Life Minus Violence-Enhanced (LMV-E) with women in custody: single-case experimental design

2019 ◽  
Vol 5 (4) ◽  
pp. 295-306
Author(s):  
Annette McKeown ◽  
Sarah McCrory
Keyword(s):  
Single Case ◽  
Baseline Period ◽  
Small Sample ◽  
Indirect Aggression ◽  
Reliable Change ◽  
Content Type ◽  
Baseline Design ◽  
Psychometric Measures ◽  
Clinically Significant

Purpose The purpose of this single-case experimental design paper is to examine the efficacy of the high-dosage Life Minus Violence – Enhanced (LMV-E) programme with a small sample of four violent women in custody. All participants were undertaking LMV-E as one component of their treatment pathway in an Offender Personality Disorder (OPD) treatment service for women with personality disorder. The methodology employed an AB baseline design with a six-month baseline period, nine-month treatment period and six-month follow-up. Levels of direct and indirect aggression were recorded throughout the baseline, intervention, and follow-up period. In the follow-up period, women were engaging in further treatment. Psychometric measures linked to treatment domains were used to explore clinically significant and reliable change following the intervention. Clinical and reliable change was indicated in some treatment domains for each participant following the intervention. The pattern of these reductions varied between the women. The patterns of findings are discussed and recommendations presented. Design/methodology/approach The methodology employed an AB baseline design with a six-month baseline period, nine-month treatment period and six-month follow-up. Levels of direct and indirect aggression were recorded throughout the baseline, intervention and follow-up period. In the follow-up period, women were engaging in further treatment. Psychometric measures linked to treatment domains were used to explore clinically significant and reliable change following the intervention. Findings Clinical and reliable change was indicated in some treatment domains for each participant following the intervention. The pattern of these reductions varied between the female offenders. The patterns of findings are discussed and recommendations presented. Practical implications The LMV-E programme was associated with some positive improvements in treatment domains measured in a small sample of female violent offenders. Improvements to some degree were most commonly found in the domains of anger, emotional control and components of criminal thinking. It would be clinically useful to examine characteristics of individuals that appear to benefit most from particular interventions. Originality/value There are no existing published findings related to the implementation of LMV-E with females. Therefore, this paper provides preliminary contribution to the evidence base in this area.

Enhancing patient flow in emergency department (ED) using lean strategies–an integrated voice of customer and voice of process perspective

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ali Alowad ◽  
Premaratne Samaranayake ◽  
Kazi Ahsan ◽  
Hisham Alidrisi ◽  
Azharul Karim
Keyword(s):  
Waiting Time ◽  
Emergency Services ◽  
Single Case ◽  
Patient Flow ◽  
Waiting Times ◽  
Small Sample ◽  
Content Type ◽  
Lean Tools ◽  
And Performance ◽  
Voice Of Customer

PurposeThe purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.Design/methodology/approachA survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.FindingsThe results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.Research limitations/implicationsThe research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.Originality/valueThis research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

Case Study of Clinical Behavior Analysis for a 20-Year-Old Client With Emetophobia

2019 ◽  
Vol 18 (3) ◽  
pp. 163-174
Author(s):  
Takashi Mitamura
Keyword(s):  
Behavior Analysis ◽  
Single Case ◽  
Intervention Strategies ◽  
Single Case Design ◽  
Clinical Behavior Analysis ◽  
Clinical Behavior ◽  
Empirically Supported ◽  
Clinically Significant

This case study illustrates a clinical behavior analytic intervention for a female client with emetophobia, the fear of vomiting. Clinical behavior analysis is a recently developing branch of empirically supported psychotherapy, derived from behavior analysis. This case study presents modified case formulations and changed intervention strategies according to the results of repeated measuring. The intervention was six sessions and three gradual follow-up sessions; the effect of the intervention was monitored by a single-case design. The intervention strategies were changed from symptom-focused interventions, which are based on exposure, to value-focused gradual follow-up sessions. The client’s phobia and depression were alleviated through the intervention and gradual follow-up phases. Moreover, her value-based activities increased through the gradual follow-up phase. The Reliable Change Indexes (RCIs) were calculated to evaluate changes between the intervention and follow-up phases. There were large and clinically significant decreases on measures. The results highlight the utility of repeated measuring and importance of a value-focused approach.

Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

1997 ◽  
Vol 86 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Jean Raymond ◽  
Daniel Roy ◽  
Michel Bojanowski ◽  
Robert Moumdjian ◽  
Georges L'Espérance
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Clinically Significant ◽  
Technical Complication ◽  
Fine Print

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

Telephone follow-up for cataract surgery: feasibility and patient satisfaction study

2016 ◽  
Vol 29 (4) ◽  
pp. 407-416 ◽  
Author(s):  
Jeremy J.S.L. Hoffman ◽  
Lucia Pelosini
Keyword(s):  
Patient Satisfaction ◽  
Cataract Surgery ◽  
Small Sample Size ◽  
Small Sample ◽  
Low Risk ◽  
Control Group ◽  
Content Type ◽  
Randomised Study ◽  
Risk Patients

Purpose – The purpose of this paper is to investigate the feasibility of telephone follow-up (TFU) after uncomplicated cataract surgery in low-risk patients and patient satisfaction with this alternative clinical pathway. Design/methodology/approach – Prospective, non-randomised cohort study. A ten-point subjective ophthalmic assessment questionnaire and a six-point patient satisfaction questionnaire were administered to patients following routine cataract surgery at two to three weeks post-procedure. All patients were offered a further clinic review if required. Exclusion criteria comprised ophthalmic co-morbidities, hearing/language impairment and high risk of post-operative complications. Patient notes were retrospectively reviewed over the study period to ensure no additional emergency attendances took place. Findings – Over three months, 50 eyes of 50 patients (mean age: 80; age range 60-91; 66 per cent second eye surgery) underwent uncomplicated phacoemulsification surgery received a TFU at 12-24 days (mean: 16 days) post-operatively. Subjective visual acuity was graded as good by 92 per cent of patients; 72 per cent patients reported no pain and 20 per cent reported mild occasional grittiness. Patient satisfaction was graded 8.9 out of 10; 81.6 per cent defined TFU as convenient and 75.5 per cent of patients preferred TFU to routine outpatient review. No additional visits were required. Research limitations/implications – Non-randomised with no control group; small sample size. One patient was unable to be contacted. Practical implications – Post-operative TFU can be suitably targeted to low-risk patients following uncomplicated cataract surgery. This study demonstrated a high patient satisfaction. A larger, randomised study is in progress to assess this further. Originality/value – This is the first study reporting TFU results and patient satisfaction to the usual alternative two-week outpatient review.

scholarly journals CFT & people with intellectual disabilities

2018 ◽  
Vol 12 (1) ◽  
pp. 44-56 ◽  
Author(s):  
Mark Hardiman ◽  
Corrina Willmoth ◽  
James J. Walsh
Keyword(s):  
Intellectual Disabilities ◽  
Small Sample ◽  
Common Humanity ◽  
Post Intervention ◽  
Content Type ◽  
Self Compassion ◽  
Depth Analysis ◽  
People With Intellectual Disabilities ◽  
Compassion Scale

Purpose The purpose of this paper is to assess the effects of compassion-focussed therapy (CFT) on anxiety in a small sample of adults with intellectual disability. Design/methodology/approach A mixed-methods design was employed. Participants (n=3) completed questionnaire measures of anxiety and self-compassion on three occasions: pre-intervention, post-intervention and, at three months follow-up. Post-intervention, they also took part in recorded interviews that were analysed using interpretive phenomenological analysis. Findings were then synthesised to develop a comprehensive understanding of their overall experience. Findings Final data synthesis revealed five themes: participant anxiety decreased (reliable for all participants); the faulty self; improved positive compassionate attitudes; increased sense of common humanity; and mindful distraction techniques. Research limitations/implications This research paper offers in-depth analysis of three participants’ experiences rather than reporting in less detail about a larger number of participants. The self-compassion scale required considerable support and reasonable adaptation to be used with these clients. Originality/value Only two other studies have explored the use of CFT with people with intellectual disabilities.

Three year follow-up study of families referred to a family intervention team – what are the outcomes that make a difference?

