

PubMed Central

Egger, Joseph R.; Cutter, Gary R.; Carney, Patricia A.; Taplin, Stephen H.; Barlow, William E.; Hendrick, R. Edward; D’Orsi, Carl J.; Fosse, Jessica S.; Abraham, Linn; Elmore, Joann G.

2011-01-01

Objective To understand mammographers’ perception of individual women’s breast cancer risk. Materials and Methods Radiologists interpreting screening mammography examinations completed a mailed survey consisting of questions pertaining to demographic and clinical practice characteristics, as well as 2 vignettes describing different risk profiles of women. Respondents were asked to estimate the probability of a breast cancer diagnosis in the next 5 years for each vignette. Vignette responses were plotted against mean recall rates in actual clinical practice. Results The survey was returned by 77% of eligible radiologists. Ninety-three percent of radiologists overestimated risk in the vignette involving a 70-year-old woman; 96% overestimated risk in the vignette involving a 41-year-old woman. Radiologists who more accurately estimated breast cancer risk were younger, worked full-time, were affiliated with an academic medical center, had fellowship training, had fewer than 10 years experience interpreting mammograms, and worked more than 40% of the time in breast imaging. However, only age was statistically significant. No association was found between radiologists’ risk estimate and their recall rate. Conclusion U.S. radiologists have a heightened perception of breast cancer risk. PMID:15951455

The effect of child characteristics on teachers' acceptability of classroom-based behavioral strategies and psychostimulant medication for the treatment of ADHD.

PubMed

Pisecco, S; Huzinec, C; Curtis, D

2001-09-01

Studied the effect of student characteristics on teachers' ratings of treatment acceptability for attention deficit hyperactivity disorder (ADHD). Participants (N = 159) included experienced elementary school teachers who read 1 of 6 vignettes describing a child with symptoms representative of ADHD. Vignettes varied by sex and symptom-subtype classification. However, the number and specific type of symptoms described in the vignettes were consistent across all conditions. Next, teachers read a description of a daily report card (DRC), response cost technique, classroom lottery, and medication and rated their levels of agreement to the items of the Behavioral Intervention Rating Scale (BIRS). Teachers preferred the DRC to all other forms of treatment. However, there was a significant interaction between the type of treatment and sex of the student on the 3 factors (Treatment Acceptability, Treatment Effectiveness, and Timeliness) of the BIRS.

Monogamy, the Protective Fallacy: Sexual versus Emotional Exclusivity and the Implication for Sexual Health Risk.

PubMed

Swan, D Joye; Thompson, Suzanne C

2016-01-01

The authors examined the hypothesis that many individuals define monogamy based on emotional rather than sexual fidelity. Participants, 373 heterosexual college students and 282 gay men, read three vignettes of decreasing mitigation in which they imagined committing an act of infidelity against a hypothetical partner and where half the participants were cued to their emotional attachment toward the partner. Despite the infidelity, relationships in the emotional attachment-cued vignettes were rated as monogamous to a greater degree than relationships in the vignettes where emotional attachment was not cued. In addition, over one-third of the participants in our study reported infidelity in their current self-defined monogamous relationships yet also reported feeling more protected from sexual health risks and reported less condom use than individuals who defined their relationship as nonmonogamous. The implications for monogamy as a protective fallacy are discussed.

Public stigma and schizophrenia in São Paulo city.

PubMed

Peluso, Erica Toledo Piza; Blay, Sérgio Luís

2011-06-01

To assess public stigma in relation to people with schizophrenia and possible factors associated with this phenomenon. A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of São Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with schizophrenia (according to DSM-IV and ICD-10 criteria). This was followed by questions that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette. People with schizophrenia were perceived as potentially dangerous by 74.2% of interviewees. In addition, 59.0% of the sample perceived them as capable of arousing negative reactions, and 57.2% as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly pro-social in nature. The most important factors associated with these responses were: attribution of "biological" causes and perceived dangerousness. This study indicated that beliefs related to public stigma towards people with schizophrenia are commonly held in São Paulo city. An important focus for future studies is to investigate the scope and impact of public stigma on the everyday experiences of people with schizophrenia in the Brazilian context.

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study.

PubMed

Harris, Ricci; Cormack, Donna; Stanley, James; Curtis, Elana; Jones, Rhys; Lacey, Cameron

2018-01-23

Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making. All final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression. Three hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses. NZ medical students demonstrated ethnic bias, although overall this was not associated with clinical decision-making. This study both adds to the small body of literature internationally on racial/ethnic bias among medical students and provides relevant and important information for medical education on indigenous health and ethnic health inequities in New Zealand.

The impact of patient-centered communication on patients' decision making and evaluations of physicians: A randomized study using video vignettes*

PubMed Central

Saha, Somnath; Beach, Mary Catherine

2011-01-01

Objective To assess the impact of patient-centered communication (PCC) behaviors on patients' evaluations of physicians and acceptance of clinical recommendations. Methods We randomized 248 patients to view video-recorded, standardized vignettes, depicting a cardiologist using a high vs. low degree of PCC while recommending bypass surgery to a patient with angina and 3-vessel coronary artery disease. We compared patients' ratings of the physician and their decision making in response to the physician's recommendation, for high vs. low PCC vignettes. Results Patients viewing high PCC vignettes rated the video physician more favorably overall (3.01 vs. 2.12, p < 0.001) and as more competent (3.22 vs. 2.66, p < 0.001) and trustworthy (2.93 vs. 2.28, p < 0.001) than those viewing the low PCC version (0–4 range for all scales). Patients viewing the high PCC version more frequently said they would undergo bypass surgery (96% vs. 74%, p < 0.001) if they were the patient in the video. Conclusion Patients expressed greater confidence in physicians who used more PCC behaviors, and greater willingness to accept an evidence-based recommendation. Practice implications PCC may make physicians more effective in the delivery of evidence-based care. PMID:21600723

Gender differences in mental health literacy among Chinese-speaking Australians in Melbourne, Australia.

PubMed

Wong, Daniel Fu Keung; Lam, Angus Yuk Kit; Poon, Ada; Chow, Amy Yin Man

2012-03-01

This study attempted to understand gender differences in knowledge of mental illness, preference for professional help, and medications and treatment methods among Australians of Chinese-speaking background. This study adopted a cluster convenience sampling method in which subjects were taken from the four major areas in cosmopolitan Melbourne where most Chinese people are living. A total of 200 Chinese-speaking Australians participated in the study. They were presented with two vignettes describing an individual with acute depression or acute schizophrenia and then questions were asked to assess their understanding of the conditions, preference for professional help, medications and treatment methods. More female than male respondents could correctly identify the conditions in the two vignettes. Female participants also perceived medications to be relatively more harmful than their male counterparts. In contrast, there were significantly more males than females who adhered to traditional views on the causation of mental illness; had significantly higher percentages of endorsement of 'deal with it alone'; believed 'traditional Chinese medical doctor' and 'Chinese herbal medicines' to be helpful to the person in the schizophrenia vignette; and significantly endorsed 'psychiatric ward', 'electro-convulsive treatment', 'changing fungshui' and 'traditional Chinese worship' to be helpful for the persons in both vignettes. A combination of factors, which included age, duration of migration and traditional Chinese cultural values, were put forward to explain the above differences. Campaigns to improve the mental health literacy of Chinese-speaking Australians must take into account the gender differences between male and female Chinese-speaking Australians so that culturally relevant and gender-specific education programmes can be developed.

[Stigmatization of a person visiting psychiatrist depends on observer's gender].

PubMed

Munjiza, Ana; Stojiljković, Dragan J; Milekić, Bojana; Latković, Olgica; Jasović-Gasić, Miroslava; Marić, Nada P

2010-01-01

The two types of stigmatization are social stigma, which includes discrimination, underestimation and distance in various social circumstances and personal stigma, which includes private relation i.e. a contact in person with stigmatized subject. Majority of recent publications has shown gender asymmetry in stigmatization (mostly indicating male predominance in stigmatizing processes), whereas the opposite data can be also found in some publications. The present study was aimed at exploring the relation of students' gender with their tendency to stigmatize subjects visiting a psychiatrist and at analyzing whether the gender influences the process of stigmatization. The survey included 523 students (227 on the second and 296 on the sixth year of School of Medicine, University of Belgrade). The instrument consisted of a vignette with questionnaire (14 items). Four versions of vignette were distributed: with/without "label" and male/female subject in the vignette. A more personal stigmatization was evident in the female students (p < 0.05). while no gender-differences existed in social stigmatization (p > 0.05). The stigmatization positively correlated with the intimacy of student's relation with the subject going to a psychiatrist. A higher rate of stigmatization was evident if the vignette was showing a person of the opposite gender. This is a unique study which analyzes separately the gender of a stigmatizing subject versus the subject being stigmatized and types of stigmatization. The data obtained should contribute to recognizing, understanding and controlling the widespread problem of stigma.

Disentangling the Effect of Valence and Arousal on Judgments Concerning Moral Transgressions.

PubMed

de la Viña, Luis; Garcia-Burgos, David; Okan, Yasmina; Cándido, Antonio; González, Felisa

2015-08-10

An increasing body of research has investigated the effect of emotions on judgments concerning moral transgressions. Yet, few studies have controlled for arousal levels associated with the emotions. High arousal may affect moral processing by triggering attention to salient features of transgressions, independently of valence. Therefore previously documented differences in effects of negative and positive emotions may have been confounded by differences in arousal. We conducted two studies to shed light on this issue. In Study 1 we developed a questionnaire including vignettes selected on the basis of psychometrical properties (i.e., mean ratings of the actions and variability). This questionnaire was administered to participants in Study 2, after presenting them with selected pictures inducing different valence but equivalent levels of arousal. Negative pictures led to more severe moral judgments than neutral (p = .054, d = 0.60) and positive pictures (p = .002, d = 1.02), for vignettes that were not associated with extreme judgments. In contrast, positive pictures did not reliably affect judgments concerning such vignettes. These findings suggest that the observed effects of emotions cannot be accounted for by an increase in attention linked to the arousal which accompanies these emotions.

Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals’ Likelihood of Speaking up about Safety Concerns

PubMed Central

Schwappach, David L. B.; Gehring, Katrin

2014-01-01

Purpose To investigate the likelihood of speaking up about patient safety in oncology and to clarify the effect of clinical and situational context factors on the likelihood of voicing concerns. Patients and Methods 1013 nurses and doctors in oncology rated four clinical vignettes describing coworkers’ errors and rule violations in a self-administered factorial survey (65% response rate). Multiple regression analysis was used to model the likelihood of speaking up as outcome of vignette attributes, responder’s evaluations of the situation and personal characteristics. Results Respondents reported a high likelihood of speaking up about patient safety but the variation between and within types of errors and rule violations was substantial. Staff without managerial function provided significantly higher levels of decision difficulty and discomfort to speak up. Based on the information presented in the vignettes, 74%−96% would speak up towards a supervisor failing to check a prescription, 45%−81% would point a coworker to a missed hand disinfection, 82%−94% would speak up towards nurses who violate a safety rule in medication preparation, and 59%−92% would question a doctor violating a safety rule in lumbar puncture. Several vignette attributes predicted the likelihood of speaking up. Perceived potential harm, anticipated discomfort, and decision difficulty were significant predictors of the likelihood of speaking up. Conclusions Clinicians’ willingness to speak up about patient safety is considerably affected by contextual factors. Physicians and nurses without managerial function report substantial discomfort with speaking up. Oncology departments should provide staff with clear guidance and trainings on when and how to voice safety concerns. PMID:25116338

Mental health literacy survey of non-mental health professionals in six general hospitals in Hunan Province of China

PubMed Central

Wu, Qiuxia

2017-01-01

Background Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals’ conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis. Methods In 2014–2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured. Results Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse. Conclusions The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals’ mental health knowledge in mainland China in order to provide better support for mental health service users. PMID:28678848

Mental health literacy survey of non-mental health professionals in six general hospitals in Hunan Province of China.

PubMed

Wu, Qiuxia; Luo, Xiaoyang; Chen, Shubao; Qi, Chang; Long, Jiang; Xiong, Yifan; Liao, Yanhui; Liu, Tieqiao

2017-01-01

Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals' conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis. In 2014-2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured. Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse. The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals' mental health knowledge in mainland China in order to provide better support for mental health service users.

Munchausen Syndrome by Proxy: A Clinical Vignette

PubMed Central

Zylstra, Robert G.; Miller, Karl E.; Stephens, Walter E.

2000-01-01

Munchausen syndrome by proxy is the act of one person fabricating or inducing an illness in another to meet his or her own emotional needs through the treatment process. The diagnosis is poorly understood and controversial. We report here the case of a 6-year-old boy who presented with possible pneumonia, nausea, vomiting, and diarrhea and whose mother was suspected of Munchausen syndrome by proxy. PMID:15014581

Child Refugees, Trauma and Education: Interactionist Considerations on Social and Emotional Needs and Development

ERIC Educational Resources Information Center

Hart, Robert

2009-01-01

This paper focuses on the social and emotional needs of children and young people who are refugees. It was inspired by casework undertaken by the author involving a 13-year-old boy who was a refugee from Montenegro. A vignette of the case is presented in addition to a review of relevant literature to illustrate and discuss the various sources of…

[Beyond boredom: the effort to make a patient interesting].

PubMed

Marin, C

2009-02-11

The doctors' emotional reaction towards the patients has an impact on the doctor-patient relationship. This article focuses on a particular emotion, boredom which is evoked by certain patients. By means of a case vignette, this phenomenon is elucidated and confronted with the psycho-analytical concept of "pensée opératoire", and ways are identified to raise the interest in patients.

Complexity of GPs' explanations about mental health problems: development, reliability, and validity of a measure

PubMed Central

Cape, John; Morris, Elena; Burd, Mary; Buszewicz, Marta

2008-01-01

Background How GPs understand mental health problems determines their treatment choices; however, measures describing GPs' thinking about such problems are not currently available. Aim To develop a measure of the complexity of GP explanations of common mental health problems and to pilot its reliability and validity. Design of study A qualitative development of the measure, followed by inter-rater reliability and validation pilot studies. Setting General practices in North London. Method Vignettes of simulated consultations with patients with mental health problems were videotaped, and an anchored measure of complexity of psychosocial explanation in response to these vignettes was developed. Six GPs, four psychologists, and two lay people viewed the vignettes. Their responses were rated for complexity, both using the anchored measure and independently by two experts in primary care mental health. In a second reliability and revalidation study, responses of 50 GPs to two vignettes were rated for complexity. The GPs also completed a questionnaire to determine their interest and training in mental health, and they completed the Depression Attitudes Questionnaire. Results Inter-rater reliability of the measure of complexity of explanation in both pilot studies was satisfactory (intraclass correlation coefficient = 0.78 and 0.72). The measure correlated with expert opinion as to what constitutes a complex explanation, and the responses of psychologists, GPs, and lay people differed in measured complexity. GPs with higher complexity scores had greater interest, more training in mental health, and more positive attitudes to depression. Conclusion Results suggest that the complexity of GPs' psychosocial explanations about common mental health problems can be reliably and validly assessed by this new standardised measure. PMID:18505616

Moral foundations vignettes: a standardized stimulus database of scenarios based on moral foundations theory.

PubMed

Clifford, Scott; Iyengar, Vijeth; Cabeza, Roberto; Sinnott-Armstrong, Walter

2015-12-01

Research on the emotional, cognitive, and social determinants of moral judgment has surged in recent years. The development of moral foundations theory (MFT) has played an important role, demonstrating the breadth of morality. Moral psychology has responded by investigating how different domains of moral judgment are shaped by a variety of psychological factors. Yet, the discipline lacks a validated set of moral violations that span the moral domain, creating a barrier to investigating influences on judgment and how their neural bases might vary across the moral domain. In this paper, we aim to fill this gap by developing and validating a large set of moral foundations vignettes (MFVs). Each vignette depicts a behavior violating a particular moral foundation and not others. The vignettes are controlled on many dimensions including syntactic structure and complexity making them suitable for neuroimaging research. We demonstrate the validity of our vignettes by examining respondents' classifications of moral violations, conducting exploratory and confirmatory factor analysis, and demonstrating the correspondence between the extracted factors and existing measures of the moral foundations. We expect that the MFVs will be beneficial for a wide variety of behavioral and neuroimaging investigations of moral cognition.

Moral foundations vignettes: a standardized stimulus database of scenarios based on moral foundations theory

PubMed Central

Iyengar, Vijeth; Cabeza, Roberto; Sinnott-Armstrong, Walter

2016-01-01

Research on the emotional, cognitive, and social determinants of moral judgment has surged in recent years. The development of moral foundations theory (MFT) has played an important role, demonstrating the breadth of morality. Moral psychology has responded by investigating how different domains of moral judgment are shaped by a variety of psychological factors. Yet, the discipline lacks a validated set of moral violations that span the moral domain, creating a barrier to investigating influences on judgment and how their neural bases might vary across the moral domain. In this paper, we aim to fill this gap by developing and validating a large set of moral foundations vignettes (MFVs). Each vignette depicts a behavior violating a particular moral foundation and not others. The vignettes are controlled on many dimensions including syntactic structure and complexity making them suitable for neuroimaging research. We demonstrate the validity of our vignettes by examining respondents’ classifications of moral violations, conducting exploratory and confirmatory factor analysis, and demonstrating the correspondence between the extracted factors and existing measures of the moral foundations. We expect that the MFVs will be beneficial for a wide variety of behavioral and neuroimaging investigations of moral cognition. PMID:25582811

Diagnosis-related groups for stroke in Europe: patient classification and hospital reimbursement in 11 countries.

PubMed

Peltola, Mikko; Quentin, Wilm

2013-01-01

Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries' systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and national DRG authorities should consider how other countries' DRG systems classify stroke patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement. In future, quantitative research is needed to verify whether the most important determinants of cost are considered in different patient classification systems, and whether differences between systems reflect country-specific differences in treatment patterns and, most importantly, what influence they have on patient outcomes. Copyright © 2013 S. Karger AG, Basel.

Attributions of Blame in a Hypothetical Child Sexual Abuse Case: Roles of Behavior Problems and Frequency of Abuse.

PubMed

Theimer, Kate; Hansen, David J

2017-06-01

Youth who are blamed for their sexual abuse may experience increased negative outcomes, such as amplified self-blame. Similarly, blaming nonoffending parents can impede their ability to support their child following disclosure. Understanding the factors that influence how people perceive victim, caregiver, and perpetrator responsibility is imperative for the protection and treatment of families who have experienced sexual abuse. Little research has explored victim and abuse characteristics that influence the perception of sexual abuse. As such, the purpose of this study was to examine the roles of behavior problems and frequency of abuse in the attribution of blame in a hypothetical sexual abuse case. In addition, the relationship between several respondent characteristics and assignment of responsibility were explored as secondary aims. The study used a two (behavior problems: three suspensions in one school semester vs. no mention of behavior problems) by two (one abuse occurrence vs. five abuse occurrences) between-subjects design. Seven hundred forty-two participants read one of the four child sexual abuse (CSA) vignettes and completed measures related to responsibility. ANOVAs revealed those who read a vignette where the youth experienced multiple abuse incidents rated the victim as more responsible regardless of whether or not the youth was described as having behavior problems. Results indicate that respondents may have attributed more blame to the victim due to the belief that she could have done something to stop the abuse after the first incident. The abuse frequency manipulation when combined with the behavior manipulation appeared to relate to how respondents perceived the victim's parents. Males and younger respondents attributed more blame to the victim; however, sexual abuse or assault history did not associate with victim responsibility ratings. Clinical and research implications were discussed.

Integrating Education and Service in Pediatric Residency Training: Results of a National Survey.

PubMed

Kesselheim, Jennifer C; Schwartz, Alan; Boyer, Debra

The definition and proper role of service, as it relates to education, in the residency training experience has been long debated. In this study we aimed to develop definitions for service and education, delineate how each is perceived to contribute value to training, and to measure respondents' ratings of service and education using case vignettes. We conducted a multisite cohort survey study of pediatric residents (n = 797) and program directors (PDs; n = 37) using a region-stratified sample of 2 to 3 participating pediatric residency programs per region. Surveys were completed by 34 PDs (92%) and 359 trainees (45%). PDs and residents agree that service can, in the absence of formal teaching, be considered educational. When asked how often rotations provide an appropriate balance between education and service, 94% of PDs responded 'extremely/very often' whereas only 68% of residents agreed (P = .005). Residents were significantly more likely than PDs to endorse definitions for service that included volunteer work (82% vs 59%; P = .002), going above and beyond for a patient (91% vs 78%; P = .017), and routine patient care activities (91% vs 72%; P < .001). For 6 of 12 case vignettes, trainees gave median service ratings that were significantly higher than PDs (P = .03). Medical educators and pediatric residents hold mismatched impressions of their training programs' balance of service obligations with clinical education. Specifically, residents more frequently report an overabundance of service. Both groups acknowledge that service activities can be educationally valuable although the groups' definitions of service are not fully aligned. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Mucosal Melanomas: A Case-Based Review of the Literature

PubMed Central

Seetharamu, Nagashree; Ott, Patrick A.

