We evaluated a noncontingent reinforcement procedure that involved initially providing three subjects with signaled, continuous access to the functional reinforcer for aggression and slowly ...increasing the amount of time subjects were exposed to the signaled unavailability of the reinforcer. Additionally, alternative potential reinforcers were available throughout the sessions. Results showed immediate and substantial reductions in aggression for all three subjects. The clinical utility of this intervention is discussed, and future research directions are recommended.
This study documents prevalence of positive depression screens at the first prenatal visit in an urban, low-income, and primarily Black population as part of initiatives to strengthen mental health ...services in a region with high rates of race disparities in infant and maternal mortality. We conducted a cross-sectional chart review of 500 patients, collecting demographics, medical histories, and scores of the Edinburgh Postnatal Depression Scale (EPDS), the instrument recommended for use during pregnancy by national United States organizations. Of those with a completed EPDS (n=414), 32% screened positive (n=131). These women were more likely to have smoked (p=.02), used illicit drugs (p=.01), or had depression (p<.0001), anxiety (p=.0004), bipolar disorder (p=.02), or postpartum depression for the subgroup with prior pregnancies (p<.0001). A high percentage of patients had positive EPDS screens, highlighting the need for better integration of mental health services into prenatal care for vulnerable populations.
Momentary time sampling has been used to evaluate quality of care in several settings, including residential facilities and nursing homes. Given the growing number of behavior analysts providing ...center‐based applied behavior analysis (ABA) therapy to children with autism spectrum disorders, ABA centers are a new area in which assessing environmental indicators that might be correlated with the quality of care could be very important. Therefore, we extended these procedures to an ABA center, where we used momentary time sampling to assess staff behavior, client behavior, client condition, and environmental condition. The results demonstrated that this descriptive assessment can be a useful tool to obtain direct measures of variables that might affect quality of care. The general utility of this assessment, intervention plans for targets identified by this assessment, limitations of the assessment, and directions for future research in this area are discussed.
The role of parent factors, such as distress and protective behaviors, on pain and functional outcomes of emerging adults living with chronic pain has been largely unexplored. The effects of ...helicopter parenting and developmental changes occurring during this transition period between adolescence and adulthood (commonly defined as the ages between 18 and 30 years) may exacerbate the pain experience and have the potential to influence chronic pain management. Clinical practice, with an additional focus on supporting the parent(s), may aid in meeting the needs of this population. In this paper, we review the available literature on (a) the socio‐cultural shift in parenting over the past decade with a focus on helicopter parenting; (b) the impact of this parenting style on the pain experience and outcomes of emerging adults living with chronic pain; (c) provide recommendations for chronic pain management with a focus on the parent‐emerging adult dyad; and (d) conclude with future research recommendations. This narrative review is the first to consider the impacts and outcomes of helicopter parenting on emerging adults with chronic pain.
This review describes the Emerging Adulthood developmental stage and evaluates available literature on the socio‐cultural shift in parenting over the past decade with a focus on helicopter parenting, and the impact of this parenting style on the pain experience and outcomes of emerging adults living with chronic pain. We also provide recommendations for chronic pain management for emerging adults with a focus on the parent‐child dyad.
Children and adolescents frequently experience chronic pain that can disrupt their usual activities and lead to poor physical and emotional functioning. The fear avoidance model of pain with an ...emphasis on the maladaptive behaviors that lead to activity avoidance has guided research and clinical practice. However, this model does not take into consideration variability in responses to pain, in particular the active pursuit of goals despite pain. This review aims to introduce a novel conceptualization of children's activity engagement versus avoidance using the framework of goal pursuit. We propose a new model of Goal Pursuit in Pediatric Chronic Pain, which proposes that the child's experience of pain is modified by child factors (e.g., goal salience, motivation/energy, pain-related anxiety/fear, and self-efficacy) and parent factors (e.g., parent expectations for pain, protectiveness behaviors, and parent anxiety), which lead to specific goal pursuit behaviors. Goal pursuit is framed as engagement or avoidance of valued goals when in pain. Next, we recommend that research in youth with chronic pain should be reframed to account for the pursuit of valued goals within the context of pain and suggest directions for future research.
The randomised controlled trial is the foundation of clinical research; yet there is concern that many trials have flaws in design, conduct, and reporting that undermine trustworthiness. Common flaws ...in trials include high risk of bias, small size, outcomes irrelevant to clinical care and patient's experience, and inability to detect efficacy even if present. These flaws carry forward into systematic reviews, which can confer the label of ‘high-quality evidence’ on inadequate data. Trials can be futile because their flaws mean that they cannot deliver any meaningful result in that different results in a small number of patients would be sufficient to change conclusions. Some trials have been discovered to be fabricated, the number of which is growing. The fields of anaesthesia and pain have more fabricated trials than other clinical fields, possibly because of increased vigilance. This narrative review examines these themes in depth whilst acknowledging an inescapable conclusion: that much of our clinical evidence is in trouble, and special measures are needed to bolster quality and confidence.