2014 ◽  
Vol 13 (2) ◽  
pp. 93-102
Author(s):  
Leah Salter ◽  
Jessica Williams
Keyword(s):  
Early Intervention ◽  
Family Intervention ◽  
Small Sample ◽  
Small Scale ◽  
Long Term Outcomes ◽  
Content Type ◽  
Intervention Team ◽  
The Impact

Purpose – The purpose of this paper is to examine the long-term outcomes for 15 young people on a range of indicators including school success, involvement with other agencies and the perceived effectiveness by the family. Design/methodology/approach – Semi-structured telephone interviews were used to gather a range of both quantitative and qualitative data. Interviews were with a parent of the referred child (n=15). Findings – In all, 87 per cent of care-givers interviewed rated the service they had received as helpful 85 per cent reported these changes to be maintained at the three year follow-up. Rate of school exclusion was only 7 per cent and 0 per cent of families went on to have involvement with statutory social services or the youth justice system. Research limitations/implications – This is a small-scale study offering a small sample (n=15) of families previously referred to this Family Intervention Team, at a three-year post-intervention period. More routine longitudinal information needs to be gathered for a more robust indication on long-term outcomes. Practical implications – The impact this study will have on the team involved will be in its recommendations for further long-term outcome studies; but also in feeding back to the service the significant key messages from those interviewed. Social implications – Contributing to a wider understanding of the long-term benefits of early intervention. Originality/value – This paper offers some new though small statistical data in the growing pool of statistics that are indicating positive outcomes for early intervention and family intervention projects.

Recovery and reliable change rates for patients scoring severe on depression, anxiety or impaired functioning in a psychological therapies service: IAPT

2015 ◽  
Vol 20 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Christopher Alan Griffiths ◽  
Laura Jayne Griffiths
Keyword(s):  
Single Case ◽  
Stepped Care ◽  
Reliable Change ◽  
Recovery Rates ◽  
Effective Measure ◽  
Content Type ◽  
Psychological Therapies ◽  
Case Evaluation ◽  
Care Approach ◽  
Set Up

Purpose – The NHS Improving Access to Psychological Therapies (IAPT) programme provides access to psychotherapy in England through a stepped care approach for adults with depression and anxiety disorders. This evaluation sought to investigate IAPT recovery and reliable change rates of those who scored severe on depression (PHQ-9), anxiety (GAD-7) or impaired functioning (WASA). The paper aims to discuss this issue. Design/methodology/approach – This evaluation employed a within groups design: a single case evaluation follow-up. Routine service data (from services set-up in 2008-2009 to February 2012) from 25,034 patients treated at four IAPT services was analysed. Findings – The analysis revealed that 29 per cent (n=7,059) of patients were assessed as being in the WASA severe range, 41 per cent (n=10,208) in the PHQ severe range, and 57 per cent (n=14,612) in the GAD-7 severe range; with 14 per cent (n=3,548) in the severe range on all three measures combined. There were significant falls on all three measures and a large effect size. The percentage of patients who recovered to a point below the recovery threshold was 30 per cent for depression, 34 per cent for anxiety, 18 per cent for impaired functioning, and for those presenting severe on all measures: recovery rates were 21 per cent for anxiety, 26 per cent for depression, and 15 per cent for impaired functioning. Reliable change for anxiety was found to be greater than IAPT patients overall. Originality/value – The results show that IAPT enables approximately a third of people scoring severe to recover, lower than IAPT recovery rates overall. Reliable change may be a more effective measure of patient progress.

scholarly journals Plasmodium vivax Chloroquine Resistance and Anemia in the Western Brazilian Amazon

2013 ◽  
Vol 58 (1) ◽  
pp. 342-347 ◽  
Author(s):  
Marly M. Marques ◽  
Monica R. F. Costa ◽  
Franklin S. Santana Filho ◽  
José L. F. Vieira ◽  
Margareth T. S. Nascimento ◽  
...  
Keyword(s):  
Plasmodium Vivax ◽  
Univariate Analysis ◽  
Control Program ◽  
Brazilian Amazon ◽  
Small Sample ◽  
Chloroquine Resistance ◽  
Public Health Issue ◽  
Content Type

