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PubMedDate not supplied

An ovarian cancer support group.

PURPOSE: Because of the low rate of cure and high rate of relapse, the disease course of ovarian cancer can be emotionally devastating. Using psychological interventions to support patients emotionally and to enhance their quality of life should therefore be considered an important complement to medical care. OVERVIEW: The authors describe a support group for patients with ovarian cancer, which was conducted over a 2-year period. The group consisted of patients with poor prognoses whose experience ranged from initial medical treatment, remission, and relapse to the dying experience. Key themes that arose during the sessions are identified, and differences between psychotherapy groups and support groups are highlighted. In contrast to psychotherapy groups, existential issues stood out as the most important therapeutic factor in this support group. CLINICAL IMPLICATIONS: Because it is widely acknowledged that support groups have unique value in the total care of women with ovarian cancer, this description of issues related to group process hopefully will assist others who may plan to offer this type of psychological intervention for patients. With increasing technology and the resulting extension of life for patients with ovarian cancer, support groups like this may become an important aspect of care to enhance quality of life. The multidisciplinary team, including psychiatry, social work, nursing, and chaplaincy, is essential in expanding support groups in healthcare settings.

Female↗
PubMed2006

The microgenesis of global perception in autism.

Several studies have reported that individuals with autism and Asperger's syndrome show a local processing bias on tasks involving features and configurations. This study assessed whether this bias results from differences in the perception of features or a cognitive bias to attend to features in autism as a consequence of a deficit in attending to configurations. Children with autism and typically developing children performed a task assessing the initial perceptual representation of features and configurations following a 50 ms stimulus display and the development of the perceptual representation by grouping processes following an 800 ms stimulus display. No differences were observed between the two groups, suggesting that the perceptual and attentional mechanisms marshalled by this task operate typically in children with autism.

Attention↗
PubMedDate not supplied

Service enhancement to a dual-diagnosis population: mental illness/substance abuse (MISA).

This study details how the Sinnissippi Center, Inc., identified, eliminated, or modified barriers to accessing services for MISA (mentally ill and substance abusing) consumers to improve their level of functioning. Barriers and impediments to MISA consumers receiving the full range of services were identified; specific systems changes and modification and clinician help were implemented; and process measures, functional measures, and comparison measures were taken, as was fidelity to the improved service model. Comparison measures showed a significantly lowered dropout rate (5.5% versus 65%) for the MISA-specific group and improved functioning over the comparison group. Process measures showed a significantly lowered use of emergency services, reduced emergency psychiatric hospitalizations, increased sobriety, decreased global assessment of functioning ranges, and an increased length of service. Functional measures showed a 199% increase in the 11 functional areas when averaged. Fidelity testing showed an average of 72% fidelity to the revised MISA services model. This study concludes that improved access to MISA-specific services significantly increases these consumers' quality of life.

Diagnosis, Dual (Psychiatry)↗
PubMed2005

OMERACT 7 psoriatic arthritis workshop: synopsis.

Outcome Measures in Rheumatology (OMERACT) conferences have developed a process by which outcome measures to be included in clinical trials are identified by consensus. During OMERACT 7, held in Asilomar, CA, USA, in May 2004, a workshop on outcome measures in psoriatic arthritis was held. Information derived through a previous Delphi exercise and nominal group process was shared with the participants, as were the results from a study using completed clinical trials with biological therapies. On the basis of the evidence presented and discussions in breakout groups at the OMERACT conference, a set of domains to be included in clinical trials in psoriatic arthritis was developed and a research agenda for further studies in psoriatic arthritis proposed.

Arthritis, Psoriatic↗
PubMed2000

Organisational development in general practice: lessons from practice and professional development plans (PPDPs).

BACKGROUND: Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. RESULTS: Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process. CONCLUSIONS: It is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals.

Evidence-Based Medicine↗
PubMed2004

A psycho-educational intervention for depressed women: a qualitative analysis of the process.

Yalom (1995) has stated that psycho-educational interventions could be made more effective by incorporating a focus on the interpersonal process. A qualitative analysis is proposed to investigate the degree of fidelity with which a psycho-educational intervention for women with depressive symptoms was delivered and to identify Yalom's significant therapeutic mechanisms operating in group therapy. The intervention consisted of six 2 two-hour weekly sessions organized around educational material. Eight groups were conducted with 5-19 participants each. A qualitative analysis was undertaken based on Kvale's (1996) technique of 'categorization of meanings' for the transcribed registers of audiotaped recordings. The analysis led to the definition of five major group process categories: establishment of rules, educational exchange, experiential exchange, reflexive work designed to achieve cognitive and behavioural change, and limitations on the exchange process. It showed that the facilitators largely adhered to the goals of the intervention, its strategies and model, and that the main limitations concerned facilitators' and participants'speaking for over-long periods of time and facilitators' failure to cover all the material due to lack of time. The subsequent analysis identified four of Yalom's categories: installation of hope, didactic instruction, catharsis, and universality. In support of Yalom's assertion, we concluded that this exercise was useful in that it highlighted important therapeutic factors that could be more purposefully manipulated in the future.

