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PubMed2005

Counselling quality in community pharmacies: implementation of the pseudo customer methodology in Germany.

OBJECTIVES: To investigate a new method for evaluating counselling performance of staff in community pharmacies and to assess the quality of patient counselling. METHOD: Trained pseudo customers, instructed to play their role according to two different self-medication scenarios, visited voluntarily participating community pharmacies in Berlin. After documenting the counselling process, immediately after each visit, outside the pharmacy on an assessment form, the pseudo customer re-entered the pharmacy and gave detailed performance feedback to the counsellor and the pharmacist in charge in order to provide support for improving counselling skills and practice behaviour, when appropriate. This was followed with a written summary of the general performance of all participating pharmacies and additional individual feedback and suggestions for improvement. Educational needs were identified for subsequent performance-based educational strategies such as group-workshops, team-training and on-site team-coaching. RESULTS: Forty-nine community pharmacies in Berlin volunteered to participate in this pilot study. Ninety-eight per cent of the participating pharmacies offered advice. However, in 36% of the cases, advice was only given on request. The different types of scenarios--presentation of a symptom or request for a specific product--made a great difference to the spontaneity of questions and advice. At least one question to check on accuracy of self-diagnosis was asked in 95% of the cases of symptom presentation but in only 47% of the cases of specific product request. Information on appropriate self-medication was provided on at least one item in 74% of pseudo customer visits, but most of the time the information was not sufficient. Communication skills (nonverbal elements, comprehensibility etc.) were very good or good in 54% of the visits. Potential for improvement was mainly in relation to the use of open-ended questions to gain more information and on counselling about appropriate self-medication. Direct feedback was given in 96% of the pharmacies (one person refused to accept feedback and one feedback had to be postponed because of time shortage). All of the participants regarded counselling as an important subject in pharmacy practice. CONCLUSION: The pseudo customer method was successfully used in this study of German community pharmacies. It was shown that pseudo customer visits and performance feedback following the counselling process, were feasible in daily practice and well accepted by the participants. A training program, focussing on areas in most need of improvement, has been developed. The promising results have led to the Federal Chamber of Pharmacists in Germany adopting this method as part of a continuous quality improvement program in community pharmacies.

Community Pharmacy Services↗
PubMed1990

Session-intersession sequences in the treatment of chronic anorexic-bulimic patients: following the model of "family games".

In this article, the author presents some technical aspects of a psychotherapeutic approach for treating chronic anorectic patients. Two basic principles underlie the approach. First, the main purpose of the treatment is to improve the patient's relational skills in order to enable her to cope with her family's "game". Second, the therapeutic relationship is considered hierarchically subordinate to her relationships outside the therapeutic context. Mastering the model of families with anorectics is essential if the therapist is to be consistent with these principles. Specialized training in verbal and nonverbal communication is considered a useful tool.

Adaptation, Psychological↗
PubMed2001

Do we really understand? An experiential exercise for training family therapists.

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing process.

Adult↗
PubMed1996

Health enhancement and companion animal ownership.

The relationship between people and companion animals, on the one hand, explains the bites and zoonotic diseases that occur among those with companion animals and, on the other hand, appears to enhance the psychological and physiological well-being of many people. Presently, no less than 56% of households in the United States have animals, typical of developed countries around the world. It is well documented that people denied human contact do not thrive well. All indications are that companion animals play the role of a family member, often a member with the most desired attributes. Animals play special roles for children, aiding the teaching of nurturing behavior and appreciation of nonverbal communication. Ordinary interactions with animals can reduce blood pressure and alter survival after a heart attack. For some, pets increase the opportunities to meet people, while for others pets permit them to be alone without being lonely.

Family↗
PubMed1976

Principles of the new sex therapy.