ABSTRACTData on chloroquine (CQ)-resistantPlasmodium vivaxin Latin America is limited, even with the current research efforts to sustain an efficient malaria control program in all these countries whereP. vivaxis endemic and where malaria still is a major public health issue. This study estimatedin vivoCQ resistance in patients with uncomplicatedP. vivaxmalaria, with use of CQ and primaquine simultaneously, in the Brazilian Amazon. Of a total of 135 enrolled subjects who accomplished the 28-day follow-up, parasitological failure was observed in 7 (5.2%) patients, in whom plasma CQ and desethylchloroquine (DCQ) concentrations were above 100 ng/dl. Univariate analysis showed that previous exposure to malaria and a higher initial mean parasitemia were associated with resistance but not with age or gender. In the multivariate analysis, only high initial parasitemia remained significant. Hemoglobin levels were similar at the beginning of the follow-up and were not associated with parasitemia. However, at day 3 and day 7, hemoglobin levels were significantly lower in patients presenting CQ resistance. TheP. vivaxdhfr(pvdhfr),pvmrp1,pvmdr1, andpvdhpsgene mutations were not related to resistance in this small sample.P. vivaxCQ resistance is already a problem in the Brazilian Amazon, which could be to some extent associated with the simultaneous report of anemia triggered by this parasite, a common complication of the disease in most of the areas of endemicity.

Life Skills Group: increasing foundation knowledge and motivation in offenders with a learning disability

2014 ◽  
Vol 5 (1) ◽  
pp. 4-13 ◽  
Author(s):  
Christy Patterson ◽  
Cathy Thomas
Keyword(s):  
Learning Disability ◽  
Readiness To Change ◽  
Single Case ◽  
Emotional Understanding ◽  
Structured Interviews ◽  
Content Type ◽  
Client Group ◽  
Psychometric Measures ◽  
Skills Group ◽  
Group Programme

Purpose – Offenders with a learning disability present with greater clinical need than those without a learning disability. However, for this client group, access to and engagement with psychological and criminogenic interventions are often limited. The purpose of this paper is to discuss a potentially useful approach to this issue. Design/methodology/approach – A single case study design was used to evaluate an introductory group programme, delivered over 12 weekly sessions, in a forensic learning disability service. Semi-structured interviews were used alongside psychometric measures, which were completed prior to, and following completion of, the group, in order to assess the individual's experience of the group, their emotional understanding and difficulties, and readiness to change. Findings – Readiness to change and emotional understanding improved following completion of the programme. Self-reported emotional difficulties showed improvement, although not all staff reports corroborated this. Notably, the service user reported a positive experience, with increased confidence and motivation to attend further groups. Research limitations/implications – Generalisation from the results of single case studies is limited. Although results suggest that motivation to engage further has increased, more research is required to assess whether this impacts on actual ability to engage. Practical implications – Offering an introductory programme prior to further, more criminogenically focused intervention may be more effective than offering these interventions as the first stage of treatment. Originality/value – An introductory group programme may be potentially helpful in providing the foundation knowledge, confidence and motivation necessary to attend further intervention focusing on criminogenic need for offenders with a learning disability.

scholarly journals Identity, glass borders and globally mobile female talent

2019 ◽  
Vol 7 (3) ◽  
pp. 285-299
Author(s):  
Susan Kirk
Keyword(s):  
Single Case ◽  
Small Sample Size ◽  
Identity Work ◽  
Small Sample ◽  
Single Case Design ◽  
Senior Managers ◽  
Content Type ◽  
Face To Face ◽  
Global Mobility ◽  
Identity Narratives

Purpose The purpose of this paper is to explore the interplay between identity and global mobility in the careers of senior, female talent, uniquely taking into account the perceptions of both female and male participants. In addition, the role organisations can play in enabling women to overcome these identity constraints is identified. Design/methodology/approach This interpretivist study draws on data from 38 in-depth interviews with senior managers in a large, multinational organisation to elicit a rich picture of how such careers are enacted. Findings Findings reveal how identity conflicts function as a glass border for globally mobile, senior female talent. Ways in which talent can access positive identity narratives to inform global mobility choices are identified. Research limitations/implications The limitations of this study include the relatively small sample size and the single case design of this research. The findings, however, offer insights into the identity work of globally mobile, female talent across different contexts. Practical implications Organisations can facilitate access to identity narratives through mentoring, face-to-face forums and via the internet to enable globally mobile, female talent to make more informed global mobility choices. Originality/value Drawing on identity theory, this paper examines how identity work for globally mobile, female talent has more fluid interpersonal boundaries than for men, creating on-going identity struggles. In highlighting how identity narratives can act as a means of breaching the glass border and facilitating global mobility for female talent, a contribution is made to existing debates in the fields of identity, gender studies and global talent management.

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