Adult↗
PubMed1994

An exploratory study of students' perceptions of the benefits of regular small group tutorials in a 2-year day release course.

This study was undertaken with the intention of improving the effectiveness of small group tutorials in a diploma in nursing course. There was concern to avoid some of the less valuable aspects of tutorials highlighted in the literature. An investigation was conducted to elicit students' perceptions of the benefits of group tutorials at a comparatively early stage in their 2-year course, at the end of the second term. A qualitative approach was taken to explore the views of four students through individual semi-structured interviews. Additional data were gathered through personal field notes to add the tutor's perspective of the group process. Data were analysed inductively using a phenomenological approach in an attempt to elucidate the essence of each participant's experience of the tutorials. While the findings suggested that students valued their involvement in small group tutorials, some questions were raised which point to the need for further investigation. Themes were revealed which drew attention to the value students place on the experience of small group tutorials, thus endorsing the strategies employed. Benefits to students include the opportunity to get to know a small group of people when part of a larger learning group, support when coping with the pressures of course work and being able to share ideas about issues relevant to nursing. The report concludes that there is scope for further investigation and reflection in order to develop educational practice.

Adaptation, Psychological↗
PubMed1994

Transition of the preterm infant to an open crib: process of the project group.

This manuscript outlines the process used by members of the AWHONN project group in conceptualizing and implementing the research utilization project Transition of the Preterm Infant to an Open Crib. The group, which was composed of clinical experts and researchers, met on three occasions at AWHONN headquarters. The outcome of this process was a research-based protocol that was tested at nine clinical sites in the United States or Canada. The process and discussions of the project group, which are detailed here might serve as a format for subsequent research utilization endeavors.

Beds↗
PubMed1998

A group for the adult daughters of mentally ill mothers: looking backwards and forwards.

A closed time-limited therapy group was conducted for four women who had all been raised by mentally ill mothers. Themes recurring frequently included hatred of self and mother, current lack of extended family support, current parenting difficulties, ongoing stigma and isolation. All group members perceived themselves as troubled despite others' perceptions of them as resilient. The results for the individuals treated are outlined using clinical material, as statistical analysis was not undertaken. All were able to cease individual therapy. Conclusions focus on the benefits of such a group process of recognition and affirmation of the profound consequences of a mother's mental illness on her daughters and thence to grandchildren. The possibility of primary prevention using techniques from infant-parent and child-group therapy is discussed.

Adaptation, Psychological↗
PubMed2004

When does visual perceptual grouping affect multisensory integration?

Several studies have shown that the direction in which a visual apparent motion stream moves can influence the perceived direction of an auditory apparent motion stream (an effect known as cross-modal dynamic capture). However, little is known about the role that intramodal perceptual grouping processes play in the multisensory integration of motion information. The present study was designed to investigate the time course of any modulation of the cross-modal dynamic capture effect by the nature of the perceptual grouping taking place within vision. Participants were required to judge the direction of an auditory apparent motion stream while trying to ignore visual apparent motion streams presented in a variety of different configurations. Our results demonstrate that the cross-modal dynamic capture effect was influenced more by visual perceptual grouping when the conditions for intramodal perceptual grouping were set up prior to the presentation of the audiovisual apparent motion stimuli. However, no such modulation occurred when the visual perceptual grouping manipulation was established at the same time as or after the presentation of the audiovisual stimuli. These results highlight the importance of the unimodal perceptual organization of sensory information to the manifestation of multisensory integration.

Adult↗
PubMed2001

Evaluating a problem based learning course: an action research study.

Problem based learning (PBL) has been widely used in the United States, United Kingdom and Australasia in undergraduate nursing education to develop critical thinking and problem solving skills. PBL has been used since 1996 in a Bachelor of Nursing course at a New Zealand tertiary institution, and several modifications have been made to foster effective learning. The 'pure' PBL process has been adapted to move students gradually from teacher direction to taking responsibility for their learning. This has provided the opportunity for students to develop critical thinking, problem solving, information retrieval and evaluation skills, and group process skills over an 18-week period. Because rigorous evaluation of these changes had not been formally undertaken, the purpose of this study was to evaluate how the current format was developing students' understanding and integration of knowledge. Two cycles of the action research method (Cardno and Piggot-Irvine, 1994) were used, involving 4 lecturers and 17 students. Data was collected both quantitatively and qualitatively over a 16-week period. Findings indicated the importance of: explaining the purpose and process of PBL; communicating in detail the role of both students and lecturers; keeping communication lines open; addressing timetabling issues and valuing this method of learning for nursing practice. Implications for nursing education are addressed.