2010-01-01

Mucosal melanoma is a rare cancer that is clearly distinct from its cutaneous counterpart in biology, clinical course, and prognosis. Recent studies have shown important differences in the frequencies of various genetic alterations in different subtypes of melanoma. Activating mutations in the c-KIT gene are detected in a significant number of patients with mucosal melanoma. This observation has resulted in the initiation of several clinical trials aimed at exploring the role of receptor tyrosine kinases that inhibit c-KIT in this patient population. We herein present a comprehensive literature review of mucosal melanoma along with case vignettes of a number of pertinent cases. We further discuss melanomas of the head and neck, the female genital tract, and the anorectum, which are the three most common sites of mucosal melanoma, with a particular focus on the diagnostic, prognostic, and therapeutic data available in the literature. PMID:20571149

["I dreamed that I dreamed": some notes on the clinical evaluation of therapist interventions, exemplified by Deserno's case study (session 290)].

PubMed

Berns, U; Hemprich, L

2001-01-01

In No. 8, 48th year, August 1998, of the journal "Psychotherapie--Psychosomatik--Medizinische Psychologie" the tape recorder transcription of the 290th session of a long-term analysis was studied by three methods (BIP, Frames, ZBKT). The paper presented here was stimulated by this publication. From the author's viewpoint substantial clinical aspects of evaluation could be added by applying a clinical evaluation method developed by R. Langs and his corresponding concept of interpretation. Clinical vignettes exemplify the possibility to resolve pathological countertransference by using this evaluation method. With the help of this method the presented transcription of the 290th session is evaluated partially.

Children's supernatural thinking as a signalling behaviour in early childhood.

PubMed

Hernández Blasi, Carlos; Bjorklund, David F; Ruiz Soler, Marcos

2017-08-01

In this study, we analysed the reaction times of 137 college students when making decisions on pairs of hypothetical children verbalizing different types of vignettes and/or exhibiting different physical appearance (photographs of faces). Vignettes depicted immature and mature versions of both supernatural (e.g., 'The sun's not out today because it's mad' vs. 'The sun's not out today because the clouds are blocking it') and natural ('I can remember all 20 cards!' vs. 'I can remember 6 or 7 cards') explanations to ordinary phenomena. Photographs of children's faces were morphed with a physical appearance of approximately 4-7 years old or approximately 8-10 years old. In earlier research, immature supernatural thinking produced positive-affect reactions from adults and older adolescents (14-18 years old) towards young children, with cognitive cues being more important than physical-appearance cues in influencing adults' judgements. Reaction times to make decisions varied for the Supernatural and Natural vignettes and for the immature and mature vignettes/faces, reflecting the differential cognitive effort adults used for making decisions about aspects of children's physical appearance and verbal expressions. The findings were interpreted in terms of the critical role that young children's immature supernatural thinking has on adults' perception, analogous to the evolved role of immature physical features on adults' perception of infants. © 2016 The British Psychological Society.

Causal explanations of distress and general practitioners' assessments of common mental disorder among punjabi and English attendees.

PubMed

Bhui, Kamaldeep; Bhugra, Dinesh; Goldberg, David

2002-01-01

The literature on the primary care assessment of mental distress among Indian subcontinent origin patients suggests frequent presentations to general practitioner, but rarely for recognisable psychiatric disorders. This study investigates whether cultural variations in patients' causal explanatory models account for cultural variations in the assessment of non-psychotic mental disorders in primary care. In a two-phase survey, 272 Punjabi and 269 English subjects were screened. The second phase was completed by 209 and 180 subjects, respectively. Causal explanatory models were elicited as explanations of two vignette scenarios. One of these emphasised a somatic presentation and the other anxiety symptoms. Psychiatric disorder was assessed by GPs on a Likert scale and by a psychiatrist on the Clinical Interview Schedule. Punjabis more commonly expressed medical/somatic and religious beliefs. General practitioners were more likely to assess any subject giving psychological explanations to vignette A and English subjects giving religious explanations to vignette B as having a significant psychiatric disorder. Where medical/somatic explanations of distress were most prevalent in response to the somatic vignette, psychological, religious and work explanations were less prevalent among Punjabis but not among English subjects. Causal explanations did not fully explain cultural differences in assessments. General practitioners' assessments and causal explanations are related and influenced by culture, but causal explanations do not fully explain cultural differences in assessments.

Stigmatization of 'psychiatric label' by medical and non-medical students.

PubMed

Totic, Sanja; Stojiljkovic, Dragan; Pavlovic, Zorana; Zaric, Nenad; Zarkovic, Boris; Malic, Ljubica; Mihaljevic, Marina; Jasovic-Gasic, Miroslava; Maric, Nadja P

2012-09-01

Stigmatization of psychiatric patients is present both in the general population and among healthcare professionals. To determine the attitudes and behaviour of medical students towards a person who goes to a psychiatrist, before and after psychiatric rotation, and to compare those attitudes between medical and non-medical students. The study included 525 medical students (second and sixth year of studies) and 154 students of law. The study instrument was a three-part self-reported questionnaire (socio-demographic data, Rosenberg Self-Esteem Scale and a vignette depicting a young, mentally healthy person). The experimental intervention consisted of ascribing a 'psychiatric label' to only one set of vignettes. All the vignettes (with or without the 'psychiatric label') were followed by 14 statements addressing the acceptance of a person described by vignette, as judged by social distance (four-point Likert scale). Higher tendency to stigmatize was found in medical students in the final year, after psychiatric rotation (Z(U) = -3.12, p = .002), particularly in a closer relationship (Z(U) = -2.67, p = .007) between a student and a hypothetical person who goes to a psychiatrist. The non-medical students had a similar tendency to stigmatize as medical students before psychiatric rotation (Z(U) = -0.03, p = .975). Neither gender, nor the size of student's place of origin or average academic mark was associated with the tendency to stigmatize in our sample. However, student's elf-esteem was lower in those with a tendency to stigmatize more in a distant relationship (ρ = -0.157, p = .005). Psychiatric education can either reinforce stigmatization or reduce it. Therefore, detailed analyses of educational domains that reinforce stigma will be the starting point for anti-stigma action.

Parent and Child Independent Report of Emotional Responses to Asthma-Specific Vignettes: The Relationship Between Emotional States, Self-Management Behaviors, and Symptoms.

PubMed

Conn, Kelly M; Fisher, Susan G; Rhee, Hyekyun

2016-01-01

Little is known about the emotional intelligence (EI) of parents and their children with asthma. Objectives of this study were to assess: 1) parent's and children's report of emotions in response to an asthma vignette (proxy for EI) and 2) the relationship between emotions, self-management behaviors, and symptoms. We conducted a descriptive, mixed methods study of children 7-12 years old with asthma. Parent-Child dyads (n=104) responded to an asthma vignette to gain insight into emotions, symptoms, and self-management behaviors. Additional questions assessed confidence and worry using a 5-point Likert scale. Thematic analyses and descriptive statistics were used to assess qualitative and quantitative outcomes. Children were predominantly male (58%), 7-9 (58%), and White (46%). The most common negative emotions reported by children were scared and sad. Children who sought help from an adult were less likely to report using medications compared to children who did not seek help (39.5% vs. 62.3%, p=.029). Children with low worry and high confidence had fewer symptoms compared to children reporting high worry and low confidence (symptoms: days 3.24 vs. 6.77, p=.012, nights 2.71 vs. 5.36, p=.004). Children provided appropriate emotional responses to the asthma vignette; emotions were related to self-management behaviors and symptoms. More studies are needed to specifically assess EI in this population. Parents and children with greater EI may be better able to understand their needs, engage in self-management behaviors, and communicate with their nurses, to improve their support network and ability to access services. Copyright © 2016 Elsevier Inc. All rights reserved.

9. Historic American Buildings Survey VIGNETTE FROM PLAN OF THE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. Historic American Buildings Survey VIGNETTE FROM PLAN OF THE CITY OF BALTIMORE... BY T. H. POPPLETON...ENGRAVED BY J. H. CONE...CORRECT TO 1852 - Aged Women's Home, 1400 West Lexington Street, Baltimore, Independent City, MD

Therapy students' recommendations of physical activity for managing persistent low back pain in older adults.

PubMed

Ryan, Cormac G; Schofield, Patricia; Martin, Denis J

2013-07-01

Negative views of older adults can lead to suboptimal care. For older adults with persistent low back pain (LBP), promotion of physical activity by health care professionals is important. Health care professionals' views of older adults are influenced by their training. This study aimed to compare recommendations for physical activity for managing persistent LBP offered by students in physiotherapy and occupational therapy to an older person vs. a younger person. In a cross-sectional online survey, participants (N = 77) randomly received a vignette of either a 40-yr-old or 70-yr-old patient with persistent LBP. Other than age, the vignettes were identical. There was no difference between the younger and older vignettes in the likelihood of participants making overall appropriate physical activity recommendations--63% vs. 59%, OR (95% CI) = 1.19 (0.48-2.99), p = .71--although there was a trend toward age bias on recommendations specific to daily activity. Postqualification education may be where ageist views need to be addressed.

Adolescents' beliefs about sources of help for ADHD and depression.

PubMed

Swords, Lorraine; Hennessy, Eilis; Heary, Caroline

2011-06-01

The peer group begins to become a source of support during late childhood and adolescence making it important to understand what type of help young people might suggest to a friend with an emotional or behavioral problem. Three groups of young people participated in the study with average ages of 12 (N = 107), 14 (N = 153) and 16 years (N = 133). All participants were presented with vignettes describing fictional peers, two of whom had symptoms of clinical problems (ADHD and depression) and a third comparison peer without symptoms. Results indicate that all participants distinguished between clinical and comparison vignette characters and they believed that the characters with clinical symptoms needed help. The 16-year-olds were more likely to differentiate between the two clinical vignettes in terms of the type of help suggested. The results are discussed in light of previous research on adolescents' understanding of sources of help for mental health problems. Copyright © 2010 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Magnetic resonance imaging (MRI) and prognostication in neonatal hypoxic-ischemic injury: a vignette-based study of Canadian specialty physicians.

PubMed

Bell, Emily; Rasmussen, Lisa Anne; Mazer, Barbara; Shevell, Michael; Miller, Steven P; Synnes, Anne; Yager, Jerome Y; Majnemer, Annette; Muhajarine, Nazeem; Chouinard, Isabelle; Racine, Eric

2015-02-01

Magnetic resonance imaging (MRI) could improve prognostication in neonatal brain injury; however, factors beyond technical or scientific refinement may impact its use and interpretation. We surveyed Canadian neonatologists and pediatric neurologists using general and vignette-based questions about the use of MRI for prognostication in neonates with hypoxic-ischemic injury. There was inter- and intra-vignette variability in prognosis and in ratings about the usefulness of MRI. Severity of predicted outcome correlated with certainty about the outcome. A majority of physicians endorsed using MRI results in discussing prognosis with families, and most suggested that MRI results contribute to end-of-life decisions. Participating neonatologists, when compared to participating pediatric neurologists, had significantly less confidence in the interpretation of MRI by colleagues in neurology and radiology. Further investigation is needed to understand the complexity of MRI and of its application. Potential gaps relative to our understanding of the ethical importance of these findings should be addressed. © The Author(s) 2014.

The misdiagnosis of bipolar disorder as a psychotic disorder: some of its causes and their influence on therapy.

PubMed

Meyer, Friederike; Meyer, Thomas D

2009-01-01

Looking at chart records bipolar disorder is often misdiagnosed as a psychotic disorder but no study has ever systematically looked into the reasons. One reason for misdiagnoses could be that clinicians use heuristics like the prototype approach in routine practice instead of strictly adhering to the diagnostic criteria. Using an experimental approach we investigated if the use of heuristics can explain when a diagnosis of psychotic disorder is given instead of bipolar disorder. We systematically varied information about the presence or absence of specific symptoms, i.e. hallucinations and decreased need for sleep during a manic episode. Experimentally varied case vignettes were randomly sent to psychiatrists in Southern Germany. The four versions of the case vignette all described the same person in a manic state and differed only in two aspects: the presence or absence of auditory hallucinations and of decreased need for sleep. The psychiatrists were asked to make a diagnosis, to rate their confidence in their diagnosis, and to recommend treatments. Almost half of the 142 psychiatrists (45%) did not diagnose bipolar disorder. Mentioning hallucinations decreased the likelihood of diagnosing bipolar disorder. The information about decreased need for sleep only affected the diagnosis significantly, if schizoaffective disorder was considered a bipolar disorder. Our results suggest that clinicians indeed use heuristics when making diagnostic decisions instead of strictly adhering to diagnostic criteria. More research is needed to better understand diagnostic decision making, especially under real life settings, and this might also be of interest when revising diagnostic manuals such as DSM.

Comparison of the Effectiveness of Interactive Didactic Lecture Versus Online Simulation-Based CME Programs Directed at Improving the Diagnostic Capabilities of Primary Care Practitioners.

PubMed

McFadden, Pam; Crim, Andrew

2016-01-01

Diagnostic errors in primary care contribute to increased morbidity and mortality, and billions in costs each year. Improvements in the way practicing physicians are taught so as to optimally perform differential diagnosis can increase patient safety and lower the costs of care. This study represents a comparison of the effectiveness of two approaches to CME training directed at improving the primary care practitioner's diagnostic capabilities against seven common and important causes of joint pain. Using a convenience sampling methodology, one group of primary care practitioners was trained by a traditional live, expert-led, multimedia-based training activity supplemented with interactive practice opportunities and feedback (control group). The second group was trained online with a multimedia-based training activity supplemented with interactive practice opportunities and feedback delivered by an artificial intelligence-driven simulation/tutor (treatment group). Before their respective instructional intervention, there were no significant differences in the diagnostic performance of the two groups against a battery of case vignettes presenting with joint pain. Using the same battery of case vignettes to assess postintervention diagnostic performance, there was a slight but not statistically significant improvement in the control group's diagnostic accuracy (P = .13). The treatment group, however, demonstrated a significant improvement in accuracy (P < .02; Cohen d, effect size = 0.79). These data indicate that within the context of a CME activity, a significant improvement in diagnostic accuracy can be achieved by the use of a web-delivered, multimedia-based instructional activity supplemented by practice opportunities and feedback delivered by an artificial intelligence-driven simulation/tutor.

Breaking Bad News to Togolese Patients.

PubMed

Kpanake, Lonzozou; Sorum, Paul Clay; Mullet, Etienne

2016-11-01

The aim of this study was to map Togolese people's positions regarding the breaking of bad news to elderly patients. Two hundred eleven participants who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the acceptability of the physician's conduct in each case. The vignettes were all combinations of five factors: (a) the severity of the disease, (b) the patient's wishes about disclosure, (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about how to communicate the bad news. Five qualitatively different positions were found. Two percent of the participants preferred that the physician always tell the full truth to both the patient and her relatives, 8% preferred that the truth be told depending on the physician's perception of the situation, 15% preferred that the physician tell the truth but understood that in some cases nondisclosure to the patient was not inappropriate, 33% preferred that the physician tell the full truth to the relatives but not as much information to the patient, and 42% preferred that the physician tell the full truth to the relatives only. These findings present a challenge to European physicians taking care of African patients living in Europe or working in African hospitals, and to African physicians trained in Europe and now working in their home countries. If these physicians respect the imperative of always telling the truth directly to their patients, their behavior may trigger anger and considerable misunderstanding among African patients and their families.

Men's Preferences for Physical Activity Interventions: An Exploratory Study Using a Factorial Survey Design Created With R Software.

PubMed

Chatfield, Sheryl L; Gamble, Abigail; Hallam, Jeffrey S

2018-03-01

Effective exercise interventions are needed to improve quality of life and decrease the impact of chronic disease. Researchers suggest males have been underrepresented in exercise intervention studies, resulting in less understanding of their exercise practices. Findings from preference survey methods suggest reasonable association between preference and behavior. The purpose of the research described in this article was to use factorial survey, a preference method, to identify the characteristics of exercise interventions most likely to appeal to male participants, so preferences might be incorporated into future intervention research. The research was guided by the framework of Bandura's social cognitive theory, such that variations in individual, environmental, and behavioral factors were incorporated into vignettes. Participants included 53 adult male nonadministrative staff and contract employees at a public university in the Southeastern United States, who each scored 8 vignettes resulting in 423 observations. Multilevel models were used to assess the influence of the factors. Participants scored vignettes that included exercising with a single partner, playing basketball, and exercising in the evening higher than vignettes with other options. Qualitative analysis of an open response item identified additional alternatives in group size, participant desire for coaching support, and interest in programs that incorporate a range of activity alternatives. Findings from this research were consistent with elements of social cognitive theory as applied to health promotion. Factorial surveys potentially provide a resource effective means of identifying participants' preferences for use when planning interventions. The addition of a single qualitative item helped clarify and expand findings from statistical analysis.

An assessment of preventive care offered to orthodontic patients by oral health therapists in NSW Australia.

PubMed

Masoe, Angela V; Blinkhorn, Anthony S; Taylor, Jane; Blinkhorn, Fiona A

2015-08-01

The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment. A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings. One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants. Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes. © 2015 FDI World Dental Federation.

`No One Should Destroy the Forest': Using photo-based vignette interviews to understand Kenyan teachers' views of the environment

NASA Astrophysics Data System (ADS)

Quigley, Cassie F.; Miller, Zachary D.; Dogbey, James; Che, S. Megan; Hallo, Jeffrey

2014-11-01

In the midst of the current environmental crisis, scientists, academics, authors, and politicians worldwide are urging citizens to create sustainable communities. However, there is little capability to build a sustainable society without an informed, active, and engaged populous. This requires more than just environmentally knowledgeable citizens. It requires a society that understands the principles of the environment and can also exemplify them in daily life. In order to create a more environmentally literate world, there has been a push for environmental education integrated into schools. This qualitative study sought to examine Kenyan teachers' perspectives on the human-nature interaction by conducting vignette focus-group interviews. It is a subject not widely explored but vital for conservation not only in this area, but also other areas that seek to have an ecological informed populous. The vignettes were created using photographs and explanations of the photographs that the participants collected and emailed to the authors. For the focus-group vignette interviews, there were a total of 55 participants (30 females and 25 males). After InVivo analysis, we had 6 codes (resentment, pride, perils, blame, pragmatism, and self-interested) within 3 major themes. This study has implications for informing science education to combat these traditions of subjecting students to a science curriculum that demotes Kenyan cultural heritage and lifestyle. By incorporating local knowledge such as the ideas discussed in this paper into Kenyan science education, Kenyans can reach one of most challenging objectives of education, which is to produce children who are fundamentally aware of their environment.

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences.

PubMed

Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M; Kamps, Willem A; Beishuizen, A; Bensing, Jozien M

2011-03-01

To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Preferences regarding health-care provider empathy in consultations, and children's involvement in information exchange and medical decision making were investigated by means of vignettes. Vignettes are brief descriptions of hypothetical situations, in which important factors are systematically varied following an experimental design. In total, 1440 vignettes were evaluated by 34 children with cancer (aged 8-16), 59 parents, and 51 survivors (aged 8-16 at diagnosis, currently aged 10-30). Recruitment of participants took place in three Dutch university-based pediatric oncology centers. Data were analyzed by multilevel analyses. Patients, parents, and survivors indicated the importance of health-care providers' empathy in 81% of the described situations. In most situations (70%), the three respondent groups preferred information about illness and treatment to be given to patients and parents simultaneously. Preferences regarding the amount of information provided to patients varied. The preference whether or not to shield patients from information was mainly associated with patients' age and emotionality. In most situations (71%), the three respondent groups preferred children to participate in medical decision making. This preference was mainly associated with patients' age. To be able to adapt communication to parents' and patients' preferences, health-care providers should repeatedly assess the preferences of both groups. Future studies should investigate how health-care providers balance their communication between the sometimes conflicting preferences of patients and parents. Copyright © 2010 John Wiley & Sons, Ltd.

Making Judgments: How Blame Mediates the Influence of Rape Myth Acceptance in Police Response to Sexual Assault.

