Food selectivity, characterized by food refusal, limited food repertoire, or preference for certain types of foods, is common among children with ASD.
In this study, researchers examined the effects ...of a response shaping procedure using a large rotating food set and a small constant food set on food acceptance for two boys with ASD. The small set consisted of three foods that were presented during every session; the large set consisted of 15 foods, of which three were presented during each session, in randomly ordered sets. Researchers measured the percentage of correct behaviors and the cumulative number of foods with which participants interacted. Two concurrently operating multiple baseline across behaviors designs were used to assess whether the shaping procedure resulted in increased correct responding compared to baseline conditions, and whether the intervention was differentially effective with large versus small food sets.
The procedures were similar in efficiency for one participant, although he ate many more foods in the large set condition. For the other participant, shaping was successful at increasing some acceptance behaviors (e.g., putting food in his mouth) but only the small set resulted in eating a new food.
Practitioners should consider use of less restrictive or intrusive interventions to promote food acceptance and the use of larger sets of foods, modified to include fewer foods in the case of poor response to intervention.
Data integration, the processes by which data are aggregated, combined, and made available for use, has been key to the development and growth of many technological solutions. In health care, we are ...experiencing a revolution in the use of sensors to collect data on patient behaviors and experiences. Yet, the potential of this data to transform health outcomes is being held back. Deficits in standards, lexicons, data rights, permissioning, and security have been well documented, less so the cultural adoption of sensor data integration as a priority for large-scale deployment and impact on patient lives. The use and reuse of trustworthy data to make better and faster decisions across drug development and care delivery will require an understanding of all stakeholder needs and best practices to ensure these needs are met. The Digital Medicine Society is launching a new multistakeholder Sensor Data Integration Tour of Duty to address these challenges and more, providing a clear direction on how sensor data can fulfill its potential to enhance patient lives.
Comparison studies conducted to determine which instructional interventions are most efficient for teaching discrete behaviors to individuals with disabilities are potentially valuable, although some ...threats to internal validity may be more likely in these studies. Studies included in this review typically met common internal validity standards, such as reliability measurement, but often did not include controls specific to comparison designs. Comparisons often included young children with autism and were frequently conducted by researchers in self-contained classroom settings. Systematic instruction was effective in nearly all comparisons, although many included undifferentiated data (i.e., both interventions were equally effective), and within-participant replications were often inconsistent (i.e., outcomes varied across comparisons for a single participant). Results suggest implementers should conduct high-fidelity instruction with corrective and instructive feedback and should choose intervention variations based on participant preference. We recommend researchers include control sets or time-lagged introductions, counterbalance behavior sets, and measure differential acquisition over time.
Background Explicit criteria for judging medication safety and use issues in patients with chronic kidney disease (CKD) are lacking. Study Design Quality improvement report. Setting & Participants ...Nephrologists (n = 4), primary care physicians (n = 2), hospital pharmacists with expertise in nephrology (n = 4), and community pharmacists (n = 2). The PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria were applied retrospectively to 90 patients with CKD in a randomized study. Quality Improvement Plan Development of an explicit set of criteria to enable rapid and systematic detection of drug-related problems (DRPs). Using a RAND method, experts judged the clinical significance of DRPs and the appropriateness of a community pharmacist intervention. The PAIR criteria include 50 DRPs grouped into 6 categories. Outcomes DRPs detected using the PAIR criteria compared with implicit clinical judgment by nephrology pharmacists. Measurements Prevalence of DRPs and reliability, validity, and responsiveness of the PAIR criteria. Results A mean of 2.5 DRPs/patient (95% CI, 2.0-3.1) was identified based on the PAIR criteria compared with 3.9 DRPs/patient (95% CI, 3.4-4.5) based on clinical judgment of nephrology pharmacists. Inter-rater reliability coefficients (κ) by PAIR category varied from 0.80-1.00, with an intraclass correlation coefficient (ICC) of 0.93 (95% CI, 0.89-0.95) for total DRPs per patient. Test-retest reliability coefficients by category varied from 0.74-1.00, with an ICC of 0.91 (95% CI, 0.82-0.96) for total DRPs per patient. During the study, the mean number of DRPs per patient did not change significantly when assessed using the PAIR criteria and clinical judgment. Limitation The prevalence of PAIR DRPs may be underestimated due to the retrospective nature of the validation. Conclusion The prevalence of DRPs requiring the intervention of community pharmacists is high in patients with CKD. The PAIR criteria are reliable, but their responsiveness remains to be shown.
Purpose
– The purpose of this paper is to discuss whether artists create research outcomes in a revolving (or spiraling) process? This can be a catch-22 where their work is responding to and ...forecasting change, while the artist’s voice is often seen as too qualitative to provide research impact for university societies or to be compared with the quantitative data that scientists use.
Design/methodology/approach
– Where will research methods, qualitative and quantitative overlap? The author knows that both methods are important for ongoing observations about creative arts practice. The qualitative is part of Holmes’ (2011/2012) query about how “knowledge involved in artistic thinking should … include the issue of how mental images are given creative form, but this is a process that remains obscure in current art research” (p. 2).
Findings
– For Holmes, “the knowledge product of art research cannot be considered separate from the researcher’s psychic processes; and the currently obscure relationship between artistic production and subjectivity might lead to one of the unique contributions to be made by art research” (Holmes, 2011/2012, p. 2). Holmes’ suggestion provides a strategic link to the way arts and sciences might overlap. “How do artists and scientists find a way to match issues, ideas and theories?” This may be especially so in relation to the integral use of image to empower a message.
Originality/value
– This paper offers an original look at how artists empower with image.