Health Services Research↗
PubMed1991

[Biochemical kinetics of plasmid replication processes].

Two groups of plasmid replication reactions occurring during the growth of cell populations were kinetically characterized: 1) short-term intermediate processes coupled with changes in plasmid concentrations in host cells and occurring in the first few generations; 2) long-term processes resulting in the loss of plasmids and occurring during prolonged cultivation of cells. It was shown that first group processes are determined by the ratios of plasmid replication rates relative to cell growth. Using growing populations of E. coli as examples, it was shown that the shape of kinetic curves reflecting the plasmid copy number depends on the nature of their replicon. In this case plasmids with ColE1 replicon exhibit kinetic behaviour of the first type (temporal loss of plasmid copy number in the cells), whereas plasmids with p15 replicon display the second type behaviour consisting in the decrease of the plasmid copy number followed by its short-term drastic increase. For both types of kinetic behaviour a kinetic description adequately reflecting these processes is given. It is supposed that the loss of plasmids during long-term cultivation of cell populations may be associated with both segregation (lower growth rates of plasmid-containing cells in comparison with cells containing no plasmids) and mutation mechanisms. Kinetic descriptions of both mechanisms are proposed and principles of their discrimination are formulated. Practical recommendations for the prevention of the plasmid loss by the cells that are based on theoretical data are given.

Kinetics↗
PubMed2004

Supportive-expressive group therapy: the transformation of existential ambivalence into creative living while enhancing adherence to anti-cancer therapies.

Supportive-Expressive Group Therapy (SEGT) has been developed and manualised in the research setting, but there have been few clinical accounts of its utility. In this qualitative review of its application in the Melbourne-based randomised control trial (RCT) for women with advanced breast cancer, SEGT is considered from the perspective of the structure and framework of therapy, its therapists, the issues that develop in exploring its common themes and what constitutes a well functioning group. Groups move through identifiable developmental phases. The mature group process transforms existential ambivalence into creative living, evidenced by humour, celebration, assertiveness, altruism, new creative pursuits and eventually courageous acceptance of dying. Challenges and pitfalls include avoidance, non-containment of ambivalence, intolerance of difference, anti-group phenomena and splitting. A key element is the medicalization of the group culture whereby members and co-therapists explore health beliefs and attitudes about care. This promotes compliance with anti-cancer treatments, including both the initiation of and perseverance with chemotherapy. This mechanism could prove to be a potentially important pathway in promoting longer survival.

Adult↗
PubMedDate not supplied

Group II introns and expression of conjugative transfer functions in lactic acid bacteria.

The homologous lactococcal conjugative elements pRS01 and the sex factor of Lactococcus lactis strain 712 both contain a Group II intron within a gene believed to encode a conjugative relaxase enzyme. This enzyme is responsible for nicking of DNA at the origin of transfer (oriT) sequence of the sex factor DNA to initiate the strand transfer process. Group II introns have been studied in eukaryotes, and several of these elements in yeast mitochondrial genes have received considerable attention. These introns are relatively large in size and generally encode a protein within the intron sequence. In addition to splicing activity. Group II introns are mobile genetic elements. The intron-encoded proteins (IEPs) contain endonuclease and reverse transcriptase domains believed to play an enzymatic role in genetic mobility reactions, while a putative maturase domain is thought to promote splicing by stabilizing the folding of the intron RNA into an active ribozyme structure which carries out the splicing reaction. The lactococcal introns represent the first examples of Group II introns shown to be functional in vivo in prokaryotes. Because of the advantages of a bacterial system for genetic and molecular studies, the Ll.ltrB intron from pRS01 has attracted the attention of several laboratories interested in Group II intron biology. Recently, it has been shown that the system can be adapted to function in Escherichia coli (although at somewhat reduced efficiency). In addition, it has been recently proven that the best studied form of mobility, the homing of the intron into an intronless allele of the cognate exon gene, occurs via an RNA intermediate and does not require DNA homology or generalized host recombination functions. Current efforts are analysis of the role Ll.ltrB splicing in regulating expression of pRS01 conjugation functions. The lactococcal Group II introns represent the first demonstrated genetically mobile prokaryotic retroelements, and they also have considerable potential as genetic engineering tools for Lactic Acid Bacteria (LAB) and other organisms.