PubMed

Venema, Rachel M

2016-08-01

As research continues to describe negative experiences and high case attrition within sexual assault cases reported to the police, it is important to better understand the role of first-responding police officers. This study surveyed a sample of sworn police officers ( N = 174) from one department in a midsized city in the Great Lakes region to examine the effect of individual police officer characteristics, rape myth acceptance (RMA), attributions of blame, and case characteristics from a hypothetical vignette, on officer perceptions of a "good" case and behavioral intentions. Results found that although RMA predicts both perceptions of the case and behavioral intentions to respond in ways indicative of perceived seriousness, RMA is mediated by attributions of suspect blame. Victim alcohol use was found to decrease an officer's likelihood of responding more vigorously, showing less likelihood of calling a detective or arresting the suspect, if identified. Future research should begin to connect not only case characteristics but also individual police officer characteristics, attitudes, and attributions of blame, with real case outcomes, in addition to hypothetical scenarios.

The development of research tools used in the STORK Study (the Scottish Trial of Refer or Keep) to explore midwives' intrapartum decision making.

PubMed

Styles, Maggie; Cheyne, Helen; O'Carroll, Ronan; Greig, Fiona; Dagge-Bell, Fiona; Niven, Catherine

2011-10-01

to develop appropriate tools to assess midwives' attitudes and behaviour in relation to decision making involving risk. a questionnaire and series of vignettes were developed and testes to explore midwives' intrapartum decision making in relation to their attitudes towards risk. An innovative online computer package was developed specifically for use in the STORK Study which enabled the programme to be very tightly controlled with limited functions accessible to participants. a pilot study was conducted with over 50 midwives and nurses to ensure face and content validity of the vignettes and questionnaire. Initially designed to be a paper-based study, rigorous piloting highlighted the many difficulties in presenting it in that particular format. The solution to this problem was to develop the study as a secure online package. online data collection provided the researchers with a greater degree of control of the data collection process, not achievable using traditional paper survey methods. Another example of this control is the immediate entry of data from participants' responses to a background database which automatically stores and backs up data this means that no additional time is required for data entry. The cost of employing an information technology professional was easily offset by the financial savings made through the limited use of stationery and postage. although the development and testing of the research tools for the STORK Study was labour and time intensive, ultimately a questionnaire and vignette package was produced that had been rigorously tested by over 50 midwives and nurses. The researchers are confident in the reliability of the questionnaire and vignettes, as well as the validity of the data collected. The use of an online survey is clearly indicated when the population has readily available internet access, and where controlling the process of data collection is required, as such control cannot be achieved in traditional survey and questionnaire implementation. Copyright © 2010 Elsevier Ltd. All rights reserved.

Racial-ethnic biases, time pressure, and medical decisions.

PubMed

Stepanikova, Irena

2012-09-01

This study examined two types of potential sources of racial-ethnic disparities in medical care: implicit biases and time pressure. Eighty-one family physicians and general internists responded to a case vignette describing a patient with chest pain. Time pressure was manipulated experimentally. Under high time pressure, but not under low time pressure, implicit biases regarding blacks and Hispanics led to a less serious diagnosis. In addition, implicit biases regarding blacks led to a lower likelihood of a referral to specialist when physicians were under high time pressure. The results suggest that when physicians face stress, their implicit biases may shape medical decisions in ways that disadvantage minority patients.

Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention.

PubMed

Holliday, Simon; Hayes, Chris; Dunlop, Adrian; Morgan, Simon; Tapley, Amanda; Henderson, Kim; Larance, Briony; Magin, Parker

2017-12-01

Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes. This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar's test. Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001). Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes.

PubMed

Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans

2017-03-01

European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. A total of 14 countries. Consensus groups of PCPs. Probability of initial presentation to a PCP for four clinical vignettes. There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = -0.16, 95% CI -0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = -0.57, 95% CI -0.83 to -0.12; ovary: r = -0.13, 95% CI -0.57 to 0.38; breast r = 0.14, 95% CI -0.36 to 0.58; bowel: r = 0.20, 95% CI -0.31 to 0.62). There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

Surgical management of intraductal papillary mucinous neoplasm with main duct involvement: an international expert survey and case-vignette study.

PubMed

Scholten, Lianne; van Huijgevoort, Nadine C M; Bruno, Marco J; Fernandez-Del Castillo, Carlos; Satoi, Sohei; Sauvanet, Alain; Wolfgang, Christopher; Fockens, Paul; Chari, Suresh T; Del Chiaro, Marco; van Hooft, Jeanin E; Besselink, Marc G

2018-05-16

The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%-60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future studies and help to prepare for a single international set of guidelines. An online survey including case vignettes was sent to 221 international experts who had published on main duct/mixed type intraductal papillary mucinous neoplasm in the previous decade and to all surgeon and gastroenterologist members of the pancreatic cyst guideline committees of the European Study Group and the International Association of Pancreatology. Overall, 97 experts (67 surgeons, 30 gastroenterologists) from 19 countries replied (44% response rate). Most (93%) worked in an academic hospital, with a median of 15 years' experience with intraductal papillary mucinous neoplasm treatment. In main duct/mixed type intraductal papillary mucinous neoplasm patients with pancreatic duct dilation (>5 mm) in the entire pancreas, 41% (n = 37) advised nonoperative surveillance every 3-6 months, whereas 59% (n = 54) advised operative intervention. Of those who advised operative intervention, 46% (n = 25) would perform a total pancreatectomy and 31% (n = 17) pancreatoduodenectomy with follow-up. No structural differences in advice were seen between surgeons and gastroenterologists, between continents where the respondents lived, and based on years of experience. This international survey identified a clinically relevant lack of consensus in the treatment strategy in main duct/mixed type intraductal papillary mucinous neoplasm among experts. Studies with long-term follow-up including quality of life after partial and total pancreatectomy for main duct/mixed type intraductal papillary mucinous neoplasm are required. Copyright © 2018 Elsevier Inc. All rights reserved.

[The Balance of Care approach for the development of custom-fit health care services for people with dementia on the margins of care between home and nursing home: experiences with its application in Germany].

PubMed

Stephan, Astrid; Renom Guiteras, Anna; Juchems, Stefan; Meyer, Gabriele

2013-01-01

In Germany as in other countries of the European Union (EU), the majority of people with dementia are cared for by their informal caregivers at home. Across countries, however, there are considerable differences in the time to nursing home admission. The European research project RightTimePlaceCare intends to establish good practice recommendations for how to sustain the preferred living situation as long as possible. The Balance of Care approach was used to develop these recommendations, which combines empirical data, cost estimates and expert consensus, and thus implemented in a multinational context for the first time. In eight EU countries a survey was conducted among 2,014 people with dementia and their informal caregivers in nursing homes (n=1,223) or at home (n=791). Selected descriptive characteristics of the study participants were used for case type development. The case types were translated into 14 case vignettes, which were discussed by five to six expert panels (each consisting of three to four participants) per country. The experts (n=161) recommended the most suitable living place (at home or in a nursing home) and customised care packages for home care situations. Across all countries, the experts predominantly recommended care at home for four of the case types whose reference group of study participants actually lived in a nursing home. These case types represent a relevant part of the study population. In Germany, the experts judged the case vignettes as realistic but criticised that information relevant for proper decision making was missing. Expert group discussions always ended in consensus, and care at home was predominately recommended. The proposed care packages most often comprised standard care services, and hence appeared to be realistic and feasible. The development of country-specific recommendations is still ongoing. In order to assess economic feasibility, estimated costs of home care packages will be compared with costs of nursing home care. Further outcomes like the quality of life will be considered for good practice recommendation finding. Balance of Care supports the development of empirically based expert recommendations. The approach is widely applicable but seems to be particularly useful for the development of local custom-fit healthcare services. The clinical effectiveness, safety, and cost implications of the Balance of Care approach remain to be investigated in future studies. Copyright © 2013. Published by Elsevier GmbH.

Understanding variations in patient screening and recruitment in a multicentre pilot randomised controlled trial: a vignette-based study.

PubMed

Hilton, Paul; Buckley, Brian S; McColl, Elaine; Howel, Denise; Tincello, Douglas G; Brennand, Catherine

2016-10-26

The INVESTIGATE-I study was designed to inform a future definitive randomised trial of invasive urodynamic testing, compared to basic clinical assessment with noninvasive tests prior to surgical treatment, in women with stress urinary incontinence or stress-predominant mixed urinary incontinence. In a pilot randomised controlled trial, women from seven participating sites were screened, consented and randomised. Overall, 771 patients were identified from clinic notes and correspondence as being potential recruits and were sent the Patient Information Leaflet. Of those screened, 284 were deemed eligible, giving an overall 'screen positive' rate of 37 %. The numbers screened at individual centres varied between 14 and 399; the 'screen positive' rate varied between 22 and 79 % and the percentage of eligible women recruited varied between 55 and 100 %. The aim of this additional substudy was to explore why 'screen positive' rates may have varied so widely between apparently similar sites. All 11 trial staff involved in screening in the seven recruiting sites were asked to evaluate a series of 20 identical vignettes, mainly based on actual general practitioner referral letters. Of the vignettes, 16 mentioned one or more definite inclusion criteria; the remainder had possible inclusions. Four had definite exclusions; 12 had possible exclusions. Free-text comments were sought to clarify the screeners' decisions. For six vignettes everyone agreed that the patient was eligible; for one all agreed she was not eligible; the breakdown for the remainder was mixed. Free-text comments illuminated uncertainties that may have led to variability in judging potential eligibility. Variability in judgements about potential trial eligibility highlights the importance of explicit and objective inclusion and exclusion criteria, and of agreed strategies for making judgements when information is missing. During the development and planning of trials, vignettes might be a valuable tool for training those involved in screening and recruiting patients, for identifying potential problems and ensuring greater consistency in the application of eligibility criteria. ISTCTN registry: ISRCTN71327395 , registered on 7 June 2010.

Community-based participatory research: a new approach to engaging community members to rapidly call 911 for stroke.

PubMed

Skolarus, Lesli E; Zimmerman, Marc A; Murphy, Jillian; Brown, Devin L; Kerber, Kevin A; Bailey, Sarah; Fowlkes, Sophronia; Morgenstern, Lewis B

2011-07-01

Acute stroke treatments are underutilized primarily because of delayed hospital arrival. Using a community-based participatory research approach, we explored stroke self-efficacy, knowledge, and perceptions of stroke among a predominately African American population in Flint, Michigan. In March 2010, a survey was administered to youth and adults after religious services at 3 churches and during 1 church health day. The survey consisted of vignettes (12 stroke, 4 nonstroke) to assess knowledge of stroke warning signs and behavioral intent to call 911. The survey also assessed stroke self-efficacy, personal knowledge of someone who had experienced a stroke, personal history of stroke, and barriers to calling 911. Linear regression models explored the association of stroke self-efficacy with behavioral intent to call 911 among adults. Two hundred forty-two adults and 90 youths completed the survey. Ninety-two percent of adults and 90% of youth respondents were African American. Responding to 12 stroke vignettes, adults would call 911 in 72% (SD, 0.26) of the vignettes, whereas youths would call 911 in 54% of vignettes (SD, 0.29; P<0.001). Adults correctly identified stroke in 51% (SD, 0.32) of the stroke vignettes and youth correctly identified stroke in 46% (SD, 0.28) of the stroke vignettes (P=0.28). Stroke self-efficacy predicted behavioral intent to call 911 (P=0.046). In addition to knowledge of stroke warning signs, behavioral interventions to increase both stroke self-efficacy and behavioral intent may be useful for helping people make appropriate 911 calls for stroke. A community-based participatory research approach may be effective in reducing stroke disparities.

Uncertainty about effects is a key factor influencing institutional review boards' approval of clinical studies.

PubMed

Wao, Hesborn; Mhaskar, Rahul; Kumar, Ambuj; Miladinovic, Branko; Guterbock, Thomas; Hozo, Iztok; Djulbegovic, Benjamin

2014-10-01

To investigate factors, which influence institutional review boards' (IRBs') decision to approve or not approve clinical studies, a nationwide vignette-based online survey of IRB members was conducted. A factorial design was used, whereby seven aspects of each hypothetical study were randomly varied in 15 phrases in each vignette to produce unique vignettes. Participants indicated the degree of study approval and described factors influencing approval decision. Qualitative responses were thematically content analyzed. Sixteen themes were obtained from 208 participants from 42 institutions. Uncertainty, adherence, study design, and harms were frequently and intensely cited to influence study approval. Analysis of two extreme subgroups (approvers vs. nonapprovers) showed that uncertainty influenced approval decisions, odds ratios (OR) = 3.5 (95% confidence interval [CI], 1.3-9.8) and OR = 3.2 (95% CI, 1.1-8.9), respectively, based on theme frequency and theme intensity, ignoring multiple observations per person. Taking into consideration multiple observations per person, similar results were obtained for uncertainty: OR = 8.9 (95% CI, 0.93-85.4). Perceived uncertainty about benefits and harms of a proposed intervention is a key driver in IRB members' approval of clinical trials. This, in turn, calls for improved standardization in the communications of information on benefits and harms in the research protocols considered by the IRBs. Published by Elsevier Inc.

Nursing diagnosis in intensive care unit: the Turkey experience.

PubMed

Korhan, Esra Akn; Yönt, Gülendam Hakverdioğlu; Erdemir, Firdevs; Müller-Staub, Maria

2014-01-01

The purpose of this study was to determine intensive care unit nurses diagnostic abilities and diagnoses that they provide. A vignette study was performed. The vignette contained a patient's history, treatment, and signs/symptoms of 18 nursing diagnoses based on NANDA-I as the criterion standard. Turkish intensive care unit nurses (N = 45) stated nursing diagnoses described by patient data in the vignette. The resulting nursing diagnoses were grouped into Gordon's Functional Health Patterns, and descriptive analyses were performed. One-way analysis of variance was used to detect possible differences in diagnostic abilities based on nurses' education levels. Nurses identified 14 nursing diagnoses. Four of the predetermined psychosocial nursing diagnoses were not identified. The highest percentage of diagnoses was risk for impaired skin integrity (62.2%) and impaired oral mucous membrane (60.0%). The lowest number of diagnoses was impaired verbal communication (2.2%). A statistically significant difference was found between the educational level of nurses and their abilities to determine nursing diagnoses (P < .05). The findings are important for nursing education. They demonstrate the need to focus on patients as complete human beings, covering not only biological aspects but also cultural and social values, as well as emotional and spiritual care needs.

Comparing Chinese and European American mental health decision making.

PubMed

Gao, Shanshan; Corrigan, Patrick W; Qin, Sang; Nieweglowski, Katherine

2017-12-20

Shared decision making (SDM) tends to reflect more Western values of individualism and empowerment, values that may be foreign to East Asian healthcare preferences for collectivism and family involvement: family centered decision making (FCDM). To show that Chinese will be more likely to believe FCDM would be more pleasing for them if they were the patient. Conversely, European Americans will respond more favorably to SDM. To examine effects of Western acculturation on FCDM compared to SDM. In this study, preferences for FCDM versus SDM and doctor-led decision making (DrDM) were examined in a vignette study completed online by European Americans (n = 298) and Chinese (n = 327). Research participants read a vignette about Lily (a depression patient) presenting with symptoms of depression. After reading the vignette, participants completed items representing two sets of outcomes: three perceptions of impact on Lily and how participants might respond for themselves in a similar decision making situation. Chinese rated FCDM greater than European and Chinese Americans. Chinese Americans mostly responded similar to European Americans and not Chinese. European Americans prefer SDM more for mental health services. Chinese value FCDM more than European Americans. Preferences of Chinese living in America seem to parallel European Americans.

The Mentor Teacher Casebook.

ERIC Educational Resources Information Center

Shulman, Judith H., Ed.; Colbert, Joel A., Ed.

This casebook, developed in collaboration with 22 mentor teachers in the Los Angeles (California) Unified School District, provides illustrative vignettes, written by the mentor teachers themselves, of their work with first-year teachers. The vignettes describe the circumstances of each event, its consequences, and the ongoing thoughts and…

Attitudes toward Posthumous Harvesting and Reproduction

ERIC Educational Resources Information Center

Hans, Jason D.

2008-01-01

Attitudes toward posthumous harvesting of reproductive material and beliefs about medical professionals' obligation to assist were examined using a multiple segment factorial vignette survey design with 407 randomly selected respondents from a southern state. Attitudes and beliefs were primarily shaped by the vignette couple's marital status,…

Vignettes in College Developmental Classes.

ERIC Educational Resources Information Center

Valeri-Gold, Maria T.

1994-01-01

Discusses providing developmental learners with the opportunity to hear and respond to vignettes (short, descriptive literary sketches such as those in "The House on Mango Street"). Notes that the activity allowed students to experiment with another writing style and to use figurative language in a creative way. (RS)

Effortful versus automatic emotional processing in schizophrenia: Insights from a face-vignette task.

PubMed

Patrick, Regan E; Rastogi, Anuj; Christensen, Bruce K

2015-01-01

Adaptive emotional responding relies on dual automatic and effortful processing streams. Dual-stream models of schizophrenia (SCZ) posit a selective deficit in neural circuits that govern goal-directed, effortful processes versus reactive, automatic processes. This imbalance suggests that when patients are confronted with competing automatic and effortful emotional response cues, they will exhibit diminished effortful responding and intact, possibly elevated, automatic responding compared to controls. This prediction was evaluated using a modified version of the face-vignette task (FVT). Participants viewed emotional faces (automatic response cue) paired with vignettes (effortful response cue) that signalled a different emotion category and were instructed to discriminate the manifest emotion. Patients made less vignette and more face responses than controls. However, the relationship between group and FVT responding was moderated by IQ and reading comprehension ability. These results replicate and extend previous research and provide tentative support for abnormal conflict resolution between automatic and effortful emotional processing predicted by dual-stream models of SCZ.

Study of Individualization and Bias in Nursing Home Fall Prevention Practices.

PubMed

Colón-Emeric, Cathleen S; Corazzini, Kirsten; McConnell, Eleanor; Pan, Wei; Toles, Mark; Hall, Rasheeda; Batchelor-Murphy, Melissa; Yap, Tracey L; Anderson, Amber L; Burd, Andrew; Anderson, Ruth A

2017-04-01

Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether care is affected by implicit bias. Randomized factorial clinical vignette survey. Sixteen nursing homes in North Carolina. Nursing, rehabilitation, and social services staff (n = 433). Vignettes describing hypothetical residents were generated from a matrix of clinical and demographic characteristics. Resident age, race and gender were suggested by a photo. Participants completed up to four randomly assigned vignettes (n = 1615), rating the likelihood that 12 fall prevention activities would be used for the resident. Fixed and random effects mixed model analysis examined the impact of vignette resident characteristics and staff characteristics on four intervention categories. Staff reported a higher likelihood of fall prevention activities in all four categories for residents with a prior fall (0.2-0.5 points higher, 10 point scale, P < 0.05), but other risk factors did not affect scores. There was little evidence of individualization; only dementia increased the reported likelihood of environmental modification (0.3, P < 0.001, 95% CI 0.2-0.5). Individualization did not vary with staff licensure category or clinical experience. Registered nurses consistently reported higher likelihoods of all fall prevention activities than did licensed practical nurses, unlicensed staff and other professional staff (1.0-2.7 points, P < 0.001 to 0.005). There was a small degree of implicit racial bias; staff indicated that environmental modification would be less likely to occur in otherwise identical vignettes including a photo of a black rather than a white resident (-0.2 points, 95% CI -0.3 to -0.1). Nursing home staff report a standardized approach to fall prevention without individualization. We found a small impact from implicit racial bias that should be further explored. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Does knowing that a suicide was "rational" influence grief?

PubMed

Brazda, Geoffrey F; Range, Lillian M; Remley, Theodore P; White, Carolyn C

2018-03-15

Counseling professionals and graduate students (N = 117) recruited online read a randomly assigned one-paragraph vignette about either a non-rational or rational suicide involving an imaginary loved one. Then, they completed the Grief Experiences Questionnaire (GEQ) about how they would feel. The non-rational suicide group expected significantly more search for explanation than the rational suicide group, but were not significantly different on the other six GEQ subscales. All participants expected few distressing reactions to either vignette, suggesting a one-paragraph vignette may not be sufficient to induce the kind of grief many experience when a loved one dies by suicide.

Clinician judgment in the diagnosis of gender identity disorder in children.

PubMed

Ehrbar, Randall D; Witty, Marjorie C; Ehrbar, Hans G; Bockting, Walter O

2008-01-01

Clinician judgment methodology was used to explore the influence of gender nonconformity and gender dysphoria on the diagnosis of children with Gender Identity Disorder (GID). A convenience sample of 73 licensed psychologists randomly received a vignette to diagnose. Vignettes varied across sex of child, gender conforming behavior, and gender dysphoria (including all possible permutations). Eight percent of respondents given a vignette involving a child who met purely behavioral criteria for GID diagnosed the child with GID. When additional information was provided, which in addition to gender nonconforming behavior the child also self-reported a cross-gender identity, this increased to 27% (significant at 5%).

