Cognitive defusion

This chapter reviews the conceptualization and empirical evidence of the midlevel process called cognitivedefusion. Firstly, we present examples of cognitive fusion and cognitive defusion definitions offered inacceptance and commitment therapy (ACT) manuals, discuss their relationships with other ACT midlevelprocesses, and offer a relational frame theory (RFT) conceptualization of these processes. Secondly, wedescribe the type of cognitive defusion exercises and discuss the basic processes involved in them. Thirdly,we review the measurement of cognitive (de)fusion in the form of self-report instruments, behavioralmeasures, and the assessment in the clinical session. Fourthly, we present a review of the research oncognitive (de)fusion separated in laboratory research, survey research, and the analysis of processes ofchange in clinical trials. Lastly, we discuss some challenges and future directions in conceptualizing andresearching cognitive (de)fusion.

Full digital workflow in fixed adhesive dental prosthesis: Description of a clinical technique

Digital dentistry has gained space in several dental specialties. It is possible to achieve excellent results with the digital workflow, which combines the efficiency of the restorative material with a greater marginal adaptation. This study aimed to report a clinical case through the digital workflow, with a faster and clinically acceptable prosthetic resolution. In this clinical case report, digital workflow allowed a faster and clinically acceptable prosthetic resolution. A 45-year-old female patient reported cementation failure of the prosthetic crown on tooth 14. As it was a vital tooth, the tooth received a total crown preparation. In the same clinical session, the patient's mouth was scanned then a capture software obtained a virtual model. After, the design software planned a digital "diagnostic wax-up", so a leucitic ceramic was chosen for the rehabilitation. The ceramic block was milled and receive stain and glaze, dispensing the prosthesis laboratory. Then, the adhesive cementation was performed with a dual-polymerized resin cement. The final crown had ideal adaptation, with no need for interproximal and occlusal adjustments, with an excellent marginal fit. Within the limitations of this study, this case report showed that the digital workflow allowed a favorable result in a shorter working time, which brought back function and aesthetics, without the need for interproximal and occlusal adjustments. Keywords Prosthodontics; Cosmetic dentistry; CAD-CAM.

The ‘Real World’ Clinic Measured Visual Acuity Versus the Best Correct Visual Acuity Measurement in Patients Treated for Neovascular Age-Related Macular Degeneration

BACKGROUNDIn ophthalmology clinics, the visual acuity (VA) is usually measured by non-refracting healthcare professionals (HCPs). We compared the ‘real world’ or clinic measured VA versus the best-corrected visual acuity measurement in patients with neovascular age-related macular degeneration (nAMD).METHODSDuring the same clinical session using Early Treatment of Diabetic Retinopathy Study (ETDRS) vision chart, monocular distance VA was measured by non-refracting HCPs in nAMD patients and compared to the monocular distance VA measured by an optometrist with subjective refractive correction (BCVA). The study was powered to detect a difference of >5 ETDRS letters between the groups and for HCP measured VA to detect a BCVA between 6/12 and 6/96 (National Institute of Health and Care Excellence condition of approval of nAMD treatment with licensed drugs in the UK).RESULTSData from 167 patients (324 eyes) were analysed. Absolute mean difference in BCVA versus HCP measured VA was 5.71 (95% confidence interval (CI) 5.10-6.41) ETDRS letters (p-value<0.001). Using Bland-Altman method, limits of agreement between the two groups was found to be between 18.39 and -14.66 ETDRS letters. The prevalence of BCVA between 6/12 and 6/96 was 53.40% (95% CI 47.96-58.83%). In detecting this BCVA bracket, the non-refracting HCP measured VA had a sensitivity of 91.91% (95% CI 87.84-95.97%) and a specificity of 84.77% (95% CI 79.04-90.50%). CONCLUSIONSThe ‘real world’ HCP measured VA was found to have considerable inaccuracy and imprecision when compared to BCVA in nAMD patients. Unreliable VA measurement can have important implications in assessing and treating eye conditions, including nAMD.

Test-Retest Reliability of Level-Specific CE-Chirp Auditory Brainstem Response in Normal-Hearing Adults

Background and Objectives: There is growing interest in the use of the Level-specific (LS) CE-Chirp^® stimulus in auditory brainstem response (ABR) due to its ability to produce prominent ABR waves with robust amplitudes. There are no known studies that investigate the test-retest reliability of the ABR to the LS CE-Chirp^® stimulus. The present study aims to investigate the test-retest reliability of the ABR to the LS CE-Chirp^® stimulus and compare its reliability with the ABR to standard click stimulus at multiple intensity levels in normal-hearing adults.Subjects and Methods: Eleven normal-hearing adults participated. The ABR test was repeated twice in the same clinical session and conducted again in another session. The ABR was acquired using both the click and LS CE-Chirp^® stimuli at 4 presentation levels (80, 60, 40, and 20 dBnHL). Only the right ear was tested using the ipsilateral electrode montage. The reliability of the ABR findings (amplitudes and latencies) to the click and LS CE-Chirp^® stimuli within the same clinical session and between the two clinical sessions was calculated using an intra-class correlation coefficient analysis (ICC).Results: The results showed a significant correlation of the ABR findings (amplitude and latencies) to both stimuli within the same session and between the clinical sessions. The ICC values ranged from moderate to excellent. Conclusions: The ABR results from both the LS CE-Chirp^® and click stimuli were consistent and reliable over the two clinical sessions suggesting that both stimuli can be used for neurological diagnoses with the same reliability.