Bacterial Proteins↗
PubMed2000

Using focus group methods to develop multicultural cancer pain education materials.

Methods to treat cancer pain effectively have existed for more than 2 decades. However, the effective treatment of cancer pain continues to elude many patients with cancer who suffer from poor management. Although efforts to address the problem of cancer pain in the United States have acknowledged the importance of patient education and advocacy, few endeavors, to date, have attended to the special needs of inner-city, low-literacy, or socioeconomically disadvantaged patients from minority cultural groups. From 1992 to 1995, the Boston Cancer Pain Education Program, funded by the National Cancer Institute and the American Cancer Society, worked collaboratively with community representatives using focus group methods to develop a culturally sensitive, linguistically appropriate cancer pain education booklet in 11 languages and for 11 ethnic groups. The booklet serves as a guide for patients and families and is to be used as a teaching tool by clinicians. The focus group approach was used to develop materials that would empower patients and families to more effectively participate in pain management when working with health care providers from cultures other than their own. Qualitative data analysis methods were used to analyze transcripts of taped focus group sessions. Themes emerged from the data regarding pain and its culturally competent management as well as the group process of booklet development.

Boston↗
PubMed1999

Journalling and the teaching of spirituality.

This paper examines the development of a teaching format suitable for teaching spirituality and spiritual care to a group of mature age nurses, all of whom are older than the age of 25 years. A teacher's journal was kept that assisted in the identification of classroom activities, which aided in relating these experiences to concepts and practices of adult learning. These principles of learning included the use of the students' preparedness to learn, respect for the student as a learner and the use of the group processes to facilitate the exchanges of experiences and learning between the educator and the students. Whilst these precepts were valuable as a means of resolving teaching concerns, it was the journal entries that identified the issues relating to the teaching process. Some of these issues were the use of student and educator experiences as a medium for reflection, the willingness of the educator to follow students' wishes to discuss apparently unrelated material, the facilitator will be apart from the group as well as part of the group, and the necessity for journal entries to be made as soon as possible after the completion of the class.

Adult↗
PubMed2004

"I'm not the only one!" group therapy with older children and adolescents who have learning disabilities.

Children and adolescents with learning disabilities (LD) are vulnerable to psychosocial difficulties. Both the detrimental impact of LD on social adjustment and the significance of peer relations for developmental needs make group therapy a natural intervention. Despite modifications that are required due to their cognitive deficits, many students with LD fit the criteria and can benefit from group psychotherapy. In this paper, a model of group therapy for older children and adolescents with LD is presented. The approach is informed by a combination of self psychology, mutual aid, and interpersonal group therapy. The leaders use special techniques to accommodate the LD and to foster the group process. Examples are presented to illustrate the approach.

Adolescent↗
PubMed2005

Development of a Chinese medicine assessment measure: an interdisciplinary approach using the delphi method.

BACKGROUND: The diagnostic framework and clinical reasoning process in Chinese medicine emphasizes the contextual and qualitative nature of a patient's illness. Chinese medicine assessment data may help interpret clinical outcomes. OBJECTIVES: As part of a study aimed at assessing the validity and improving the inter-rater reliability of the Chinese diagnostic process, a structured assessment instrument was developed for use in clinical trials of acupuncture and other Chinese medical therapies. STUDY DESIGN: To foster collaboration and maximize resources and information, an interdisciplinary advisory team was assembled. Under the guidance of two group process facilitators, and in order to establish whether the assessment instrument was consistent with accepted Chinese medicine diagnostic categories (face validity) and included the full range of each concept's meaning (content validity), a panel of Traditional Chinese Medicine (TCM) expert clinicians was convened and their responses were organized using the Delphi process, an iterative, anonymous, idea-generating and consensus-building process. An aggregate rating measure was obtained by taking the mean of mean ratings for each question across all 10 experts. RESULTS: Over three rounds, the overall rating increased from 7.4 (SD = 1.3) in Round 1 to 9.1 (SD = 0.5) in Round 3. The level of agreement among clinicians was measured by a decrease in SD. CONCLUSIONS: The final instrument TEAMSI-TCM (Traditional East Asian Medicine Structured Interview, TCM version) uses the pattern differentiation model characteristic of TCM. This modular, dynamic version was specifically designed to assess women, with a focus on gynecologic conditions; with modifications it can be adapted for use with other populations and conditions. TEAMSI-TCM is a prescriptive instrument that guides clinicians to use the proper indicators, combine them in a systematic manner, and generate conclusions. In conjunction with treatment manualization and training it may serve to increase inter-rater reliability and inter-trial reproducibility in Chinese medicine clinical trials. Testing of the validity and reliability of this instrument currently is underway.

Data Interpretation, Statistical↗