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

PubMed

Kazemian, Ali; Berg, Isabelle; Finkel, Christina; Yazdani, Shahram; Zeilhofer, Hans-Florian; Juergens, Philipp; Reiter-Theil, Stella

2015-06-19

Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers. A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound. 732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively. Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

The Use of Vignettes to Empower Effective Responses to Attempted Sexual Assault

ERIC Educational Resources Information Center

Allen, Kaylie T.; Meadows, Elizabeth A.

2017-01-01

Objective: Women assertively resisting sexual aggression have the best chances of avoiding completed rape. Especially with acquaintances, there are significant social and psychological barriers to resistance. Novel vignettes depicting acquaintance rape were designed to enhance self-efficacy, reduce unrealistic optimism, and empower assertive…

Unconscious Race and Class Biases among Registered Nurses: Vignette-Based Study Using Implicit Association Testing.

PubMed

Haider, Adil H; Schneider, Eric B; Sriram, N; Scott, Valerie K; Swoboda, Sandra M; Zogg, Cheryl K; Dhiman, Nitasha; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Freischlag, Julie A; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A

2015-06-01

Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions. In a prospective study conducted among surgical RNs at the Johns Hopkins Hospital, participants were presented 8 multi-stage clinical vignettes in which patients' race or social class were randomly altered. Registered nurses were administered implicit association tests (IATs) for social class and race. Ordered logistic regression was then used to examine associations among treatment differences, race, or social class, and RN's IAT scores. Spearman's rank coefficients comparing RN's implicit (IAT) and explicit (stated) preferences were also investigated. Two hundred and forty-five RNs participated. The majority were female (n=217 [88.5%]) and white (n=203 [82.9%]). Most reported that they had no explicit race or class preferences (n=174 [71.0%] and n=108 [44.1%], respectively). However, only 36 nurses (14.7%) demonstrated no implicit race preference as measured by race IAT, and only 16 nurses (6.53%) displayed no implicit class preference on the class IAT. Implicit association tests scores did not statistically correlate with vignette-based clinical decision making. Spearman's rank coefficients comparing implicit (IAT) and explicit preferences also demonstrated no statistically significant correlation (r=-0.06; p=0.340 and r=-0.06; p=0.342, respectively). The majority of RNs displayed implicit preferences toward white race and upper social class patients on IAT assessment. However, unlike published data on physicians, implicit biases among RNs did not correlate with clinical decision making. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses.

PubMed

Secker, Barbara; Goldenberg, Maya J; Gibson, Barbara E; Wagner, Frank; Parke, Bob; Breslin, Jonathan; Thompson, Alison; Lear, Jonathan R; Singer, Peter A

2006-08-29

Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs - equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care - and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of - or revisions to - a regionalised health care strategy.

Interactive Learning: Vignettes from America's Most Wired Campuses.

ERIC Educational Resources Information Center

Brown, David G., Ed.

This book presents a collection of best practices in using instructional technology from 42 college campuses. In 93 brief, informal, and practical vignettes, professors show how they transformed courses with technology, discuss how the technology affects teaching and learning, and distill important lessons learned. The book is divided into two…

"Doing School": Cross Cultural Encounters

ERIC Educational Resources Information Center

Edwards, Viv

2015-01-01

In this paper, a series of vignettes is used to explore important current challenges in TESOL. These vignettes are drawn from many different settings, including Bengali-, Pahari- and Chinese-speaking children in UK primary schools, speakers of Aboriginal English in Australia and Chinese teachers of English on courses in Higher Education. A number…

Vignettes of Ambiguity

ERIC Educational Resources Information Center

Gotz, Ignacio L.

2010-01-01

This article is an exploration of ambiguity as it appears in various guises in philosophical, social, political, and educational situations. Among these situations is the experience of exile. The exploration is conducted by means of literary anecdotes and real-life instances, hence the use of vignettes. The suggestion is made that ambiguity can be…

Judging Mental Disorder in Youths: Effects of Client, Clinician, and Contextual Differences

ERIC Educational Resources Information Center

Pottick, Kathleen J.; Kirk, Stuart A.; Hsieh, Derek K.; Tian, Xin

2007-01-01

Using a vignette-based, mailed survey of 1,401 experienced psychologists, psychiatrists, and social workers, the authors examined how clients' race/ethnicity and clinicians' professional and social characteristics affect their judgment of mental disorder among antisocially behaving youths. Vignettes described problematic behaviors meeting the …

An Attributional Analysis of Personal and Interpersonal Motivation for Collaborative Projects

ERIC Educational Resources Information Center

Peterson, Sarah E.; Schreiber, James B.

2006-01-01

Attribution theory provides a framework for examining personal and interpersonal motivation for collaborative projects. Undergraduates were asked to read vignettes concerning student dyads engaged in collaborative projects. The vignettes systematically varied on outcome of the project, student self-ability, student self-effort, partner ability,…

Teachers' Perceptions of Bullying among Youth

ERIC Educational Resources Information Center

Bell, Karen J. S.; Willis, W. Grant

2016-01-01

A series of 48 vignettes of bullying was constructed by crossing (a) four kinds of social contact (physical aggression, verbal aggression, relational aggression, and non-aggression) with (b) male and female bullies, (c) male and female and victims, and (d) reaction of the victim (aggressive, passive, and no reaction). Teachers rated vignettes for…

Whiteness in the Academy: Using Vignettes to Move beyond Safe Silences

ERIC Educational Resources Information Center

Behm Cross, Stephanie

2017-01-01

This point of departure presents the writings of a White, female teacher educator's experiences in the academy. Through the use of vignettes, the author discusses how four recent experiences--and her writing about those experiences--reveal the insidiousness of silence and Whiteness in the academy.

Adherence to infection prevention and control guidelines: A vignette-based study of decision-making and risk-taking in young adults with cystic fibrosis.

PubMed

Bowmer, Grace; Latchford, Gary; Duff, Alistair; Denton, Miles; Dye, Louise; Lawton, Clare; Lee, Tim

2017-01-01

Balancing cystic fibrosis (CF) care with demands of normal life is associated with decreased adherence to infection prevention and control (IPC) guidelines. Adults with CF, aged 18-25years, were invited to participate via UK CF Trust social media platforms. An online survey evaluated participants' decision-making in nine clinician-rated vignettes and assessed the perceived influence of infection-related information sources. Participants (n=87, mean 21.4years [SD=2.45]; 75% female) were less likely to engage in the high-risk scenarios, although demonstrated greater awareness of cross-infection than environmental risks. Associations between risk-perception and willingness to participate in five vignette-based hypothetical activities were significant (p<0.05). Thematic analysis emphasised influences of past experience and a need to achieve good quality of life. Knowledge gaps were evident. People with CF make decisions that discriminate between risk-levels but are not always based on robust knowledge. They also show some inclination towards engaging in risky behaviours. Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Self-assessed competency at working with a medical interpreter is not associated with knowledge of good practice.

PubMed

Hudelson, Patricia; Perneger, Thomas; Kolly, Véronique; Perron, Noëlle Junod

2012-01-01

Specific knowledge and skills are needed to work effectively with an interpreter, but most doctors have received limited training. Self-assessed competency may not accurately identify training needs. The purpose of this study is to explore the association between self-assessed competency at working with an interpreter and the ability to identify elements of good practice, using a written vignette. A mailed questionnaire was sent to 619 doctors and medical students in Geneva, Switzerland. 58.6% of respondents considered themselves to be highly competent at working with a professional interpreter, but 22% failed to mention even one element of good practice in response to the vignette, and only 39% could name more than one. There was no association between self-rated competency and number of elements mentioned. Training efforts should challenge the assumption that working with an interpreter is intuitive. Evaluation of clinicians' ability to work with an interpreter should not be limited to self-ratings. In the context of large-scale surveys, written vignettes may provide a simple method for identifying knowledge of good practice and topics requiring further training.

Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method.

PubMed

Thissen, David; Liu, Yang; Magnus, Brooke; Quinn, Hally; Gipson, Debbie S; Dampier, Carlton; Huang, I-Chan; Hinds, Pamela S; Selewski, David T; Reeve, Bryce B; Gross, Heather E; DeWalt, Darren A

2016-01-01

To assess minimally important differences (MIDs) for several pediatric self-report item banks from the National Institutes of Health Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). We presented vignettes comprising sets of two completed PROMIS questionnaires and asked judges to declare whether the individual completing those questionnaires had an important change or not. We enrolled judges (including adolescents, parents, and clinicians) who responded to 24 vignettes (six for each domain of depression, pain interference, fatigue, and mobility). We used item response theory to model responses to the vignettes across different judges and estimated MID as the point at which 50 % of the judges would declare an important change. We enrolled 246 judges (78 adolescents, 85 parents, and 83 clinicians). The MID estimated with clinician data was about 2 points on the PROMIS T-score scale, and the MID estimated with adolescent and parent data was about 3 points on that same scale. The MIDs enhance the value of PROMIS pediatric measures in clinical research studies to identify meaningful changes in health status over time.

Beyond the checklist: assessing understanding for HIV vaccine trial participation in South Africa.

PubMed

Lindegger, Graham; Milford, Cecilia; Slack, Catherine; Quayle, Michael; Xaba, Xolani; Vardas, Eftyhia

2006-12-15

Informed consent and understanding are essential ethical requirements for clinical trial participation. Traditional binary measures of understanding may be limited and not be the best measures of level of understanding. This study designed and compared 4 measures of understanding for potential participants being prepared for enrollment in South African HIV vaccine trials, using detailed operational scoring criteria. Assessment of understanding of 7 key trial components was compared via self-report, checklist, vignettes, and narrative measures. Fifty-nine participants, including members of vaccine preparedness groups and 1 HIV vaccine trial, took part. There were significant differences across the measures for understanding of 5 components and for overall understanding. Highest scores were obtained on self-report and checklist measures, and lowest scores were obtained for vignettes and narrative descriptions. The findings suggest that levels of measured understanding are dependent on the tools used. Forced-choice measures like checklists tend to yield higher scores than open-ended measures like narratives or vignettes. Consideration should be given to complementing checklists and self-reports with open-ended measures, particularly for critical trial concepts, where the consequences of misunderstanding are potentially severe.

Public Stigma in China Associated With Schizophrenia, Depression, Attenuated Psychosis Syndrome, and Psychosis-Like Experiences.

PubMed

Lee, Edwin Ho-Ming; Hui, Christy Lai-Ming; Ching, Elaine Yee-Ning; Lin, Jingxia; Chang, Wing-Chung; Chan, Sherry Kit-Wa; Chen, Eric Yu-Hai

2016-07-01

Attenuated psychosis syndrome (APS) has recently been included in the appendix of DSM-5 as a condition for further study. This study compared public stigma associated with four mental health conditions among study participants in Hong Kong. The cross-sectional study involved 204 participants (154 members of the general public general public and 50 health care professionals) recruited through a public awareness campaign and the e-mail network of the University of Hong Kong. Participants read four vignettes describing persons with schizophrenia, depression, APS, or psychosis-like experiences. For each vignette, they used a scale to rate their level of stigma in seven domains: social distance, traditional prejudice, exclusionary sentiments, negative affect, perceptions of dangerousness, treatment carryover, and disclosure carryover. Analyses compared ratings within and across vignettes. Schizophrenia received the highest public stigma ratings, followed by APS, depression, and psychosis-like experiences. Total stigma scores were higher for the general public than for health care professionals. Public stigma associated with APS was similar to that associated with depression. Ratings of treatment carryover indicated that participants believed that being known to have received treatment for APS or depression would have lasting consequences. Stigma should be considered in the development of mental health services and research in China, particularly in regard to people with schizophrenia and those at risk of psychosis.

PICU Nurses' Pain Assessments And Intervention Choices for Virtual Human And Written Vignettes

PubMed Central

LaFond, Cynthia M.; Vincent, Catherine Van Hulle; Corte, Colleen; Hershberger, Patricia E.; Johnson, Andrew; Park, Chang G.; Wilkie, Diana J.

2015-01-01

The purpose of this concurrent mixed-methods study was to 1) examine the factors pediatric intensive care unit nurses consider when assessing and intervening for children who report severe pain and to 2) determine the effect of child behavior and diagnosis on the nurses’ pain ratings and intervention choices for written and virtual human vignettes. Quantitative and qualitative results substantiated that despite recommendations to use self-report, many PICU nurses use behavior as the primary indicator to assess and treat pain, even when a child is old enough to articulate pain intensity and there is sufficient cause for pain to be present. PMID:25682019

Gender nonconforming youth: current perspectives

PubMed Central

Ehrensaft, Diane

2017-01-01

Beginning with a case vignette, a discussion follows of the reformulation of theories of gender development taking into consideration the recent upsurge of gender nonconforming and transgender youth presenting for gender services and also in the culture at large. The three predominant models of pediatric gender care are reviewed and critiqued, along with a presentation of the recently developed interdisciplinary model of gender care optimal in the treatment of gender nonconforming youth seeking either puberty blockers or cross-sex hormones. PMID:28579848

Physicians must honor refusal of treatment to restore competency by non-dangerous inmates on death row.

PubMed

Zonana, Howard

2010-01-01

The role of physicians in death penalty cases has provoked discussion in both the legal system as well as in professional organizations. Professional groups have responded by developing ethical guidelines advising physicians as to current ethical standards. Psychiatric dilemmas as a subspecialty with unique roles have required more specific guidelines. A clinical vignette provides a focus to explicate the conflicts. © 2010 American Society of Law, Medicine & Ethics, Inc.

Ischial Pain and Sitting Disability Due to Ischiogluteal Bursitis: Visual Vignette.

PubMed

Ekiz, Timur; Biçici, Vedat; Hatioglu, Cem; Yalçın, Süha; Cingöz, Kagan

2015-01-01

Ischial bursitis or ischiogluteal bursitis is the inflammation of the ischiogluteal bursa due to excessive or inappropriate physical exercise, prolonged sitting, running, repetitive jumping, and kicking. Since ischial bursitis is a rare, infrequently recognized pathology and is difficult to differentiate from the soft tissue disease and tumors (both malignant and benign), herein exemplified is a case with ischiogluteal bursitis whereby the role of magnetic resonance imaging (MRI) in the prompt diagnosis has been highlighted.

Stakeholders identify similar barriers but different strategies to facilitate return-to-work: A vignette of a worker with an upper extremity condition.

PubMed

Peters, Susan E; Truong, Anthony P; Johnston, Venerina

2018-01-01

Stakeholders involved in the return-to-work (RTW) process have different roles and qualificationsOBJECTIVE:To explore the perspectives of Australian stakeholders of the RTW barriers and strategies for a worker with an upper extremity condition and a complex workers' compensation case. Using a case vignette, stakeholders were asked to identify barriers and recommend strategies to facilitate RTW. Content analysis was performed on the open-ended responses. The responses were categorised into RTW barriers and strategies using the biopsychosocial model. Pearson's Chi Square and ANOVA were performed to establish group differences. 621 participants (488 healthcare providers (HCPs), 62 employers, 55 insurers and 16 lawyers) identified 36 barriers (31 modifiable): 4 demographic; 8 biological; 15 psychological and 9 social barriers. 484 participants reported 16 RTW strategies: 4 biological; 6 psychological and 6 social strategies. 'Work relationship stressors' (83.4%) and 'Personal relationship stressors' (64.7%) were the most frequently nominated barriers. HCPs most frequently nominated 'Pain management' (49.6%), while employers, insurers and lawyers nominated 'RTW planning/Suitable duties programs' (40.5%; 42.9%; 80%). Stakeholders perceived similar barriers for RTW but recommended different strategies. Stakeholders appeared to be more proficient in identifying barriers than recommending strategies. Future research should focus on tools to both identify RTW barriers and direct intervention.

Child Sexual Abuse Attributions Among Undergraduate Psychology Students in Singapore.

PubMed

Hawkins, Russell; Teng Sze Wei, Stephanie

2017-10-01

Experimental vignettes were used to investigate attributions relating to child sexual abuse with a focus on the degree of blame allocated to the family and to society, factors thought to be particularly relevant in a collectivist society. One hundred and sixty-two undergraduates in Singapore evaluated media reports describing a case of child sexual abuse. A 2 x 2 x 2 between-subjects design manipulated victim sex, perpetrator sex, and victim-perpetrator relationship. Participants rated the vignettes on degree of blame and prevention potential and rated the abusiveness of the case. Individualism and collectivism attitudes of the participants were also measured. While the highest blame ratings were attributed to perpetrators, significantly more blame was attributed to the family and to society than to the victim. The demonstration of the present attributions of blame to family and to society is a timely finding given recent recommendations to broaden approaches to child abuse prevention by moving away from a reliance on school based child protection programs, which leave the onus on the child to prevent and report abuse, toward a public health approach, which is particularly inclusive of parent and community education approaches . Allocation of some blame to victims, in spite of their status as children, while not a unique finding in victimology research, emphasizes the challenges still to be faced in encouraging the reporting of child sexual abuse.

Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.

PubMed

Streit, Sven; Gussekloo, Jacobijn; Burman, Robert A; Collins, Claire; Kitanovska, Biljana Gerasimovska; Gintere, Sandra; Gómez Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Johansen, Kasper L; Kerse, Ngaire; Koskela, Tuomas H; Peštić, Sanda Kreitmayer; Kurpas, Donata; Mallen, Christian D; Maisonneuve, Hubert; Merlo, Christoph; Mueller, Yolanda; Muth, Christiane; Ornelas, Rafael H; Šter, Marija Petek; Petrazzuoli, Ferdinando; Rosemann, Thomas; Sattler, Martin; Švadlenková, Zuzana; Tatsioni, Athina; Thulesius, Hans; Tkachenko, Victoria; Torzsa, Peter; Tsopra, Rosy; Tuz, Canan; Verschoor, Marjolein; Viegas, Rita P A; Vinker, Shlomo; de Waal, Margot W M; Zeller, Andreas; Rodondi, Nicolas; Poortvliet, Rosalinde K E

2018-03-01

We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. This study included 2543 GPs from 29 countries. GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98). GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points  • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).  • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.  • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.  • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.

Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old

PubMed Central

Streit, Sven; Gussekloo, Jacobijn; Burman, Robert A.; Collins, Claire; Kitanovska, Biljana Gerasimovska; Gintere, Sandra; Gómez Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Johansen, Kasper L.; Kerse, Ngaire; Koskela, Tuomas H.; Peštić, Sanda Kreitmayer; Kurpas, Donata; Mallen, Christian D.; Maisonneuve, Hubert; Merlo, Christoph; Mueller, Yolanda; Muth, Christiane; Ornelas, Rafael H.; Šter, Marija Petek; Petrazzuoli, Ferdinando; Rosemann, Thomas; Sattler, Martin; Švadlenková, Zuzana; Tatsioni, Athina; Thulesius, Hans; Tkachenko, Victoria; Torzsa, Peter; Tsopra, Rosy; Tuz, Canan; Verschoor, Marjolein; Viegas, Rita P. A.; Vinker, Shlomo; de Waal, Margot W. M.; Zeller, Andreas; Rodondi, Nicolas; Poortvliet, Rosalinde K. E.

2018-01-01

Objectives We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. Design This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. Setting GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. Subjects This study included 2543 GPs from 29 countries. Main outcome measures GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. Results Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00–4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12–4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56–1.98). Conclusions GPs’ choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points  • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).  • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.  • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.  • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old. PMID:29366388

Structured didactic teaching sessions improve medical student neurology clerkship test scores: a pilot study.

PubMed

Menkes, Daniel L; Reed, Mary

2008-01-01

To determine the effectiveness of didactic case-based instruction methodology to improve medical student comprehension of common neurological illnesses and neurological emergencies. Neurology department, academic university. 415 third and fourth year medical students performing a required four week neurology clerkship. Raw test scores on a 1 hour, 50-item clinical vignette based examination and open-ended questions in a post-clerkship feedback session. There was a statistically significant improvement in overall test scores (p<0.001). Didactic teaching sessions have a significant positive impact on neurology student clerkship test score performance and perception of their educational experience. Confirmation of these results across multiple specialties in a multi-center trial is warranted.

Latino Immigrant Men's Perceptions of Depression and Attitudes toward Help Seeking

ERIC Educational Resources Information Center

Cabassa, Leopoldo J.

2007-01-01

Perceptions of depression, attitudes toward depression treatments, help-seeking preferences, and perceived barriers to care were examined in a sample of 56 Latino immigrant men recruited from a primary health care clinic. Each participant was presented a vignette depicting an individual with major depression. Men described the vignette as a…

Using Anchoring Vignettes to Assess Group Differences in General Self-Rated Health

ERIC Educational Resources Information Center

Grol-Prokopczyk, Hanna; Freese, Jeremy; Hauser, Robert M.