Background Use of over-the-counter medications and natural products may be associated with drug-related problems among patients with chronic renal insufficiency. The aim of this study is to describe ...the use of nonprescription medications in patients attending a predialysis clinic and identify drug-related problems associated with the use of these products. Methods In a 6-month cluster randomized controlled trial, patients with moderate (n = 46) and severe (n = 41) chronic renal insufficiency were interviewed over the telephone at baseline by a community pharmacist to document their use of over-the-counter medications and natural products. The safety of each product was assessed, and drug-related problems were identified independently by 2 pharmacists. Results Overall, 83% (95% confidence interval CI, 72 to 94) of patients with moderate chronic renal insufficiency and 68% (95% CI, 54 to 83) with severe chronic renal insufficiency reported using at least 1 over-the-counter medication. Contraindicated over-the-counter medications were reported by 9% of patients. Natural products were used by 22% (95% CI, 10 to 34) and 29% (95% CI, 15 to 43) of patients with moderate and severe chronic renal insufficiency, respectively. Similarly, 3% of patients reported using at least 1 contraindicated natural product. Patients had consulted a health professional for 49% of over-the-counter medications and 19% of natural products. Overall, 65 drug-related problems were identified. Conclusion The use of over-the-counter medications and natural products is highly prevalent in patients with chronic renal insufficiency and often is associated with a drug-related problem. These results emphasize the importance for community pharmacists to closely monitor the use of these products in patients with chronic renal insufficiency.
Introduction:
Chronic kidney disease (CKD) patients are multimorbid elderly at high risk of drug‐related problems. A Web‐based training program was developed based on a list of significant ...drug‐related problems in CKD patients requiring a pharmaceutical intervention. The objectives were to evaluate the impact of the program on community pharmacists' knowledge and skills and their satisfaction with the training.
Methods:
Pharmacists were randomized to the training program or the control group. Training comprised a 60‐minute Web‐based interactive session supported by a clinical guide. Pharmacists completed a questionnaire on knowledge (10 multiple‐choice questions) and skills (2 clinical vignettes) at baseline and a second time within 1 month. Trained pharmacists completed a written satisfaction questionnaire. Semidirected telephone interviews were conducted with 8 trained pharmacists. Changes in knowledge and skills scores were compared between the groups.
Results:
Seventy pharmacists (training: 52; control: 18) were recruited; the majority were women with <15 years' experience. Compared with the control group, an adjusted incremental increase in the knowledge score (22%; 95% confidence interval CI: 16%–27%) and skills score (24%; 95% CI: 16%–33%) was observed in the training group. Most pharmacists (87%–100%) rated each aspect of the program “excellent'' or “very good.” Additional training and adding a discussion forum were suggested to complement the program.
Discussion:
Pharmacists like the Web‐based continuing education program. Over a short time span, the program improved their knowledge and skills. Its impact on their clinical practices and quality of medication use in CKD patients remains to be assessed.
Drug-related problems (DRPs) are prevalent among chronic kidney disease (CKD) patients. However, little is known about their severity and management by community pharmacists.
To (a) describe the ...prevalence of DRPs by severity level in CKD patients and (b) assess the effect of a training-and-communication network program in nephrology (ProFiL) on these DRPs.
This is a secondary analysis of a cluster randomized controlled trial evaluating the effect of the ProFiL-program. In 6 CKD clinics, patients at CKD stage 3 or 4 and their community pharmacists were recruited and assigned to the ProFiL group or a usual care (UC) group. Using validated criteria, 2 pharmacists identified DRPs and assessed their severity at baseline and after 12 months. The mean annual change in the number of DRPs per patient by severity level was assessed using a 2-level multivariable linear mixed-effects model.
A total of 494 pharmacists and 442 patients participated. At baseline, the prevalence (mean number of DRPs per patient SD) of mild DRPs (e.g., requiring dosage adjustment) and moderate DRPs (e.g., drug adherence requiring a monitoring plan) were 0.55 (0.98) and 1.04 (1.51), respectively. After 12 months, an unadjusted incremental annual reduction of 0.34 moderate DRPs (95% CI = -0.66 to -0.01) was observed in the ProFiL group compared with the UC group. After adjustment, no between-group differences were observed.
Among patients followed in CKD clinics, most DRPs have a moderate severity requiring specific monitoring by pharmacists. The benefit of continuing education programs, such as ProFiL, to reduce moderate DRPs remains to be determined.
This study was supported by the Canadian Institutes of Health Research (grant number: MOP-230207). Part of the study was also funded by Pfizer Canada, Leo Pharma, and Amgen. The authors declare that they have no relevant financial interests. Study concept and design were contributed by Quintana-Bárcena, Lord, and Lalonde. Quintana-Bárcena, Lord, and Lizotte were responsible for the data analysis, and Quintana-Bárcena and Berbiche performed the statistical analysis. The manuscript was written by Quintana-Bárcena and Lalonde and revised by Quintana-Bárcena and Lalonde, along with the other authors.
Professor Paul Carter's statement, In the present research environment practice-based research represents a concerted attack on the institutionalized separation of the heuristic disciplines (the ...Sciences, broadly) from the hermeneutical ones (broadly, the Humanities) is significant. It provides some ground to search for and identify the creation of image in visual arts as an empowering process. He identifies this as an aspect of issue-based art. The 'concerted attack' on institutionalized separation also presents a context to look at the work by many art researchers who choose their topics and methods of research to work across the qualitative and quantitative research models. The qualitative model in Carter's proposal refers to 'a double movement' where creative people can break things down and put them back together or reconfigure things. This involves a conceptual approach as much as a practical process. Carter discussed how ambiguity in art and the ability to recognize this in the creative process is a strength of the arts.
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