The authors review the development of their rapid treatment dual-sex therapy for sexual dysfunction. The basic tenets of the new sex therapy include 1) sound knowledge of physiology, endocrinology, and metabolic function, 2) institution of psychotherapy only when organic factors have been identified or ruled out, 3) treatment of the couple as a unit by dual-sex therapy teams, 4) a short-term intensive program, and 5) education in techniques of verbal and nonverbal communication. Since its inception in 1958, the new therapy has been adopted, modified, and examined by clinicians and researchers all over the world. The authors suggest that professionals interested in effective treatment for sexual dysfunction should improve techniques, train personnel, and encourage sound research.

Communication↗
PubMed2003

Analysis and psychotherapy by telephone: twenty years of clinical experience.

Psychoanalysis via telephone is becoming increasingly prevalent while remaining an area of comparatively little study. The author's early telephone treatment of a series of patients living some distance away or engaged in business travel, and his subsequent telephone treatment of nine analytic and five psychotherapy patients following his own geographic move, are discussed in detail. The mechanics of beginning and carrying out such treatment are examined. The theoretical implications of the shift to the telephone and the ambivalence with which it is often met by clinicians are also explored. The role of nonverbal communication in both in-person and telephone analysis is considered, as is the concept of the analytic office as a literal space and a psychological container. Suggestions for future research are advanced.

History, 20th Century↗
PubMed1993

Multivariate predictors of audiological success with multichannel cochlear implants.

To predict the audiological outcomes of 2 multichannel cochlear implants, a preoperative battery of historical, audiological, electrophysiologic, and psychologic variables from 48 postlingually deafened adults was tested in a prospective randomized clinical trial. Multivariate analyses were used to select and combine these preoperative variables in a predictive index that was significantly related to audiological outcome at 9 months. The preoperative variables included in the predictive index were duration of profound deafness, speech reading ability, residual hearing, cognitive ability, measures of compliance and engagement with treatment, and use of nonverbal communication strategies. The preoperative predictive index had correlations of .81 with the Iowa Sentences Test, and .78 with the NU-6 word understanding scores, both obtained in a sound-only test. Probability and percentile curves generated from these data offer considerable optimism in forecasting the range of likely audiological outcomes that would be realized by postlingually deafened adult candidates for multichannel cochlear implants.

Adult↗
PubMedDate not supplied

Screening a skilled nursing home population for depression.

The population resident in the skilled nursing home of a Veterans Administration Hospital on the 27th of June 1988 was screened for the presence of depression. Only 74% of the patients (59 of 80) were able to complete most of the screening battery: the Folstein Mini-Mental State Examination, the 15-item Geriatric Depression Scale, and the Hamilton Depression Scale. Thirty-four percent of the sample (20 of 59) met the criteria for a DSM-III-R psychiatric diagnosis; 22% (13 patients) had a major depressive disorder, and 12% (seven patients) had an adjustment disorder with depressed mood. The 15-item version of the Geriatric Depression Scale was more effective than the Hamilton Depression Scale as a screening instrument in this population of frail elderly veterans who had multiple and severe medical problems (end-stage cardiac disease, progressive myasthenia gravis, terminal pulmonary disease, and multiple cerebrovascular accidents) that limited verbal and nonverbal communication, as well as physical endurance.

Adult↗
PubMed2005

Bases for assessments made by telephone advice nurses.

Telephone advice nursing includes triage, advice, referral, information and coordination. The aim of the study was to explore what telephone nurses base their assessments on. We conducted 14 interviews with seven telephone nurses at a health-care call centre in Sweden. Two authentic calls per nurse were used in stimulated recall interviews, where the nurses commented on the basis for their assessments. A qualitative manifest content analysis was employed. Three major categories emerged in the analysis: care-seeker, e.g. 'symptomatic sounds'; nurse, e.g. 'nurse's own experience'; and organization, e.g. 'health-care accessibility'. The findings show that the telephone advice nurses' bases for assessments appear to be very broad. They include both verbally and nonverbally communicated information, and care-seeker-, nurse- and certain organization-related factors influence the assessments. We found that an individualistic view of the care-seeker seems to dominate the assessments in non-urgent calls to a health-care call centre.