2011-01-01

This article addresses a potentially serious problem with the widely used self-rated health (SRH) survey item: that different groups have systematically different ways of using the item's response categories. Analyses based on unadjusted SRH may thus yield misleading results. The authors evaluate anchoring vignettes as a possible solution to this…

Validation of Assessment Vignettes and Scoring Rubric of Multicultural and International Competency in Faculty Teaching

ERIC Educational Resources Information Center

Henderson, Sheila J.; Horton, Ruth A.; Saito, Paul K.; Shorter-Gooden, Kumea

2016-01-01

The purpose of this research was to develop a new tool for assessing multicultural and international competency in faculty teaching through vignette scenarios of university classroom critical incidents--across disciplines of clinical and forensics psychology, business, and education. Construct and content validity of the initial draft vignettes…

The Use of Vignettes in Participatory Research with Young Children

ERIC Educational Resources Information Center

Palaiologou, Ioanna

2017-01-01

Participatory advocacy in research has brought new ways of thinking and researching young children's lives. Although some such methods in research are more successful than others, it is the process of involving children and their voices that matter most. Thus, this paper examines to what extent the vignette method facilitates participatory…

Using Vignettes as Self-Reflexivity in Narrative Research of Problematised History Pedagogy

ERIC Educational Resources Information Center

Hunter, Philippa

2012-01-01

This article focuses on the use of vignettes as an emergent dimension of narrative research writing. The author draws on doctoral research that problematised history curriculum and pedagogy with pre-service teachers in the context of secondary teacher education in New Zealand. Pedagogic crossings of history education sites, and negotiation of…

Knowledge as a Contingency Factor: Achieving Coordination in Interorganizational Systems

DTIC Science & Technology

2010-09-01

Problem...............................70 b. Vignette 2: Terrorism Threat to an International Event Held in a Archipelagic Environment...72 c. Vignette 3: Containing a Pandemic in a Archipelagic Environment...Operations (NEO) and disaster relief operations), and they also agree that there is no doctrine or procedures written to help them achieve successful

The New Friends Vignettes: Measuring Parental Psychological Control that Confers Risk for Anxious Adjustment in Preschoolers

ERIC Educational Resources Information Center

McShane, Kelly E.; Hastings, Paul D.

2009-01-01

This investigation examined the links between preschoolers' internalizing problems and anxiety-related social difficulties and two aspects of maternal and paternal psychological control: overprotection and critical control. Some 115 mothers and 92 fathers completed the New Friends Vignettes (NFV), a new measure of psychological control and…

Doing History: Investigating with Children in Elementary and Middle Schools.

ERIC Educational Resources Information Center

Levstik, Linda S.; Barton, Keith C.

This book draws on classroom experience to provide models of instructionally sound, thoughtful, and thought-provoking history teaching for students from a wide variety of backgrounds. Most chapters begin with a classroom vignette showing a community of inquiry as students are actively engaged in their history education. Each vignette offers a…

Alcohol's Effects on Women's Risk Detection in a Date-Rape Vignette

ERIC Educational Resources Information Center

Loiselle, Marci; Fuqua, Wayne R.

2007-01-01

Researchers have established that alcohol is a risk factor for date rape for both victims and perpetrators. Objective: The authors tried to experimentally address the link between alcohol consumption and women's risk detection abilities in a risky sexual vignette. Participants: The authors recruited 42 women from undergraduate classrooms at a…

Audience and Witnessing: Research into Dramatherapy using Vignettes and aMSN Messenger

ERIC Educational Resources Information Center

Jones, Phil

2008-01-01

This article describes the process of research undertaken to examine therapists' responses to the concept of the core processes of change in dramatherapy. The research uses a combination of vignette description and analysis using aMSN messenger. The article describes the theoretical underpinning and rationale to the approach, and the…

Devising a Supportive Climate Based on Clinical Vignettes of College Students with Attention Deficit Disorder.

ERIC Educational Resources Information Center

Willis, Christy; And Others

1995-01-01

Interviews with five students with Attention Deficit Disorder (ADD) at The George Washington University (District of Columbia), their families, and professionals in student disabilities resulted in five clinical vignettes representing a spectrum of ADD students. Six recurring personal issues emerged: self-esteem, family/peer support, stress,…

The Utility of Vignette Judgment Tasks and Their Relationship to Past Behavioral Data.

ERIC Educational Resources Information Center

Peterson, Lizette; Homer, Andrew

While research examining altruism has relied on subject responses to written vignettes rather than actual altruism-eliciting situations, the relationship between written responses and actual behavior has not been established. To assess the degree to which some classic social/psychological behavior results could be replicated using short, written…

Children's Use and Knowledge of Display Rules for Anger following Hypothetical Vignettes versus following Live Peer Interaction.

ERIC Educational Resources Information Center

Parker, Elizabeth H.; Hubbard, Julie A.; Ramsden, Sally R.; Relyea, Nicole; Dearing, Karen F.; Smithmyer, Catherine M.; Schimmel, Kelly D.

2001-01-01

Examined correspondence between second-graders' use and knowledge of anger display rules. Found that children's responses were moderately related across two contexts. Following live interactions, compared to hypothetical vignettes, children reported feeling and expressing less anger, intending to hide their anger more, and dissembling their anger…

The Effect of Perceived Child Anxiety Status on Parental Latency to Intervene with Anxious and Non-Anxious Youth

PubMed Central

Aschenbrand, Sasha G.; Kendall, Philip C.

2012-01-01

Objective Examined the effect of perceived child anxiety status on parental latency to intervene with anxious and non-anxious youth. Method Parents (68) of anxiety-disordered (PAD) and non-anxiety-disordered (56: PNAD) children participated. Participants listened and responded to an audio vignette of a parent-child interaction: half were told the child was anxious and half were given a neutral description. Participants completed measures of anxiety and emotional responding before and after the audio vignette, and signaled when the mother on the vignette should accommodate the child. Results Whereas PNAD responded significantly faster when provided with neutral information about the child than when told the child was anxious, PAD did not differ in response latency. However, PAD exhibited a significant increase in state anxiety and negative affect and a decrease in positive affect after the vignette, whereas PNAD did not. Conclusions Results suggest that PNAD are more flexible and adaptable in their parenting behavior than PAD and that the greater anxiety and emotional lability of PAD may influence their parenting. Suggestions for research are discussed. PMID:22309473

Do single people want to date a cancer survivor? A vignette study

PubMed Central

2018-01-01

Objective Qualitative studies indicated that cancer survivors may be worried about finding a partner in the future, but whether this concern is warranted is unknown. We examined single people´s interest in dating a cancer survivor, how they perceive survivors’ traits, and their preferences about the timing of disclosing a cancer history. Methods In three experimental vignette studies, dating website members (n = 324) and college students (n = 138 and n = 131) were randomly assigned to a vignette of a person with or without a history of cancer (experiment 1 & 2), or a cancer survivor beyond or during active follow-up (experiment 3). Respondents rated their interest in dating this fictive person, this person’s traits, and indicated their preferences about the timing of disclosure. ANOVAs with main and interaction effects of condition, gender, and relationship history were conducted, partial eta squared and Cohen’s d were used to estimate the magnitude of effects. Correlations were used to investigate relationships between interest in a date and assessment of traits. Results Cancer survivors’ traits were assessed more positively, but interest to date them did not differ from healthy vignettes for both men and women. However, widowed respondents were much less interested in a date with a cancer survivor, and women showed less interest in a cancer survivor during active follow-up relative to survivors beyond follow-up. Most respondents wanted to hear about the cancer diagnosis after a few dates, hardly anyone wanted to hear about this before the first date (2% - 5%). Conclusion and implications for cancer survivors Cancer survivors do not have to expect any more problems in finding a date than people without a cancer history, and can wait a few dates before disclosing. Survivors dating widowed people and survivors in active follow-up could expect more hesitant reactions and should disclose earlier. PMID:29566002

Correcting bias in self-rated quality of life: an application of anchoring vignettes and ordinal regression models to better understand QoL differences across commuting modes.

PubMed

Crane, Melanie; Rissel, Chris; Greaves, Stephen; Gebel, Klaus

2016-02-01

Likert scales are frequently used in public health research, but are subject to scale perception bias. This study sought to explore scale perception bias in quality-of-life (QoL) self-assessment and assess its relationships with commuting mode in the Sydney Travel and Health Study. Multilevel ordinal logistic regression analysis was used to analyse the association between two global QoL items about overall QoL and health satisfaction, with usual travel mode to work or study. Anchoring vignettes were applied using parametric and simpler nonparametric methods to detect and adjust for differences in reporting behaviour across age, sex, education, and income groups. The anchoring vignettes exposed differences in scale responses across demographic groups. After adjusting for these biases, public transport users (OR = 0.37, 95 % CI 0.21-0.65), walkers (OR = 0.44, 95 % CI 0.24-0.82), and motor vehicle users (OR = 0.47, 95 % CI 0.25-0.86) were all found to have lower odds of reporting high QoL compared with bicycle commuters. Similarly, the odds of reporting high health satisfaction were found to be proportionally lower amongst all competing travel modes: motor vehicle users (OR = 0.31, 95 % CI 0.18-0.56), public transport users (OR = 0.34, 95 % CI 0.20-0.57), and walkers (OR = 0.35, 95 % CI 0.20-0.64) when compared with cyclists. Fewer differences were observed in the unadjusted models. Application of the vignettes by the two approaches removed scaling biases, thereby improving the accuracy of the analyses of the associations between travel mode and quality of life. The adjusted results revealed higher quality of life in bicycle commuters compared with all other travel mode users.

Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India.

PubMed

Kermode, Michelle; Bowen, Kathryn; Arole, Shoba; Pathare, Soumitra; Jorm, Anthony F

2009-12-01

People with mental disorders experience discrimination as a consequence of stigmatising attitudes that are largely socio-culturally constructed. Thus, there is a need to understand local contexts in order to develop effective programs to change such attitudes. We undertook a mental health literacy survey in rural Maharashtra, India, prior to developing a mental health training program for village health workers (VHWs) in a primary health care setting. A cross-sectional mental health literacy survey was undertaken in late 2007, which involved interviewer-administration of a questionnaire to 240 systematically sampled community members, and 60 purposively sampled VHWs. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked about attitudes towards, and desired social distance from, the people in the vignettes (the latter being a proxy measure for stigma). Linear regression modelling was undertaken to identify predictors of social distance. Although the community was relatively accepting of people with mental disorders, false beliefs and negative attitudes were still evident. Desired social distance was consistently greater for the person depicted in the psychosis vignette compared to the depression vignette. For both vignettes, the main predictor of greater social distance was perceiving the person as dangerous, and the predictors of reduced social distance were being a VHW, and seeing the problem as a sign of personal weakness. For depression, believing the cause to be family tensions also reduced social distance. For psychosis, labelling the disorder as a mind/brain problem, and believing the cause to be lack of control over life or genetic factors increased social distance. The vast majority did not agree that the problems experienced in the vignettes were 'a real medical illness'. Promoting bio-medical explanations for mental disorders in this setting may exacerbate discriminatory attitudes. Provision of contextually relevant mental health training for the VHWs so that they are able to communicate, model and shape more positive attitudes is the next step.

Predictors of mental illness stigma and attitudes among college students: using vignettes from a campus common reading program.

PubMed

Feeg, Veronica D; Prager, Laura S; Moylan, Lois B; Smith, Kathleen Maurer; Cullinan, Meritta

2014-09-01

Research has demonstrated that stigmatizing mentally ill individuals is prevalent and often results in lack of adherence to or avoidance of treatment. The present study sought to examine attitudes of college students regarding mental illness as part of a campus-wide "common readings" program. The book selected was a non-fiction account of a young girl with mental illness and the program was developed to initiate dialogue about young people with mental problems. Faculty from multiple disciplines collaborated on the project. A sample of 309 students completed a web-based survey after reading a vignette about an adolescent girl with mental illness. The vignette description was based on a character in the book selected in the program. The instruments measured attribution of stigma, social distance, and familiarity with people who have mental illness. Results demonstrated that younger students and those who are less familiar with mental illness were more likely to stigmatize and maintain social distance from those who are mentally ill. Awareness of the study findings can assist health professionals and mental health workers to identify interventions that can decrease stigma. Psychiatric mental health nurses are well positioned to lead the education effort aimed at reducing stigmatizing attitudes among the public.

Validating vignette and conjoint survey experiments against real-world behavior

PubMed Central

Hainmueller, Jens; Hangartner, Dominik; Yamamoto, Teppei

2015-01-01

Survey experiments, like vignette and conjoint analyses, are widely used in the social sciences to elicit stated preferences and study how humans make multidimensional choices. However, there is a paucity of research on the external validity of these methods that examines whether the determinants that explain hypothetical choices made by survey respondents match the determinants that explain what subjects actually do when making similar choices in real-world situations. This study compares results from conjoint and vignette analyses on which immigrant attributes generate support for naturalization with closely corresponding behavioral data from a natural experiment in Switzerland, where some municipalities used referendums to decide on the citizenship applications of foreign residents. Using a representative sample from the same population and the official descriptions of applicant characteristics that voters received before each referendum as a behavioral benchmark, we find that the effects of the applicant attributes estimated from the survey experiments perform remarkably well in recovering the effects of the same attributes in the behavioral benchmark. We also find important differences in the relative performances of the different designs. Overall, the paired conjoint design, where respondents evaluate two immigrants side by side, comes closest to the behavioral benchmark; on average, its estimates are within 2% percentage points of the effects in the behavioral benchmark. PMID:25646415

Effect of race and sex on primary care physicians' diagnosis and treatment of late-life depression.

PubMed

Kales, Helen C; Neighbors, Harold W; Valenstein, Marcia; Blow, Frederic C; McCarthy, John F; Ignacio, Rosalinda V; Taylor, Kiran K-K; Gillon, Leah; Mellow, Alan M

2005-05-01

To examine primary care physician (PCP) contributions toward racial and sex differences in the diagnosis and treatment of late-life depression. Survey using a computerized instrument incorporating video interviews and text, with volunteer PCPs randomly assigned to one of four standardized video vignettes of an elderly patient depicting late-life depression. Vignettes differed only in the patient/actor's race (white/African-American) or sex. American Academy of Family Physicians meeting, San Diego, California, 2002. One hundred seventy-eight U.S.-practicing postresidency PCPs who were asked to participate in a clinical decision-making study. The computerized survey instrument assessed PCPs' diagnoses, first-line treatment and management recommendations, and judgment of personal characteristics/behaviors for the patients in the vignettes. Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. There were no significant differences in the diagnosis of depression, treatment recommendations, or PCP assessment of most patient characteristics by the race or sex of the patient/actor in the vignette, but PCP characteristics, most notably the location of medical school training (U.S. vs international), affected the likelihood of a depression diagnosis and treatment recommendations. Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as in white older people, suggesting that bias based simply on apparent patient race is not a likely explanation for the lower rates of depression diagnosis and treatment in older African Americans. PCPs who have trained at international medical schools may benefit from targeted training initiatives on the diagnosis and treatment of late-life depression.

Beliefs about dangerousness of people with mental health problems: the role of media reports and personal exposure to threat or harm.

PubMed

Reavley, N J; Jorm, A F; Morgan, A J

2016-09-01

To assess the associations between beliefs about the dangerousness of people with mental health problems and exposure to media reports of violence or personal experiences of fear, threat or harm. Telephone interviews were carried out with 5220 Australians aged 18+. Respondents heard a vignette of a person with depression or early schizophrenia and were asked whether they believed him to be dangerous. Other questions covered past 12-month recall of media reports of violence and mental health problems, contact with and experiences of fear, threat or harm by people with mental health problems. Multinomial logistic regression was used to assess the associations between beliefs about dangerousness and media and these types of contact with people with mental health problems. For the early schizophrenia vignette, recall of media reports and having felt afraid of someone were associated with beliefs about dangerousness. For the depression vignette, media reports about violence and mental health problems or the experiences of feeling afraid or having been threatened or harmed were not strongly associated with beliefs about dangerousness. For both vignettes, knowing someone with a mental health problem and having a higher level of education were associated with less belief in dangerousness. Media reports may play a greater role in forming attitudes in low prevalence disorders and further efforts to reduce any adverse impact of media reporting should focus on these disorders. The study also supports the effectiveness of contact with people with mental health problems in reducing beliefs about dangerousness.

Reactions to children's transgressions in at-risk caregivers: does mitigating information, type of transgression, or caregiver directive matter?

PubMed

Irwin, Lauren M; Skowronski, John J; Crouch, Julie L; Milner, Joel S; Zengel, Bettina

2014-05-01

This study examined whether caregivers who exhibit high risk for child physical abuse differ from low-risk caregivers in reactions to transgressing children. Caregivers read vignettes describing child transgressions. These vignettes varied in: (a) the type of transgression described (moral, conventional, personal), (b) presentation of transgression-mitigating information (present, absent), and (c) whether a directive to avoid the transgression was in the vignette (yes, no). After reading each vignette, caregivers provided ratings reflecting their: (a) perceptions of transgression wrongness, (b) internal attributions about the transgressing child, (c) perceptions of the transgressing child's hostile intent, (d) own expected negative post-transgression affect, and (e) perceived likelihood of responding to the transgression with discipline that displayed power assertion and/or induction. For moral transgressions (cruelty, dishonesty, hostility, or greed), mitigating information reduced caregiver expectations that they would feel negative affect and, subsequent to the transgression, use disciplinary strategies that display power assertion. These mitigating effects were smaller among at-risk caregivers than among low-risk caregivers. Moreover, when transgressions disobeyed a directive, among low-risk caregivers, mitigating information reduced the expectation that responses to transgressions would include inductive disciplinary strategies, but it did not do so among at-risk caregivers. In certain circumstances, compared to low-risk caregivers, at-risk caregivers expect to be relatively unaffected by transgression-mitigating information. These results suggest that interventions that increase an at-risk caregiver's ability to properly assess and integrate mitigating information may play a role in reducing the caregiver's risk of child physical abuse. Copyright © 2013 Elsevier Ltd. All rights reserved.

"His skin doesn't match what he wants to do": Children's perceptions of stereotype threat.

PubMed

Wegmann, Kate M

2017-01-01

Stereotype threat is a key contributor to chronic racial/ethnic disparities in mental health, physical health, and academic outcomes. Emerging evidence suggests that stereotype threat may be a critical concern for narrowing these disparities. The objective of the current study is to determine whether children between the ages of 7-11 consciously perceive stereotype threat, and to examine children's descriptions of the phenomenon. Age-appropriate vignettes illustrated 6 forms of stereotype threat. 15 children from diverse racial/ethnic backgrounds read and responded to 3 vignettes each. Interview transcripts were analyzed to determine if participants identified and articulated the core concept and eliciting conditions for each form of threat. All children were able to recognize and describe the core concept for at least 1 form of stereotype threat. Threats to a person's own self-concept were the most commonly identified, whereas threats directed toward a group were less easily recognized and articulated. Children were able to describe conditions associated with threat, although not all conditions were recognized in the context of each particular vignette. Children's responses to the vignettes illustrating stereotype threat suggest that children are able to perceive and describe stereotype threat in ways similar to adults. The primary importance of threats to the self and secondary importance of group threats may be explained by the developmental context of children's emerging social perspective taking skills. Addressing the effects of stereotype threat at younger ages may prevent persistent and cumulative disparities in health, mental health, and academic outcomes from arising. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The pathway to consultation for rheumatoid arthritis: exploring anticipated actions between the onset of symptoms and face-to-face encounter with a healthcare professional.

PubMed

Simons, Gwenda; Lumley, Sophie; Falahee, Marie; Kumar, Kanta; Mallen, Christian D; Stack, Rebecca J; Raza, Karim

2017-06-14

When people first experience symptoms of rheumatoid arthritis (RA) they often delay seeking medical attention resulting in delayed diagnosis and treatment. This research assesses behaviours people might engage in prior to, or instead of, seeking medical attention and compares these with behaviours related to illnesses which are better publicised. Thirty-one qualitative interviews with members of the general public explored intended actions in relation to two hypothetical RA vignettes (with and without joint swelling) and two non-RA vignettes (bowel cancer and angina). The interviews were audio-recorded and transcribed. Analysis focused on intended information gathering and other self-management behaviours in the interval between symptom onset and help-seeking. Participants were more likely to envision self-managing symptoms when confronted with the symptoms of RA compared to the other vignettes. Participants would look for information to share responsibility for decision making and get advice and reassurance. Others saw no need for information seeking, perceived the information available as untrustworthy or, particularly in the case of bowel cancer and angina, would not want to delay seeking medical attention. Participants further anticipated choosing not to self-manage the symptoms; actively monitoring the symptoms (angina/ bowel cancer) or engaging in self-treatment of symptom(s). These results help define targets for interventions to increase appropriate help-seeking behaviour for people experiencing the initial symptoms of RA, such as educational interventions directed at allied healthcare professionals from whom new patients may seek information on self-management techniques, or the development of authoritative and accessible informational resources for the general public.