Aims
The main aim of the wellbeing day was to increase the sense of wellbeing amongst psychiatry higher trainees in the West Midlands. We first wanted to understand the wellbeing needs of the ...trainees and what they hoped to get out of an away day. We wanted then to evaluate whether the away day had met these needs.
Background
The Psychiatry Trainees Committee (PTC) published a report ‘Supported and Valued? A trainee led review into morale and training within psychiatry’ in 2017. The importance of feeling valued and supported and the value trainees place upon the support of their peers, were highlighted in this report.
As higher trainees we are often geographically isolated from each other, and whilst the peer group meet once per month, this is mostly for academic lectures resulting in poor familiarity amongst trainees which can leave trainees feeling unknown and unsupported.
Method
We decided to apply to HEE for funding for an away day. We surveyed the peer group, asking what they most wanted to get out of an away day. The results showed that ‘a morale boost’, ‘destress/relaxation’ and ‘opportunity to get to know other trainees’ were the trainee's priorities, followed by improving leadership, team working and negotiation skills.
With these priorities in mind, an away day programme was developed which included a talk from Dr Mike Blaber, a palliative care doctor with a special interest in doctors’ wellbeing, a ‘getting to know you’ art activity and a team building GPS treasure hunt funded by HEE. The day finished with a dinner in a local restaurant sponsored by Recordati. The rest of the day was paid for by the peer group.
Result
28 higher trainees attended the away day which was held in Birmingham on 11/07/2019. Trainees gave feedback on the day using an online anonymous survey. 81% of attendees said the away day decreased their stress levels. 90% said that the day had increased their sense of wellbeing. 86% felt an increased sense of belonging and less isolated as a trainee.
Conclusion
Regular trainee away days may help tackle isolation and increase morale which is linked to better patient outcomes. Improving trainees’ sense of wellbeing leads to better job satisfaction, which may ultimately lead to higher rates of retention within psychiatry.
Zusammenfassung
Die Frage, wie sich ein Neuauftreten von Schmerz, dessen Fortbestehen oder Verschlimmerung vermeiden lässt, ist ein Schwerpunkt der klinischen Schmerzforschung. Schmerzprävention kann ...klar in einen primären, sekundären und tertiären Bereich untergliedert werden. Primärprävention bedeutet die Vermeidung von Verletzung oder Schmerz, während die Sekundärprävention auf die Linderung eines unvermeidlichen Schmerzes zielt. Zuletzt beschreibt Tertiärprävention eine Vermeidung oder Reduktion bestehender negativer Folgen von chronischem Schmerz, beispielsweise einer starken Funktionseinschränkung oder psychischen Belastung. Jeder der drei Präventionsbereiche ist mit anderen Herausforderungen verbunden, wobei jeweils spezifische psychologische Faktoren eine Rolle spielen. In diesem kurzen Übersichtsbeitrag werden psychologische Faktoren mit Bedeutung in der Primär‑, Sekundär- und Tertiärprävention beleuchtet. Die Arbeit bietet einen orientierenden Überblick über den Themenbereich. Es werden zwei Fallstudien vorgestellt, eine zur Sekundärprävention bei Kindern und Jugendlichen, eine zur Tertiärprävention bei Erwachsenen mit chronischem Schmerz. Zuletzt formulieren wir einen Leitfaden, um die Forschung in diesem Bereich voranzubringen. Dabei werden drei Aspekte hervorgehoben: die Relevanz einer klaren theoretischen Ausrichtung; die Identifikation von Risikofaktoren für Personen mit höchstem Risiko der Schmerzentwicklung und die Bedeutsamkeit der Therapie.
How to prevent the onset, maintenance, or exacerbation of pain is a major focus of clinical pain science. Pain prevention can be distinctly organised into primary, secondary, and tertiary prevention. ...Primary prevention describes avoiding hurt or pain, secondary prevention describes reducing pain when pain is unavoidable, and tertiary prevention describes preventing or reducing ongoing negative consequences such as high functional disability or distress due to chronic pain. Each poses separate challenges where unique psychological factors will play a role. In this short review article, we highlight psychological factors important to primary, secondary, and tertiary prevention and provide direction for the field. We present 2 case studies on secondary prevention in children and adolescents and tertiary prevention in adults with chronic pain. Finally, we provide research directions for progression in this field, highlighting the importance of clear theoretical direction, the identification of risk factors for those most likely to develop pain, and the importance of treatment.
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