Communication↗
PubMed2006

The immune response in autism: a new frontier for autism research.

Autism spectrum disorders (ASD) are part of a broad spectrum of neurodevelopmental disorders known as pervasive developmental disorders, which occur in childhood. They are characterized by impairments in social interaction, verbal and nonverbal communication and the presence of restricted and repetitive stereotyped behaviors. At the present time, the etiology of ASD is largely unknown, but genetic, environmental, immunological, and neurological factors are thought to play a role in the development of ASD. Recently, increasing research has focused on the connections between the immune system and the nervous system, including its possible role in the development of ASD. These neuroimmune interactions begin early during embryogenesis and persist throughout an individual's lifetime, with successful neurodevelopment contingent upon a normal balanced immune response. Immune aberrations consistent with a dysregulated immune response, which so far, have been reported in autistic children, include abnormal or skewed T helper cell type 1 (T(H)1)/T(H)2 cytokine profiles, decreased lymphocyte numbers, decreased T cell mitogen response, and the imbalance of serum immunoglobulin levels. In addition, autism has been linked with autoimmunity and an association with immune-based genes including human leukocyte antigen (HLA)-DRB1 and complement C4 alleles described. There is potential that such aberrant immune activity during vulnerable and critical periods of neurodevelopment could participate in the generation of neurological dysfunction characteristic of ASD. This review will examine the status of the research linking the immune response with ASD.

Animals↗
PubMed1998

[Vocalization response used for evaluation of pain-related behavior in guinea pigs].

In general, pain has been defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage", and hence pain is a subjective and emotional experience for each individual. For this reason, it is difficult to study pain in nonverbal animals. However, painful stimuli (noxious stimuli) can cause both a simple and an overt emotional behavior such as self-defense reaction and vocalization in animals. Therefore, we are able to measure these behaviors as nonverbal communication of pain. The vocalization responses is the natural nociceptive reaction of conscious animals and prelingual children. In the present overview, we described the methodology for objective assessment of guinea pig's vocalization response to arterial algogenics and its characteristics.

Animals↗
PubMed2006

Validity of the autism diagnostic interview-revised.

The factor structure, internal consistency, and convergent validity of the Autism Diagnostic Interview-Revised (ADI-R) algorithm items were examined in a sample of 226 youngsters with pervasive developmental disabilities. Exploratory factor analyses indicated a three-factor solution closely resembling the original algorithm and explaining 38% of the variance, with one significant discrepancy: Unlike the algorithm, all nonverbal communication items were associated with the Social factor. Internal consistencies of domain scores ranged from .54 to .84. Correlations between ADI-R domain and total scores and instruments assessing adaptive behavior, psychopathology, and autism were examined. They indicated some similarities between constructs, but also that the ADI-R measures autism in a unique fashion.

Adolescent↗
PubMed2003

Bonding in group: the therapist's contribution.

Bonding is an ongoing aspect of intersubjective experience, a type of mental relationship to oneself and others. As a behavioral mode, bonding utilizes verbal and nonverbal communication primarily to establish a basic feeling of connection between individuals. Bonding is the floor, a cognitive-affective state that precedes and prepares the way for the complex processes underlying identification. The concept relates to Bion's early theory of basic assumptions, and takes on new and different meanings according to his later ideas regarding social communication. Bonding is also a therapeutic posture or technique, an element in the establishment of group cohesion, the positive transference, and therapeutic and group alliance. Case examples illustrate how the therapist and other group members bring a complex of bonding needs and anxieties that must be negotiated to establish and maintain bonding, which is a necessary condition for successful therapeutic work.

Adult↗
PubMed2004

The amygdala is enlarged in children but not adolescents with autism; the hippocampus is enlarged at all ages.