Gender bias and judicial decisions of undue influence in testamentary challenges.

PubMed

Recupero, Patricia R; Christopher, Paul P; Strong, David R; Price, Marilyn; Harms, Samara E

2015-03-01

Allegations of undue influence constitute a common basis for contests of wills. Legal research from the 1990s suggests that gender bias factors significantly into judicial decision-making regarding alleged undue influence and testamentary intent. In this study, we sought to assess whether this bias is present today and to identify any factors that may be associated with it. Probate judges from several jurisdictions in the United States were asked to consider two hypothetical case vignettes drawn from actual published decisions. In our study, the gender of the testator played only a minor role in how judges weighed factors in the decision-making process and, overall, did not significantly influence opinions regarding the presence of undue influence. The specifics of the case and the gender of the judge emerged as the most consistent and robust potential influences on decision-making. Our results suggest that probate rulings involving undue influence are likely to represent a complex interaction of factors involving the testator's and judge's genders and the specifics of individual cases. The implications of these findings are discussed. © 2015 American Academy of Psychiatry and the Law.

Virtual standardized patients: an interactive method to examine variation in depression care among primary care physicians

PubMed Central

Hooper, Lisa M.; Weinfurt, Kevin P.; Cooper, Lisa A.; Mensh, Julie; Harless, William; Kuhajda, Melissa C.; Epstein, Steven A.

2009-01-01

Background Some primary care physicians provide less than optimal care for depression (Kessler et al., Journal of the American Medical Association 291, 2581–90, 2004). However, the literature is not unanimous on the best method to use in order to investigate this variation in care. To capture variations in physician behaviour and decision making in primary care settings, 32 interactive CD-ROM vignettes were constructed and tested. Aim and method The primary aim of this methods-focused paper was to review the extent to which our study method – an interactive CD-ROM patient vignette methodology – was effective in capturing variation in physician behaviour. Specifically, we examined the following questions: (a) Did the interactive CD-ROM technology work? (b) Did we create believable virtual patients? (c) Did the research protocol enable interviews (data collection) to be completed as planned? (d) To what extent was the targeted study sample size achieved? and (e) Did the study interview protocol generate valid and reliable quantitative data and rich, credible qualitative data? Findings Among a sample of 404 randomly selected primary care physicians, our voice-activated interactive methodology appeared to be effective. Specifically, our methodology – combining interactive virtual patient vignette technology, experimental design, and expansive open-ended interview protocol – generated valid explanations for variations in primary care physician practice patterns related to depression care. PMID:20463864

An examination of perceptions of individuals with an intellectual disability, with and without co-morbid schizophrenia: effects of labels on stigma.

PubMed

Rasdale, A R; Warman, D M; Phalen, P L

2018-06-01

Research demonstrates negative perceptions of individuals with intellectual disabilities (ID) and individuals with schizophrenia, but no study has examined ID with a co-morbid psychiatric disorder. The present study examined the social distance desired from and perceptions of dangerousness of ID, schizophrenia and co-morbid schizophrenia and ID and examined the impact of providing a label for the behaviours presented in a vignette. A total of 160 participants, all university students, were randomly assigned to one of six vignettes detailing a person with schizophrenia, ID, or a person with both presenting problems. Half of the participants were randomly assigned to read vignettes that had a label provided for the behaviours of the target. Participants desired more social distance from the unlabelled than labelled targets. Presence of schizophrenia resulted in increased social distance, but co-morbid ID and schizophrenia elicited less desire for social distance than schizophrenia alone. Schizophrenia resulted in more perceived danger, but labelled co-morbid schizophrenia and ID resulted in little perceived danger. Labels resulted in positive outcomes, particularly, when ID was co-morbid with schizophrenia. Schizophrenia stigma appears to be impacted by an ID label, indicating educating the public about the spectrum of co-morbidity may be useful. © 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Conversion disorder as psychogenic nonepileptic seizures in suspected cancer: a case report.

PubMed

Jimenez, Xavier F; Sharma, Jennifer S; Dar, Syma A

2014-01-01

Psychogenic nonepileptic seizures (PNES), a form of conversion disorder, are paroxysmal episodes resembling epilepsy while lacking electrographic correlation. The phenomenon has rarely been reported in elderly patients and has not been associated with a new-onset medical diagnosis. We present the case of an 81-year-old female with no past psychiatric or traumatic history who developed PNES within the context of a new, suspected cancer. To our knowledge, this is the first such reported case of a suspected cancer (or otherwise medical) diagnosis contributing directly and temporally to the development of PNES. Discussion of involved psychosocial variables follows the vignette, and a brief review of relevant literature is offered. Copyright © 2014 Elsevier Inc. All rights reserved.

What do health workers in Timor-Leste want, know and do? Findings from a national health labour market survey.

PubMed

Hou, Xiaohui; Witter, Sophie; Zaman, Rashid U; Engelhardt, Kay; Hafidz, Firdaus; Julia, Fernanda; Lemiere, Christophe; Sullivan, Eileen B; Saldanha, Estanislau; Palu, Toomas; Lievens, Tomas

2016-11-18

The objectives of this study were to understand the labour market dynamics among health workers, including their preferences and concerns, and to assess the skills, competence and performance (i.e. the 'know-do gap') of doctors working in Timor-Leste. This cross-sectional survey was implemented in all 13 districts of Timor-Leste in 2014. We surveyed 443 health workers, including 175 doctors, 150 nurses and 118 midwives (about 20% of the health workers in the country). We also observed 632 clinical consultations with doctors, including 442 direct clinical observations, and tested 190 vignettes. The study highlights some positive findings, including the gender balance of health workers overall, the concentration of doctors in rural areas, the high overall reported satisfaction of staff with their work and high motivation, the positive intention to stay in the public sector, the feeling of being well prepared by training for work, the relatively frequent and satisfactory supervisions, and the good attitudes towards patients as identified in observations and vignettes. However, some areas require more investigations and investments. The overall clinical performance of the doctors was very good in terms of attitude and moderate in regard to history taking, health education and treatment. However, the average physical examination performance score was low. Doctors performed better with simulated cases than the real cases in general, which means they have better knowledge and skills than they actually demonstrated. The factors that were significantly associated with the clinical performance of doctors were location of the health facility (urban doctors were better) and consultation time (cases with more consultation time were better). Regression analysis suggests that lack of knowledge was significantly associated with lack of performance, while lack of motivation and equipment were not significant. The survey provides essential information for workforce planning and for developing training policies and terms and conditions that will attract and retain health workers in rural service. Improving the work environment and performance of doctors working in rural health facilities and ensuring compliance with clinical protocols are two priority areas needed to improve the performance of doctors in Timor-Leste.

Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial.

PubMed

Gimbel, Ronald W; Pirrallo, Ronald G; Lowe, Steven C; Wright, David W; Zhang, Lu; Woo, Min-Jae; Fontelo, Paul; Liu, Fang; Connor, Zachary

2018-03-12

The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems. Multi-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision. One hundred sixteen of the 167 participants (66.9%) initially ordered a brain CT scan. After CCHR presentation, the number of clinicians ordering a CT dropped to 76 (45.8%), representing a 21.1% reduction in CT ordering (P = 0.002). This reduction in CT ordering was maintained, in comparison to initial imaging orders, when presented with malpractice review information (p = 0.002) and patient cost information (p = 0.002). About 57% of clinicians changed their order during study, while 43% never modified their imaging order. This study suggests that ED clinician brain CT imaging decisions may be influenced by clinical decision support rules, patient out-of-pocket cost information and findings from malpractice case review. NCT03449862 , February 27, 2018, Retrospectively registered.

Cultural Studies Methodologies and Narrative Family Therapy: Therapeutic Conversations About Pop Culture.

PubMed

Tilsen, Julie; Nylund, David

2016-06-01

Therapists recognize that popular media culture is an influential force that shapes identities and relationships in contemporary society. Indeed, people have serious relationships with the commodities and practices that emerge from pop culture. However, they often lack the conceptual and conversational resources to engage meaningfully with clients about pop culture's influence in their lives. Cultural studies is introduced as an interdisciplinary approach that provides frameworks for both theory and practice that position therapists and clients to critically examine the role of pop culture in their lives. Cultural studies and narrative therapy are discussed as praxis allies that share a populist political intention and counter-hegemonic discursive practices. The integration of cultural studies methodologies into narrative therapy practice with a parent and her teenage daughter is illustrated through a case vignette. © 2016 Family Process Institute.

Cross-Country Heterogeneity in Students' Reporting Behavior: The Use of the Anchoring Vignette Method

ERIC Educational Resources Information Center

Vonkova, Hana; Zamarro, Gema; Hitt, Collin

2018-01-01

Self-reports are an indispensable source of information in education research but they are often affected by heterogeneity in reporting behavior. Failing to correct for this heterogeneity can lead to invalid comparisons across groups. The researchers use the parametric anchoring vignette method to correct for cross-country incomparability of…

The Factorial Survey: Design Selection and its Impact on Reliability and Internal Validity

ERIC Educational Resources Information Center

Dülmer, Hermann

2016-01-01

The factorial survey is an experimental design consisting of varying situations (vignettes) that have to be judged by respondents. For more complex research questions, it quickly becomes impossible for an individual respondent to judge all vignettes. To overcome this problem, random designs are recommended most of the time, whereas quota designs…

Sharing Practices, but What Is the Story? Exploring Award-Winning Teachers' Conceptions of Teaching

ERIC Educational Resources Information Center

Gan Joo Seng, Mark; Geertsema, Johan

2018-01-01

This paper critically considers the attempt by a research-intensive university in Asia to draw on and make public the practices of teaching award winners in different disciplines through the use of narrative vignettes. More specifically, this paper examines what the vignettes suggest about the connection between award-winning teachers' conceptions…

In Our Voices: Latino Students on Higher Education. (Videotape and Discussion Guide.)

ERIC Educational Resources Information Center

Intercultural Development Research Association, San Antonio, TX.

This 40-minute video presents 10 vignettes about Latino young people reflecting on important issues as they move from high school to college and into civic engagement as leaders in their communities. The vignettes are based on composite life experiences of Latino students. The script, lyrics, and music are original compositions of Los Inocentes…

Values in Action: The Meaning of Executive Vignettes. Technical Report 28.

ERIC Educational Resources Information Center

Lombardo, Michael M.

This technical report contains executive vignettes collected during a research project involving 400 executives in 8 organizations. It analyzes individual stories and categorizes them into four broad themes: (1) how things work politically in an organization; (2) how people are treated; (3) how one gets ahead; and (4) the proper role of an…

Toward a Methodology for Evaluating the Impact of Technologies on Infantry Situation Awareness

DTIC Science & Technology

2004-10-01

enhanced free - play exercise was conducted to investigate the effect of the ISR on SA. Ten Air Field Defence Guards participated in two vignettes, loosely...post- experiment interview), this result again seems logical. The DQT and free - play methodology was able to successfully discriminate between baseline...8 3.1.6 Free - play Vignettes

Values in School Science: Some Practical Materials and Suggestions. Third Edition.

ERIC Educational Resources Information Center

Brinckerhoff, Richard F.

The collection of vignettes in this book provide science teachers with a multitude of source materials and useful alternatives for incorporation into their curricula and teaching. Teachers may select topics as brief issues for casual reflection or as a means for promoting deeper investigation and analysis. Most of the vignettes can be extended and…

Understanding HIV Stigma among University Students: Judgment, Blame, and Interpersonal Avoidance

ERIC Educational Resources Information Center

Watson, Victoria J.; Guagnano, Gregory; Davis, Shannon N.

2012-01-01

Using vignettes, levels of HIV stigma among university students (n = 971) were examined to identify the likelihood of judging and blaming or avoiding personal and intimate contact with an HIV-positive individual. Reactions to the vignettes showed judgment and blame and intimate avoidance were higher when HIV was contracted through unprotected sex.…

Safety assessment in schools: beyond risk: the role of child psychiatrists and other mental health professionals.

PubMed

Rappaport, Nancy; Pollack, William S; Flaherty, Lois T; Schwartz, Sarah E O; McMickens, Courtney

2015-04-01

This article presents an overview of a comprehensive school safety assessment approach for students whose behavior raises concern about their potential for targeted violence. Case vignettes highlight the features of 2 youngsters who exemplify those seen, the comprehensive nature of the assessment, and the kind of recommendations that enhance a student's safety, connection, well-being; engage families; and share responsibility of assessing safety with the school. Copyright © 2015 Elsevier Inc. All rights reserved.

Working with Russian-Jewish immigrants in end-of-life care settings.

PubMed

Newhouse, Leonid

2013-01-01

This article examines Russian-Jewish immigrant clients' attitudes toward death and dying in the context of today's health care system. Aspects of individuals' collective past--such as the traumatic history of their country of origin; cultural prohibitions against discussing pain, suffering, and death; and the lack of familiarity with palliative care that are likely to affect their decisions about end-of-life care--are discussed. Case vignettes are provided, with a discussion on how best to engage these clients in therapeutic work.

The Concept of “Metaemotion”: What is There to Learn From Research on Metacognition?

PubMed Central

Norman, Elisabeth; Furnes, Bjarte

2014-01-01

We first present a selection of vignette examples from empirical psychological research to illustrate how the phenomenon of metaemotion (Gottman, Katz, & Hooven, 1996; Mendonça, 2013) is studied within different domains of psychology. We then present a theoretical distinction which has been made between three facets of metacognition, namely metacognitive experiences, metacognitive knowledge, and metacognitive strategies (e.g., Efklides, 2008; Flavell, 1979). Referring back to the vignette examples from metaemotion research, we argue that a similar distinction can be drawn between three facets of metaemotion, namely metaemotional experiences, metaemotional knowledge, and metaemotional strategies. We argue that this distinction clarifies some of the unresolved issues in metaemotion research, and therefore has important implications for the study of metaemotion, both methodologically and theoretically. PMID:27110281

Big Robots for Little Kids: Investigating the Role of Scale in Early Childhood Robotics Kits

NASA Astrophysics Data System (ADS)

Vizner, Miki Z.

Couch fort and refrigerator box constructions are staples of early childhood play in American culture. Can this this large-scale fantasy type of play be leveraged to facilitate computational thinking? This thesis looks at the ways Kindergarteners (age 5-6) use two variations of the KIBO robotics platform in their play and learning. The first is the standard KIBO kit developed at the DevTech research group at Tufts University and commercialized by Kinderlab robotics. The second, created by the author, is 100 times bigger and can be ridden by children and adults. Specifically this study addresses the research question "How are children's experiences with big-KIBO different from KIBO?" To do so this thesis presents two analytical tools that were assembled conceptually from literature and the authors experiences with KIBO, examined using the data collected in this study, refined, and used as frameworks for understanding the data. They are a developmental model of programming with KIBO and an operationalization of Bers's (2018) powerful ideas of computational thinking when using KIBO. Vignettes from the data are presented and analyzed using these frameworks. Content and structural play themes are extracted from additional vignettes with each robot. In this study there are no clear differences in the ways children engage in computational thinking or develop their ability to program. There appear to be differences in the ways children play with the robots. Suggesting that a larger robot offers new opportunities and pathways for children to engage in computational thinking tasks. This study makes a case for the importance of thinking developmentally about computational thinking. Connections to literature and theory as well as suggestions for future work, both for children and designers, are discussed.

Relaxing moral reasoning to win: How organizational identification relates to unethical pro-organizational behavior.

PubMed

Chen, Mo; Chen, Chao C; Sheldon, Oliver J

2016-08-01

Drawing on social identity theory and social-cognitive theory, we hypothesize that organizational identification predicts unethical pro-organizational behavior (UPB) through the mediation of moral disengagement. We further propose that competitive interorganizational relations enhance the hypothesized relationships. Three studies conducted in China and the United States using both survey and vignette methodologies provided convergent support for our model. Study 1 revealed that higher organizational identifiers engaged in more UPB, and that this effect was mediated by moral disengagement. Study 2 found that organizational identification once again predicted UPB through the mediation of moral disengagement, and that the mediation relationship was stronger when employees perceived a higher level of industry competition. Finally, Study 3 replicated the above findings using a vignette experiment to provide stronger evidence of causality. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Altruism as a courtship display: some effects of third-party generosity on audience perceptions.

PubMed

Barclay, Pat

2010-02-01

Public generosity may be a means to convincingly advertise one's good character. This hypothesis suggests that altruistic individuals will be desirable as romantic partners. Few studies have tested this prediction, and these showed mixed results. Some studies have found that altruism is not particularly attractive; other studies showed that altruism is attractive by contrasting descriptions of 'nice guys' with 'jerks'. The present study sought to resolve this debate by having participants read a series of experimentally manipulated vignettes of persons with corresponding photographs, such that altruistic vignettes were compared with control descriptions that differed only in the presence or absence of small hints of altruistic tendencies. Altruists were more desirable for long-term relationships than neutral individuals. Women also preferred altruists for single dates whereas men had no such preference. These results are discussed with regard to the idea that people (males in particular) signal their good character via generosity.

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes

PubMed Central

Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans

2017-01-01

Objective European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting A total of 14 countries. Subjects Consensus groups of PCPs. Main outcome measures Probability of initial presentation to a PCP for four clinical vignettes. Results There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62). Conclusions There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. Key points European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival. PMID:28277044

Using Research-Based Interactive Video Vignettes to Enhance Out-of-Class Learning in Introductory Physics

NASA Astrophysics Data System (ADS)

Laws, Priscilla W.; Willis, Maxine C.; Jackson, David P.; Koenig, Kathleen; Teese, Robert

2015-02-01

Ever since the first generalized computer-assisted instruction system (PLATO1) was introduced over 50 years ago, educators have been adding computer-based materials to their classes. Today many textbooks have complete online versions that include video lectures and other supplements. In the past 25 years the web has fueled an explosion of online homework and course management systems, both as blended learning and online courses. Meanwhile, introductory physics instructors have been implementing new approaches to teaching based on the outcomes of Physics Education Research (PER). A common theme of PER-based instruction has been the use of active-learning strategies designed to help students overcome alternative conceptions that they often bring to the study of physics.2 Unfortunately, while classrooms have become more active, online learning typically relies on passive lecture videos or Kahn-style3 tablet drawings. To bring active learning online, the LivePhoto Physics Group has been developing Interactive Video Vignettes (IVVs) that add interactivity and PER-based elements to short presentations. These vignettes incorporate web-based video activities that contain interactive elements and typically require students to make predictions and analyze real-world phenomena.

Teacher Perceptions of Classroom Interventions for Children with ADHD: A Cross-Cultural Comparison of Teachers in the United States and New Zealand

ERIC Educational Resources Information Center

Curtis, David F.; Pisecco, Stewart; Hamilton, Richard J.; Moore, Dennis W.

2006-01-01

This investigation compared United States and New Zealand teachers' perceptions of classroom interventions for attention deficit hyperactivity disorder (ADHD). Participants read one of six vignettes describing a child with symptoms representative of ADHD. The number and type of symptoms were consistent across all vignettes. Next, teachers read a…

Cultural and Political Vignettes in the English Classroom: Problem-Posing, Problem-Solving, and the Imagination

ERIC Educational Resources Information Center

Darvin, Jacqueline

2009-01-01

One way to merge imagination with problem-posing and problem-solving in the English classroom is by asking students to respond to "cultural and political vignettes" (CPVs). CPVs are cultural and political situations that are presented to students so that they can practice the creative and essential decision-making skills that they will need to use…

Do Social Work Students Assess and Address Economic Barriers to Clients Implementing Agreed Tasks?

ERIC Educational Resources Information Center

Eamon, Mary Keegan; Zhang, Sai-jun

2006-01-01

Identical vignettes except for a sentence describing a client's economic resources were randomly assigned to 129 MSW students. The vignettes described a social worker who agreed with a client's decision to relocate her residence as a partial solution to a presenting problem but did not assess or address economic barriers to the client's…

Temporo-Parietal Junction Activity in Theory-of-Mind Tasks: Falseness, Beliefs, or Attention

ERIC Educational Resources Information Center

Aichhorn, Markus; Perner, Josef; Weiss, Benjamin; Kronbichler, Martin; Staffen, Wolfgang; Ladurner, Gunther

2009-01-01

By combining the false belief (FB) and photo (PH) vignettes to identify theory-of-mind areas with the false sign (FS) vignettes, we re-establish the functional asymmetry between the left and right temporo-parietal junction (TPJ). The right TPJ (TPJ-R) is specially sensitive to processing belief information, whereas the left TPJ (TPJ-L) is equally…

Tune in to Your Rights...A Guide for Teenagers about TURNING OFF Sexual Harassment.

ERIC Educational Resources Information Center

Morris, Barbra; And Others

Targeted to secondary school students, this booklet discusses sexual harassment. The booklet opens with a vignette about a teenage girl who is harassed by a fellow student and several shorter vignettes describing various types of sexual harassment. Sexual harassment is defined, and nine forms of harassment are listed. The right to a life and an…

The Career Success/Personal Failure Phenomenon as Perceived in Others: Comparing Vignettes of Male and Female Managers.

ERIC Educational Resources Information Center

Westman, Mina; Etzion, Dalia

1990-01-01

Reactions to 4 versions of a vignette describing a successful manager were obtained from 233 management students, including 50 executives in an extension course. Career success was perceived as a major cause of personal failure. The personal price paid by successful people was perceived differently depending on gender and marital status. (SK)

The Causal Attributions of Teaching Staff towards Children with Intellectual Disabilities: A Comparison of "Vignettes" Depicting Challenging Behaviour with "Real" Incidents of Challenging Behaviour

ERIC Educational Resources Information Center

Lucas, Victoria L.; Collins, Suzanne; Langdon, Peter E.

2009-01-01

Background: We examined whether staff attributions, emotions and helping behaviours in reaction to "real" incidents of challenging behaviour (CB) exhibited by children with intellectual disabilities were different from reactions to "vignettes". We also examined whether these reactions are congruent with that predicted by attribution theory.…

Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review.

PubMed

Karimi, Kian; McKneally, Martin F; Adamson, Peter A

2012-11-01

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty. The vignettes are based on the experience and observations of the senior author (P.A.A.) over nearly 30 years of practice and teaching. Fellowship directors and facial plastic surgery fellows of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed anonymously. Five of the 15 vignettes demonstrated significant differences between the responses of the fellowship directors and the fellows. No single vignette had a unanimous consensus in either group. Aesthetic rhinoplasty surgeons encounter ethical issues that should be reflected on by both experienced and inexperienced facial plastic surgeons, preferably before being faced with them in practice. We present a practical approach to ethical issues in clinical practice. Our survey can also be used as a stimulus for further discussion and teaching.

Primary school teachers' attitudes about children with attention deficit/hyperactivity disorder and the role of pharmacological treatment.

PubMed

Moldavsky, Maria; Pass, Sarah; Sayal, Kapil

2014-04-01

Clinical experience and research suggest that teachers' attitudes about attention deficit/hyperactivity disorder (ADHD) are an important factor influencing access to specialist assessment and treatment, including medication. We performed a thematic analysis of comments written by primary school teachers who participated in a case-vignette study investigating the ability of teachers to recognise ADHD. Teachers read one of four types of vignette describing the behaviour of a nine-year-old child who met diagnostic criteria for ADHD (either a boy or a girl with inattentive or combined subtype of ADHD). They answered questions (identical for all types of vignette) about their views regarding the problems and their management. Teachers were invited to add their own comments. Altogether 496 teachers from 110 schools completed the questionnaire: 250 (50%) teachers from 94 schools wrote at least one comment, adding up to 341 comments. Regarding their views on the need to refer the child to specialist services, 32 teachers made comments that reflected caution. The most frequent comments were that it was too early to say whether a referral was necessary, the problems were not severe enough or the main support would come from school. Teachers also reported a lack of knowledge about specialist services or criticised them. When asked whether medication might be beneficial for the child, 125 teachers expressed hesitant or negative views: that it was premature to express an opinion about medication or too soon to give medication to the child; that medication was not necessary or should not be used at all; or that the problems were not severe enough or were emotional in nature. Only five teachers reported having a positive experience of the effect of medication. Teachers' comments suggested a strong preference in using within-school strategies for the management of children with ADHD. Teachers were reluctant to endorse medication for DHD and expressed negative views about its use. Health services should support teachers' management of ADHD-related behaviours in school and provide information to increase teachers' ability to identify the need for a referral to specialist health services.

Emergency nurses' decisions regarding frequency and nature of vital sign assessment.

PubMed

Lambe, Katherine; Currey, Judy; Considine, Julie

2017-07-01

To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. A 96% response rate was achieved (n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice. © 2016 John Wiley & Sons Ltd.

Surgeon Perception of Risk and Benefit in the Decision to Operate.

PubMed

Sacks, Greg D; Dawes, Aaron J; Ettner, Susan L; Brook, Robert H; Fox, Craig R; Maggard-Gibbons, Melinda; Ko, Clifford Y; Russell, Marcia M

2016-12-01

To determine how surgeons' perceptions of treatment risks and benefits influence their decisions to operate. Little is known about what makes one surgeon choose to operate on a patient and another chooses not to operate. Using an online study, we presented a national sample of surgeons (N = 767) with four detailed clinical vignettes (mesenteric ischemia, gastrointestinal bleed, bowel obstruction, appendicitis) where the best treatment option was uncertain and asked them to: (1) judge the risks (probability of serious complications) and benefits (probability of recovery) for operative and nonoperative management and (2) decide whether or not they would recommend an operation. Across all clinical vignettes, surgeons varied markedly in both their assessments of the risks and benefits of operative and nonoperative management (narrowest range 4%-100% for all four predictions across vignettes) and in their decisions to operate (49%-85%). Surgeons were less likely to operate as their perceptions of operative risk increased [absolute difference (AD) = -29.6% from 1.0 standard deviation below to 1.0 standard deviation above mean (95% confidence interval, CI: -31.6, -23.8)] and their perceptions of nonoperative benefit increased [AD = -32.6% (95% CI: -32.8,--28.9)]. Surgeons were more likely to operate as their perceptions of operative benefit increased [AD = 18.7% (95% CI: 12.6, 21.5)] and their perceptions of nonoperative risk increased [AD = 32.7% (95% CI: 28.7, 34.0)]. Differences in risk/benefit perceptions explained 39% of the observed variation in decisions to operate across the four vignettes. Given the same clinical scenarios, surgeons' perceptions of treatment risks and benefits vary and are highly predictive of their decisions to operate.

Why patients' disruptive behaviours impair diagnostic reasoning: a randomised experiment.

PubMed

Mamede, Sílvia; Van Gog, Tamara; Schuit, Stephanie C E; Van den Berge, Kees; Van Daele, Paul L A; Bueving, Herman; Van der Zee, Tim; Van den Broek, Walter W; Van Saase, Jan L C M; Schmidt, H G

2017-01-01

Patients who display disruptive behaviours in the clinical encounter (the so-called 'difficult patients') may negatively affect doctors' diagnostic reasoning, thereby causing diagnostic errors. The present study aimed at investigating the mechanisms underlying the negative influence of difficult patients' behaviours on doctors' diagnostic performance. A randomised experiment with 74 internal medicine residents. Doctors diagnosed eight written clinical vignettes that were exactly the same except for the patients' behaviours (either difficult or neutral). Each participant diagnosed half of the vignettes in a difficult patient version and the other half in a neutral version in a counterbalanced design. After diagnosing each vignette, participants were asked to recall the patient's clinical findings and behaviours. Main measurements were: diagnostic accuracy scores; time spent on diagnosis, and amount of information recalled from patients' clinical findings and behaviours. Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than neutral patients' vignettes (0.41 vs 0.51; p<0.01). Time spent on diagnosing was similar. Participants recalled fewer clinical findings (mean=29.82% vs mean=32.52%; p<0.001) and more behaviours (mean=25.51% vs mean=17.89%; p<0.001) from difficult than from neutral patients. Difficult patients' behaviours induce doctors to make diagnostic errors, apparently because doctors spend part of their mental resources on dealing with the difficult patients' behaviours, impeding adequate processing of clinical findings. Efforts should be made to increase doctors' awareness of the potential negative influence of difficult patients' behaviours on diagnostic decisions and their ability to counteract such influence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Teaching a Systematic Approach for Transitioning Patients to College: An Interactive Continuing Medical Education Program.

PubMed

Martel, Adele; Derenne, Jennifer; Chan, Vivien

2015-10-01

The purpose of this article is to determine the effectiveness of a hands-on continuing education program for practicing child and adolescent psychiatrists (CAPs) with a focus on best practices in transitioning psychiatric patients to college. The plan was to build on the unique knowledge and skill set of CAPs, use audience and facilitator feedback from prior programs to inform program content, structure, and format, and incorporate findings from the evolving literature. A 3-h interactive workshop was designed with an emphasis on audience participation. The workshop was divided into three main segments: didactics, whole group discussion/brainstorming, and small group discussion of illustrative case vignettes. Improvements and changes in knowledge, skills, and attitudes related to transition planning were identified by program participants. Quantitative feedback in the form of course evaluations, pre- and posttests, and a 6-month follow-up questionnaire indicate that the use of interactive teaching techniques is a productive learning experience for practicing CAPs. Qualitative feedback was that the discussion of the case vignettes was the most helpful. The use of a workshop format is an effective strategy to engage practicing CAPs in learning about and implementing best practices to support the transition of their patients to college and into young adulthood. Comprehensive and proactive transition planning, facilitated by clinicians, should promote the wellness of college-bound patients and help to reduce the potential risks in the setting of an upcoming transition.

Managing disclosure following recent-onset psychosis: utilizing the individual placement and support model.

PubMed

Allott, Kelly A; Turner, Luana R; Chinnery, Gina L; Killackey, Eoin J; Nuechterlein, Keith H

2013-08-01

Individual Placement and Support is the most defined and evidence-based approach to supported employment for severe mental illness, including recent-onset psychosis. However, there is limited evidence or detailed guidelines informing the management of mental illness disclosure to educators or employers when delivering individual placement and support. In this paper, we describe the initial disclosure preferences of young people with recent-onset psychosis enrolled in individual placement and support and provide guidance for managing disclosure when delivering Individual Placement and Support with this population. Drawing from sites in Melbourne, Australia and Los Angeles, USA, clients' initial disclosure preferences were examined. We describe approaches to providing individual placement and support when no disclosure is permitted compared with when disclosure is permitted, including two illustrative case vignettes. No disclosure of mental illness or disability was requested by 54-59% of clients; 41-46% of clients permitted partial or complete disclosure. The 'no disclosure' scenario required the individual placement and support worker to provide support 'behind the scenes', whereas when disclosure was permitted, the individual placement and support worker could have contact with instructors/employers and work 'on the front lines'. The case vignettes illustrate how both approaches can lead to successful vocational outcomes. We found that Individual Placement and Support can be provided in an educative, flexible, creative and collaborative manner according to client disclosure preferences. We suggest that disclosure preferences do not prevent successful vocational outcomes, although this supposition requires empirical investigation. © 2013 Wiley Publishing Asia Pty Ltd.

Kyol Goeu (‘Wind Overload’) Part II: Prevalence, Characteristics, and Mechanisms of Kyol Goeu and Near-Kyol Goeu Episodes of Khmer Patients Attending a Psychiatric Clinic

PubMed Central

Hinton, Devon; Um, Khin; Ba, Phalnarith

2009-01-01

Kyol goeu (literally, ‘wind overload’) is an orthostatically triggered syncopal syndrome often found among Khmer refugees in the US. In the present study, 36 of 100 (36%) Khmer patients attending a psychiatric clinic were found to have suffered a kyol goeu episode in the past, whereas 60 of 100 (60%) patients had experienced a near-kyol goeu event in the last six months. Following a survey-based characterization of kyol goeu, as well as the presentation of case vignettes, the article discusses six mechanisms resulting in the high prevalence of the syndrome. The article concludes by comparing kyol goeu and ataque de nervios. PMID:20808711

Kyol Goeu ('Wind Overload') Part II: Prevalence, Characteristics, and Mechanisms of Kyol Goeu and Near-Kyol Goeu Episodes of Khmer Patients Attending a Psychiatric Clinic.

PubMed

Hinton, Devon; Um, Khin; Ba, Phalnarith

2001-12-01

Kyol goeu (literally, 'wind overload') is an orthostatically triggered syncopal syndrome often found among Khmer refugees in the US. In the present study, 36 of 100 (36%) Khmer patients attending a psychiatric clinic were found to have suffered a kyol goeu episode in the past, whereas 60 of 100 (60%) patients had experienced a near-kyol goeu event in the last six months. Following a survey-based characterization of kyol goeu, as well as the presentation of case vignettes, the article discusses six mechanisms resulting in the high prevalence of the syndrome. The article concludes by comparing kyol goeu and ataque de nervios.

Challenges of Pre- and Post-Test Counseling for Orthodox Jewish Individuals in the Premarital Phase.

PubMed

Rose, E; Schreiber-Agus, N; Bajaj, K; Klugman, S; Goldwaser, T

2016-02-01

The Jewish community has traditionally taken ownership of its health, and has taken great strides to raise awareness about genetic issues that affect the community, such as Tay-Sachs disease and Hereditary Breast and Ovarian Cancer syndrome. Thanks in part to these heightened awareness efforts, many Orthodox Jewish individuals are now using genetics services as they begin to plan their families. Due to unique cultural and religious beliefs and perceptions, the Orthodox Jewish patients who seek genetic counseling face many barriers to a successful counseling session, and often seek the guidance of programs such as the Program for Jewish Genetic Health (PJGH). In this article, we present clinical vignettes from the PJGH's clinical affiliate, the Reproductive Genetics practice at the Montefiore Medical Center. These cases highlight unique features of contemporary premarital counseling and screening within the Orthodox Jewish Community, including concerns surrounding stigma, disclosure, "marriageability," the use of reproductive technologies, and the desire to include a third party in decision making. Our vignettes demonstrate the importance of culturally-sensitive counseling. We provide strategies and points to consider when addressing the challenges of pre- and post-test counseling as it relates to genetic testing in this population.

Varying ethics rules in clinical research and routine patient care – research ethics committee chairpersons’ views in Finland

PubMed Central

2014-01-01

Background To present empirical data on how the variation in regulating clinical research and patient care was perceived in Finland between 2009 and 2012. Methods Notes of interviews with 22 research ethics committee (REC) chairpersons were analyzed to identify whether differences in the regulation of clinical research and patient care were addressed. REC chairpersons’ opinions on three imaginary cases of clinical research projects challenging current research ethics rules (vignettes) were requested with a questionnaire; 18 of the 22 interviewed chairpersons responded. Results Based on REC chairpersons’ interviews, the differences between care and research regulation were not considered important issues in Finland. In the vignettes, REC chairpersons’ assumptions on how their REC would decide varied in regard to allowing research without informed consent, while solutions that are not allowed by current law were even anticipated. Mostly, but not always, the chairpersons’ own personal view agreed with their REC. Conclusions The distinction between care and research regulation has not been publicly challenged by Finnish RECs, even though it is a challenge when research relevant to health care is carried out. There is a need for debate and changes in laws and practices. PMID:24666735

Who's the Boss? Concepts of Social Power Across Development.

PubMed

Gülgöz, Selin; Gelman, Susan A

2017-05-01

Power differences are observed in children's early relationships, yet little is known about how children conceptualize social power. Study 1 recruited adults (n = 35) to assess the validity of a series of vignettes to measure five dimensions of social power. Using these vignettes, Study 2 (149 three- to nine-year-olds, 42 adults) and Study 3 (86 three- to nine-year-olds, 22 adults) showed that children visiting a science museum at a middle class university town are sensitive to several dimensions of social power from a young age; however, an adult-like breadth of power concepts does not develop until 7-9 years. Children understand social power whether the powerful character is malevolent or benevolent, though malevolent power is easier to detect for children and adults. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

Adolescent Mental Health Literacy: Young People's Knowledge of Depression and Social Anxiety Disorder.

PubMed

Coles, Meredith E; Ravid, Ariel; Gibb, Brandon; George-Denn, Daniel; Bronstein, Laura R; McLeod, Sue

2016-01-01

Understanding why nearly 80% of youth ages 6-18 years with a mental disorder fail to receive treatment represents an important public health priority. International data suggest that underrecognition of mental illness and the need for treatment are barriers to service utilization. This study extends work to a U.S. sample of 1,104 adolescents. High School students were invited to participate in a self-report study assessing knowledge and beliefs regarding mental illness. Participants completed the survey in groups at school and read vignettes portraying peers experiencing major depression, social anxiety disorder, and a situation where the individual has to cope with a common life stressor followed by a series of questions in reference to each vignette. Adolescents had better recognition of depression than social anxiety disorder and were more likely to recommend seeking help for it. However, <50% of youth recognized depression. Family, friends, and counselors were recommended as sources of help. Differences according to the sex of the respondent and person in the vignette were observed. These data are among the first to provide information regarding the mental health literacy of American adolescents and suggest potential points for intervention. Pending replication of the findings herein, efforts to help adolescents recognize mental health problems and to increase the likelihood of recommending professional help will be important. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Beliefs and Recommendations Regarding Child Custody and Visitation in Cases Involving Domestic Violence: A Comparison of Professionals in Different Roles.

PubMed

Saunders, Daniel G; Faller, Kathleen C; Tolman, Richard M

2016-05-01

Research is lacking on differing perspectives regarding custody cases involving domestic violence (DV). In a survey of judges, legal aid attorneys, private attorneys, DV program workers, and child custody evaluators (n = 1,187), judges, private attorneys, and evaluators were more likely to believe that mothers make false DV allegations and alienate their children. In response to a vignette, evaluators and private attorneys were most likely to recommend joint custody and least likely to recommend sole custody to the survivor. Legal aid attorneys and DV workers were similar on many variables. Gender, DV knowledge, and knowing victims explained many group differences. © The Author(s) 2015.

Caregivers as money managers for adults with severe mental illness: how treatment providers can help.

PubMed

Elbogen, Eric B; Wilder, Christine; Swartz, Marvin S; Swanson, Jeffrey W

2008-01-01

To review the prevalence, benefits, and problems associated with families who, either informally or formally as representative payees, manage money for adults with severe mental illness. Based on empirical research and clinical cases, suggestions are offered for minimizing downsides and capitalizing upon benefits of family money management. The findings and case vignettes demonstrate four specific strategies for treatment providers: facilitating collaboration, increasing knowledge about disability funds, improving money-management skills, and developing plans for financial decision-making. By following these recommendations and becoming aware of whether their clients had family money managers, clinicians can promote independent functioning and family support for a substantial number of people with severe mental illness.

On the Complexity of Digital Video Cameras in/as Research: Perspectives and Agencements

ERIC Educational Resources Information Center

Bangou, Francis

2014-01-01

The goal of this article is to consider the potential for digital video cameras to produce as part of a research agencement. Our reflection will be guided by the current literature on the use of video recordings in research, as well as by the rhizoanalysis of two vignettes. The first of these vignettes is associated with a short video clip shot by…

Comparison of work and time estimates by chiropractic physicians with those of medical and osteopathic providers.

PubMed

Hess, J A; Mootz, R D

1999-06-01

Resource-based relative value scales (RBRVS) have become a standard method for identifying costs and determining reimbursement for physician services. Development of RBRVS systems and methods are reviewed, and the RBRVS concept of physician "work" is defined. Results of work and time inputs from chiropractic physicians are compared with those reported by osteopathic and medical specialties. Last, implications for reimbursement of chiropractic fee services are discussed. Total work, intraservice work, and time inputs for clinical vignettes reported by chiropractic, osteopathic, and medical physicians are compared. Data for chiropractic work and time reports were drawn from a national random sample of chiropractors conducted as part of a 1997 workers' compensation chiropractic fee schedule development project. Medical and osteopathic inputs were drawn from RBRVS research conducted at Harvard University under a federal contract reported in 1990. Both data sets used the same or similar clinical vignettes and similar methods. Comparisons of work and time inputs are made for clinical vignettes to assess whether work reported by chiropractors is of similar magnitude and variability as work reported by other specialties. Chiropractic inputs for vignettes related to evaluation and management services are similar to those reported by medical specialists and osteopathic physicians. The range of variation between chiropractic work input and other specialties is of similar magnitude to that within other specialties. Chiropractors report greater work input for radiologic interpretation and lower work input for manipulation services. Chiropractors seem to perform similar total "work" for evaluation and management services as other specialties. No basis exists for excluding chiropractors from using evaluation and management codes for reimbursement purposes on grounds of dissimilar physician time or work estimates. Greater work input by chiropractors in radiology interpretation may be related to a greater importance placed on findings in care planning. Consistently higher reports for osteopathic work input on manipulation are likely attributable to differences in reference vignettes used in the respective populations. Research with a common reference vignette used for manipulation providers is recommended, as is development of a single generic approach to coding for manipulation services.

The situation specificity of youth responses to peer provocation.