Autism is a neurodevelopmental disorder characterized by impairments in reciprocal social interaction, deficits in verbal and nonverbal communication, and a restricted repertoire of activities or interests. We performed a magnetic resonance imaging study to better define the neuropathology of autistic spectrum disorders. Here we report findings on the amygdala and the hippocampal formation. Borders of the amygdala, hippocampus, and cerebrum were defined, and their volumes were measured in male children (7.5-18.5 years of age) in four diagnostic groups: autism with mental retardation, autism without mental retardation, Asperger syndrome, and age-matched typically developing controls. Although there were no differences between groups in terms of total cerebral volume, children with autism (7.5-12.5 years of age) had larger right and left amygdala volumes than control children. There were no differences in amygdala volume between the adolescent groups (12.75-18.5 years of age). Interestingly, the amygdala in typically developing children increases substantially in volume from 7.5 to 18.5 years of age. Thus, the amygdala in children with autism is initially larger, but does not undergo the age-related increase observed in typically developing children. Children with autism, with and without mental retardation, also had a larger right hippocampal volume than typically developing controls, even after controlling for total cerebral volume. Children with autism but without mental retardation also had a larger left hippocampal volume relative to controls. These cross-sectional findings indicate an abnormal program of early amygdala development in autism and an abnormal pattern of hippocampal development that persists through adolescence. The cause of amygdala and hippocampal abnormalities in autism is currently unknown.

Adolescent↗
PubMed2006

The attitude of parents toward behavior management techniques in pediatric dentistry.

PURPOSE: Investigate the parental attitude toward behavior management techniques used in pediatric dentistry. METHODS AND MATERIALS: Parents watched a videotape that showed these techniques and then filled a questionnaire. RESULTS: Tell-Show-Do, Positive Reinforcement, and Distraction were highly approved. Voice Control, Parent Separation, and Nonverbal Communication were moderately approved. The Hand-Over-Mouth, Nitrous Oxide Sedation, Conscious Sedation, and General Anesthesia were least approved. CONCLUSION: The general parental attitudes were positive regarding the behavioral management techniques.

Attitude↗
PubMed2004

Pharmacotherapy of pervasive developmental disorders in children and adolescents.

Pervasive developmental disorders (PDDs) are severe psychiatric disorders characterised by impaired social interaction, reduced verbal and nonverbal communication, and restricted and stereotyped patterns of interest and behaviour, with onset in the first 3 years of life. As part of a multimodal approach that includes educational and behavioural interventions, appropriate use of pharmacotherapy in patients with PDDs can improve some symptoms and behaviours and increase the patient's response to nonpharmacological interventions. Pharmacotherapy is aimed at stabilising the dysregulated systems that are thought to underlie the abnormal behaviours, namely the serotonergic and dopaminergic systems.This paper critically reviews the available literature on the pharmacotherapy of PDDs in children and adolescents. Pharmacological, efficacy and safety data on drugs acting on serotonin (serotonergic agents such as clomipramine, fluoxetine, paroxetine, sertraline, citalopram and fluvoxamine), on both serotonin and norepinephrine (venlafaxine and mirtazapine), dopamine (dopamine-blocking antipsychotics such as haloperidol and pimozide), and on both serotonin and dopamine (atypical antipsychotics such as clozapine, risperidone, olanzapine, quetiapine and ziprasidone) are presented. The paper concludes with a brief discussion of other psychotropic medications, such as the opioid antagonists, alpha-adrenoceptor agonists (clonidine and guanfacine), psychostimulants, mood stabilisers, glutamatergic compounds (lamotrigine, amantadine), buspirone, and secretin. Available evidence suggests that atypical antipsychotics (mainly risperidone and olanzapine) are particularly indicated when more serious behavioural symptoms, such as aggression, self-injurious behaviours and hyperactivity, are prominent. Serotonergic agents may be effective in children with repetitive phenomena or affective symptoms. Social relatedness is more frequently refractory to both atypical antipsychotics and serotonergic agents. Further research into the drug treatment of PDDs, including placebo-controlled trials and long-term, naturalistic follow-up studies of large samples of patients of different age ranges, is warranted.

Adolescent↗