PubMed

Dirks, Melanie A; Treat, Teresa A; Weersing, V Robin

2007-01-01

Previous studies have identified peer provocation as a challenging class of situations for youth. The work presented here builds on previous methods of assessing peer provocation by (a) increasing the contextual detail of the vignettes; (b) developing a reliable, descriptive coding system of the range of youth responses to physical, verbal, and relational provocation; and (c) assessing the relevance of these situations for a sample (N = 76) of ethnically diverse, economically disadvantaged youth ages 12 to 14. The vignettes were used to examine the situation specificity of youth responses to provocation. Situation and identity of aggressor were both predictors of youth responses. For example, participants "matched" physical aggression to physical provocation. These findings are consistent with previous studies demonstrating the situation specificity of social information processing, even within the relatively homogeneous category of peer provocations.

Gender differences in BOLD activation to face photographs and video vignettes.

PubMed

Fine, Jodene Goldenring; Semrud-Clikeman, Margaret; Zhu, David C

2009-07-19

Few neuroimaging studies have reported gender differences in response to human emotions, and those that have examined such differences have utilized face photographs. This study presented not only human face photographs of positive and negative emotions, but also video vignettes of positive and negative social human interactions in an attempt to provide a more ecologically appropriate stimuli paradigm. Ten male and 10 female healthy right-handed young adults were shown positive and negative affective social human faces and video vignettes to elicit gender differences in social/emotional perception. Conservative ROI (region of interest) analysis indicated greater male than female activation to positive affective photos in the anterior cingulate, medial frontal gyrus, superior frontal gyrus and superior temporal gyrus, all in the right hemisphere. No significant ROI gender differences were observed to negative affective photos. Male greater than female activation was seen in ROIs of the left posterior cingulate and the right inferior temporal gyrus to positive social videos. Male greater than female activation occurred in only the left middle temporal ROI for negative social videos. Consistent with previous findings, males were more lateralized than females. Although more activation was observed overall to video compared to photo conditions, males and females appear to process social video stimuli more similarly to one another than they do for photos. This study is a step forward in understanding the social brain with more ecologically valid stimuli that more closely approximates the demands of real-time social and affective processing.

A mental health program for ground zero rescue and recovery workers: cases and observations.

PubMed

Katz, Craig L; Smith, Rebecca; Silverton, Marsha; Holmes, Anastasia; Bravo, Carlos; Jones, Kristina; Kiliman, Marta; Lopez, Norma; Malkoff, Laurie; Marrone, Kathryn; Neuman, Alla; Stephens, Tricia; Tavarez, Wendy; Yarowsky, Anne; Levin, Stephen; Herbert, Robin

2006-09-01

Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.

Community Based Participatory Research: A New approach to engaging community members to rapidly call 911 for Stroke

PubMed Central

Skolarus, Lesli E.; Zimmerman, Marc A.; Murphy, Jillian; Brown, Devin L.; Kerber, Kevin A.; Bailey, Sarah; Fowlkes, Sophronia; Morgenstern, Lewis B.

2014-01-01

Background and Purpose Acute stroke treatments are underutilized primarily due to delayed hospital arrival. Using a community based participatory research approach, we explored stroke self-efficacy, knowledge and perceptions of stroke among a predominately African American population in Flint, Michigan. Methods In March 2010, a survey was administered to youth and adults after religious services at three churches and one church health day. The survey consisted of vignettes (12 stroke, 4 non-stroke) to assess knowledge of stroke warning signs and behavioral intent to call 911. The survey also assessed stroke self-efficacy, personal knowledge of someone who had had a stroke, personal history of stroke and barriers to calling 911. Linear regression models explored the association of stroke self-efficacy with behavioral intent to call 911 among adults. Results Two hundred forty two adults and 90 youth completed the survey. Ninety two percent of adults and 90% of youth respondents were African American. Responding to 12 stroke vignettes, adults would call 911 in 72% (sd=0.26) of the vignettes while youth would call 911 in 54% (sd=0.29) (p<0.001). Adults correctly identified stroke in 51% (sd=0.32) of the stroke vignettes and youth in 46% (sd=0.28) of the stroke vignettes (p=0.28). Stroke self-efficacy predicted behavioral intent to call 911 (p=0.046). Conclusion In addition to knowledge of stroke warning signs, behavioral interventions to increase both stroke self-efficacy and behavioral intent may be useful for helping people make appropriate 911 calls for stroke. A community based participatory research approach may be effective in reducing stroke disparities. PMID:21617148

International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data.

PubMed

Nicholson, Brian D; Mant, David; Neal, Richard D; Hart, Nigel; Hamilton, Willie; Shinkins, Bethany; Rubin, Greg; Rose, Peter W

2016-02-01

Variation in cancer survival persists between comparable nations and appears to be due, in part, to primary care practitioners (PCPs) having different thresholds for acting definitively in response to cancer-related symptoms. To explore whether cancer guidelines, and adherence to them, differ between jurisdictions and impacts on PCPs' propensity to take definitive action on cancer-related symptoms. A secondary analysis of survey data from six countries (10 jurisdictions) participating in the International Cancer Benchmarking Partnership. PCPs' responses to five clinical vignettes presenting symptoms and signs of lung (n = 2), colorectal (n = 2), and ovarian cancer (n = 1) were compared with investigation and referral recommendations in cancer guidelines. Nine jurisdictions had guidelines covering the two colorectal vignettes. For the lung vignettes, although eight jurisdictions had guidelines for the first, the second was covered by a Swedish guideline alone. Only the UK and Denmark had an ovarian cancer guideline. Survey responses of 2795 PCPs (crude response rate: 12%) were analysed. Guideline adherence ranged from 20-82%. UK adherence was lower than other jurisdictions for the lung vignette covered by the guidance (47% versus 58%; P <0.01) but similar (45% versus 46%) or higher (67% versus 38%; P <0.01) for the two colorectal vignettes. PCPs took definitive action least often when a guideline recommended a non-definitive action or made no recommendation. UK PCPs adhered to recommendations for definitive action less than their counterparts (P <0.01). There wasno association between jurisdictional guideline adherence and 1-year survival. Cancer guideline content is variable between similarly developed nations and poor guideline adherence does not explain differential survival. Guidelines that fail to cover high-risk presentations or that recommend non-definitive action may reduce definitive diagnostic action. © British Journal of General Practice 2016.

The utility of case formulation in treatment decision making; the effect of experience and expertise.

PubMed

Dudley, Robert; Ingham, Barry; Sowerby, Katy; Freeston, Mark

2015-09-01

We examined whether case formulation guides the endorsement of appropriate treatment strategies. We also considered whether experience and training led to more effective treatment decisions. To examine these questions two related studies were conducted both of which used a novel paradigm using clinically relevant decision-making tasks with multiple sources of information. Study one examined how clinicians utilised a pre-constructed CBT case formulation to plan treatment. Study two utilised a clinician-generated formulation to further examine the process of formulation development and the impact on treatment planning. Both studies considered the effect of therapist experience. Both studies indicated that clinicians used the case formulation to select treatment choices that were highly matched to the case as described in the vignette. However, differences between experts and novice clinicians were only demonstrated when clinicians developed their own formulations of case material. When they developed their own formulations the experts' formulations were more parsimonious, internally consistent, and contained fewer errors and the experts were less swayed by irrelevant treatment options. The nature of the experimental task, involving ratings of suitability of possible treatment options suggested for the case, limits the interpretation that formulation directs the development or generation of the clinician's treatment plan. In study two the task may still have limited the capacity to demonstrate further differences between expert and novice therapists. Formulation helps guide certain aspects of effective treatment decision making. When asked to generate a formulation clinicians with greater experience and expertise do this more effectively. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Medical Students' Development of Ethical Judgment - Exploring the Learners' Perspectives using a mixed methods approach.

PubMed

Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W

2016-01-01

Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students' perspectives on their development in ethical judgment has received less attention. Better insights in the learners' experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient's parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant's preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants' responses changed overtime. Accepting parents' autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents' decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the participants seemed to increasingly frame the presented vignette as a medical problem. To optimize the development of ethical judgment teaching of ethics should be more integrated in clinical teaching. In addition to the analysis of rare and extreme cases, teaching ethics should also expand on challenges students and junior doctors commonly encounter themselves to promote ethical sensitivity and confidence in students.

Medical Students’ Development of Ethical Judgment – Exploring the Learners’ Perspectives using a mixed methods approach

PubMed Central

Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W.

2016-01-01

Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students’ perspectives on their development in ethical judgment has received less attention. Better insights in the learners’ experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient’s parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant’s preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants’ responses changed overtime. Accepting parents’ autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents’ decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the participants seemed to increasingly frame the presented vignette as a medical problem. To optimize the development of ethical judgment teaching of ethics should be more integrated in clinical teaching. In addition to the analysis of rare and extreme cases, teaching ethics should also expand on challenges students and junior doctors commonly encounter themselves to promote ethical sensitivity and confidence in students. PMID:27990470

Case factors affecting hearing aid recommendations by hearing care professionals.

PubMed

Gioia, Carmine; Ben-Akiva, Moshe; Kirkegaard, Matilde; Jørgensen, Ole; Jensen, Kasper; Schum, Don

2015-03-01

Professional recommendations to patients concerning hearing instrument (HI) technology levels are not currently evidence-based. Pre-fitting parameters have not been proven to be the primary indicators for optimal patient outcome with different HI technology levels. This results in subjective decision-making as regards the technology level recommendation made by professionals. The objective of this study is to gain insight into the decision-making criteria utilized by professionals when recommending HI technology levels to hearing-impaired patients. A set of patient variables (and their respective levels) was identified by professionals as determinant for their recommendation of HIs. An experimental design was developed and 21 representative patient cases were generated. The design was based on a contrastive vignette technique according to which different types of vignettes (patient cases) were randomly presented to respondents in an online survey. Based on these patient cases, professionals were asked in the survey to make a treatment recommendation. The online survey was sent to approximately 3,500 professionals from the US, Germany, France, and Italy. The professionals were randomly selected from the databases of Oticon sales companies. The manufacturer sponsoring the survey remained anonymous and was only revealed after completing the survey, if requested by the respondent. The response rate was 20.5%. Data comprised of respondent descriptions and patient case recommendations that were collected from the online survey. A binary logit modeling approach was used to identify the variables that discriminate between the respondents' recommendations of HI technology levels. The results show that HI technology levels are recommended by professionals based on their perception of the patient's activity level in life, the level of HI usage for experienced users, their age, and their speech discrimination score. Surprisingly, the patient's lifestyle as perceived by the hearing care professional, followed by speech discrimination, were the strongest factors in explaining treatment recommendation. An active patient with poor speech discrimination had a 17% chance of being recommended the highest technology level HI. For a very active patient with good speech discrimination, the probability increases to 68%. The discrepancies in HI technology level recommendations are not justified by academic research or evidence of optimal patient outcome with a different HI technology level. The paradigm of lifestyle as the significant variable identified in this study is apparently deeply anchored in the mindset of the professional despite the lack of supporting evidence. These results call for a shift in the professional's technology level recommendation practice, from nonevidence-based to a proven practice that can maximize patient outcome. American Academy of Audiology.

Medical student abuse: perceptions and experience.

PubMed

Bourgeois, J A; Kay, J; Rudisill, J R; Bienenfeld, D; Gillig, P; Klykylo, W M; Markert, R J

1993-07-01

A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first- and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.

Training Requirements for Visualizing Time and Space at Company and Platoon Level

DTIC Science & Technology

2007-09-01

vignettes. Participants were given approximately 20 minutes to develop a concept of operations, using whiteboards or butcher paper as necessary (see Figure...was conducted based on workshops with active and retired military personnel (n = 50). The CTA used a representative scenario and supporting...throughout this research effort including design of the scenario and vignettes used in the workshops, participation in and facilitation of the workshops

Lack of racial and sex stereotypes in the prediction of completed suicide.

PubMed

Redd, Charlitta S; Lester, David

2013-12-01

A sample of 252 college students was presented with vignettes and asked to predict the likelihood that the protagonist in each vignette would complete suicide. The crisis confronting the protagonist significantly affected judgments of the likelihood of completed suicide, but neither the race nor the sex of the protagonist affected this judgment, suggesting that sex and racial stereotypes about who completes suicide may no longer exist.

Sports chronobiology consultation: from the lab to the arena.

PubMed

Postolache, Teodor T; Hung, Tsung-Min; Rosenthal, Richard N; Soriano, Joseph J; Montes, Fernando; Stiller, John W

2005-04-01

This final article, coauthored by a chronobiology consultant, a sports psychologist who applied a chronobiology-based program to an Olympic national team, a clinical neurologist, a performance data analyst, a training-conditioning coach from a major league baseball team who applied chronobiology principles to major league pitchers, and a substance abuse expert, discusses practical aspects of a sports chronobiology consultation, including the goals and current arsenal of available interventions. Short vignettes of actual cases are presented for edification, and references are made to appropriate reviews found elsewhere in this issue.

Ethics of birth at the limits of viability: the risky business of prediction.

PubMed

Shinwell, Eric S

2015-01-01

Infants born at the limits of viability present neonatologists in particular and society in general with difficult challenges. Ethical and legal considerations establish a framework for action, although this varies between countries, departments and individuals and shows dynamic changes over time. This brief review includes a vignette telling a familiar story. In this case, the parents ask searching questions and the caring, knowledgeable neonatologist uses up-to-date information to offer empathic and thoughtful guidance - a challenge for all. © 2015 S. Karger AG, Basel.

Impulsive behavior in a consumer culture.

PubMed

Hartston, Heidi J; Koran, Lorrin M

2002-01-01

Compulsive shopping behaviour has recently received long overdue attention as a clinical issue. Curiosity about this condition has led to questions about its identification, characterization as a disorder, and treatment. This article presents two case vignettes illustrating diagnostic criteria and points that distinguish this disorder from OCD hoarding or mania. These issues are discussed. The authors present some suggested treatment approaches Greater awareness of the prevalence and social consequences of compulsive shopping behaviour highlights the need for treatment and for educational resources for clinicians and the general public. (Int J Psych Clin Pract 2002; 6: 65-68).

Politically-motivated torture and child survivors.

PubMed

Green, Crystal

2007-01-01

It is critical that healthcare providers recognize behaviors common to children who have endured politically-motivated torture in order to create a safe and reliable treatment plan for such children and their families. Three vignettes taken from actual cases illustrate the way child survivors of torture are likely to present in educational, medical, or healthcare settings. Children or youth are resilient and can be helped to process their traumatic experiences and thrive emotionally and physically if providers are observant, competent and responsive. Federally funded resource centers exist to assist in caring for children who have survived torture.

Therapeutic Issues with Transgender Elders.

PubMed

Carroll, Lynne

2017-03-01

Research demonstrates that transgender and nonconforming (TGNC) elders face social isolation and discrimination in policies and practices in mental and health care settings. The purpose of this article is to provide clinicians with practical input about therapeutic issues and interventions for use with TGNC elders. A case vignette describes the challenges and rewards of therapy with an elder trans woman. Her story illustrates the complex interplay between age, life phase, and sociocultural and historical contexts. Recommendations regarding research, practice, and advocacy are offered. Copyright © 2016 Elsevier Inc. All rights reserved.

'Mastication rage': a review of misophonia - an under-recognised symptom of psychiatric relevance?

PubMed

Bruxner, George

2016-04-01

To explore the condition of misophonia, its definition, possible neurological correlates, its associated morbidity, its possible psychiatric relevance and potential treatment. Provision of an illustrative case vignette and a review of the limited literature. Misophonia is a symptom associated with obsessive-compulsive disorder and anxiety disorders and may be a syndrome in itself associated with significant distress and avoidance. Treatments are not well validated. Misophonia may be an under-recognised condition of psychiatric relevance. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Perceptions of Stepfathers: Disciplinary and Affectionate Behavior.

ERIC Educational Resources Information Center

Claxton-Oldfield, Stephen

1992-01-01

College students read vignettes and rated behavior of adult, identified as stepfather or father and depicted as spanking child (Study 1) or behaving affectionately toward child (Study 2). Findings revealed less positive perception of stepfathers, compared to fathers, carrying out disciplinary role in Study 1. In Study 2, affectionate stepfathers…

The Influence of Patient Identification and Narrative Transportation on Intentions to Participate in Cancer Research.

PubMed

Neil, Jordan M; Gough, Aisling; Kee, Frank; George, Thomas J; Pufahl, Jeffrey; Krieger, Janice L

2018-05-03

Cancer decision-making interventions commonly utilize narratives as a persuasive strategy to increase identification with the message source, promote involvement with the topic, and elicit greater willingness to adopt recommended behaviors. However, there is little empirical research examining the mechanisms underlying the effectiveness of this strategy in the context of cancer research participation. Data for the current manuscript were collected as part of a larger study conducted with cancer patients (N = 413) from the USA, UK, and the Republic of Ireland. Participants viewed and evaluated video-recorded vignettes, illustrating different strategies for discussing clinical trials participation with family members. Results showed nationality was a significant predictor of identification with the main character (i.e., patient) in the vignette. Unexpectedly, these cross-national differences in identification disappeared when patients currently undergoing treatment had higher perceived susceptibility of their cancer. Identification with the main character in the vignettes was a significant predictor of intentions to participate in cancer research, but only when the mediating role of narrative transportation was considered. The findings demonstrate the importance of considering how individual and social identities influence identification with characters in cancer narratives and yield practical guidance for developing arts-based interventions to increase cancer research participation.

Can attribution theory explain carers' propensity to help men with intellectual disabilities who display inappropriate sexual behaviour?

PubMed

Willner, P; Smith, M

2008-01-01

This study examined the responses of care managers and direct care staff to vignettes of inappropriate sexual behaviour by a man with an intellectual disability. The aim was to test the theory that helping behaviour is determined by emotional responses (positive and negative emotional reactions, and optimism), which in turn are determined by causal attributions (respectively: controllability and stability of the incident depicted in the vignette). The vignettes varied in response topography and the age of the victim. Regression analysis was used to examine the relationships between causal attributions, emotional responses, and willingness to invest extra time and effort in the service user's care. No support was found for the pathway: low controllability --> increased sympathy and/or decreased negative emotions --> increased helping. However, strong support was found for the pathway: low stability --> high optimism --> increased helping, particularly in direct care staff. High levels of sympathy were also associated with increased helping, the effect again being mediated by feelings of optimism. The data provide support for one (but not the other) strand of attribution theory as applied to inappropriate sexual behaviour. The discussion considers the discrepancy between the present data and the far less encouraging literature on attribution theory as applied to challenging behaviour.

Racial and mental illness stereotypes and discrimination: an identity-based analysis of the Virginia Tech and Columbine shootings.

PubMed

Chen, Charlene Y; Purdie-Vaughns, Valerie; Phelan, Jo C; Yu, Gary; Yang, Lawrence H

2015-04-01

The Virginia Tech and Columbine High shootings are 2 of the deadliest school massacres in the United States. The present study investigates in a nationally representative sample how White Americans' causal attributions of these shooting moderate their attitudes toward the shooter's race. White Americans shown a vignette based on the Virginia Tech shooting were more likely to espouse negative beliefs about Korean American men and distance themselves from this group the more they believed that the shooter's race caused the shooting. Among those who were shown a vignette based on the Columbine High shooting, believing that mental illness caused the shooting was associated with weaker negative beliefs about White American men. White Americans in a third condition who were given the Virginia Tech vignette and prompted to subtype the shooter according to his race were less likely to possess negative beliefs about Korean American men the more they believed that mental illness caused the shooting. There was no evidence for the ultimate attribution error. Theoretical accounts based on the stereotype and in-group-out-group bias literature are presented. The current findings have important implications for media depictions of minority group behavior and intergroup relations. (c) 2015 APA, all rights reserved).

Racial and Mental Illness Stereotypes and Discrimination: An Identity-Based Analysis of the Virginia Tech and Columbine Shootings

PubMed Central

Chen, Charlene Y.; Purdie-Vaughns, Valerie; Phelan, Jo C.; Yu, Gary; Yang, Lawrence H.

2015-01-01

The Virginia Tech and Columbine High shootings are 2 of the deadliest school massacres in the United States. The present study investigates in a nationally representative sample how White Americans’ causal attributions of these shooting moderate their attitudes toward the shooter’s race. White Americans shown a vignette based on the Virginia Tech shooting were more likely to espouse negative beliefs about Korean American men and distance themselves from this group the more they believed that the shooter’s race caused the shooting. Among those who were shown a vignette based on the Columbine High shooting, believing that mental illness caused the shooting was associated with weaker negative beliefs about White American men. White Americans in a third condition who were given the Virginia Tech vignette and prompted to subtype the shooter according to his race were less likely to possess negative beliefs about Korean American men the more they believed that mental illness caused the shooting. There was no evidence for the ultimate attribution error. Theoretical accounts based on the stereotype and in-group-out-group bias literature are presented. The current findings have important implications for media depictions of minority group behavior and intergroup relations. PMID:25198415