The Relationship between PID-5 Personality Traits and Mental States. A Study on a Group of Young Adults at Risk of Psychotic Onset

Background and Objectives: The diagnosis of psychosis is a challenge for the scientific community, both in terms of its definition and treatment. Some recent studies have investigated the relationship between personality and psychosis onset to prevent or intervene early. Materials and Methods: Sixty young adults were recruited during their first access in 2019 near the Community Mental Health Service of Niguarda Hospital, Milan, Italy. The assessment included the Social and Occupational Functioning Assessment Scale (SOFAS), the Global Assessment of Functioning (GAF) (clinician scales), the 16-item Version of the Prodromal Questionnaire (PQ-16), the Personality Inventory for DSM-5 (PID-5) (self-report), and a clinical session. Statistical analysis was performed by SPSS. Results: The results show a negative correlation between the Detachment domain and the GAF scores. Correlational analysis also highlights that all PID-5 domains, except for Antagonism, have positive correlations with high scores in the PQ-16. The multivariate analysis of variance showed that patients diagnosed with versus without a psychotic disorder significantly differed on Detachment, Antagonism and Psychoticism PID-5 domains. Conclusions: The involvement of the personality construct in psychopathological development is displayed. In particular, higher levels of Detachment and Psychoticism can distinguish people who are more vulnerable to psychosis or who already have overt psychosis from those who do not have a psychotic predisposition. The study highlights the fundamental role of personality traits, emerging from PID-5, to distinguish young adults at risk of onset.

Evaluation of the Relationship between Trait and State Anxiety and Temporomandibular Dysfunction

Background: Anxiety is an important factor in the process of chronic pain in patients with Temporomandibular Dysfunction (TMD). Objective: The objective of this study was to evaluate the influence of minimally invasive management of muscular TMD on the levels of anxiety (state and trait), pain, and other parameters in patients with muscular TMD. Methods: A total of 83 patients (64 women and 19 men; mean age, 25.16 ± 4.40 years) who were clinically diagnosed with TMD were evaluated. During the first clinical session (T1) and after clinical evaluation and diagnosis, the participants filled out a pain visual analog scale and answered the Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S). In addition, the bite strength of the participants was evaluated, and minimally invasive management (thermotherapy, orientation exercises, and cognitive behavioral therapy) was initiated in that session. After 8 weeks (T2), all parameters were reevaluated. The results obtained were statistically analyzed and found to have a significance level of 5%. Results: A significant decrease in pain, STAI-T, and STAI-S scales were observed from T1 to T2 (p < 0.0001). Higher values of bite strength were observed at T2 compared to T1 (p < 0.0001). Furthermore, a significant correlation was observed between the levels of pain, trait-anxiety, and state-anxiety. Conclusion: Minimally invasive management of TMD resulted in a reduction in the levels of pain and anxiety (trait and state) of the participants evaluated, suggesting a possible association of these factors with chronic myofascial pain.

Predictors of health professionals’ satisfaction with continuing education: A cross-sectional study

Objectives: to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction. Method: a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015. Results: the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01). Conclusion: the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.

Urology highlights 2017 to 2018

The final clinical session of the British Association of Urological Surgeons (BAUS) annual meeting is the Updates and Highlights session, where the most important advances in the main urological sub-specialities are summarised and presented by sub-specialist experts representing each BAUS section. The aim of the session is to disseminate knowledge on the latest research, new guidelines and changes to general and specialist clinical practice. This paper covers contemporary urological advances as presented at the Liverpool BAUS meeting in June 2018.

Effectiveness of percutaneus needle electrolysis and eccentric exercise in chronic patellar tendinopathy

Aims The aim of this study was to evaluate the effect of percutaneous needle electrolysis together with exercise with eccentric loading for the treatment of chronic patellar tendinopathy. Material and Methods An experimental study was performed including eight subjects medically diagnosed with chronic patellar tendinopathy. The sample included subjects with a mean age of 40 years old (SD:10), a sample of 10 tendons was obtained with over four months' evolution. Functionality was assessed using the VISA-P scale, pain was evaluated using the Visual Analog Scale (VAS), the tendon structure was evaluated by analyzing of ultrasound images which evaluated the AP diameter, perimeter and echogenicity. All study subjects belonged to the same group and were applied the same treatment. This consisted of three sessions of percutaneous needle electrolysis, following the protocol defined by Valera & Minaya with a dosage of 3:3:3, with 3 mA of intensity for 3 seconds and 3 current applications, together with a program of eccentric overloading which was developed in nine exercise sessions, which consisted of three series of 12 repetitions single-legged semi squats with maximum patient load on a decline board. A 48-hour window was left between the clinical session and sports practice with eccentric overloading. Results In the initial assessment, a VISA-P score of 40.90 was obtained (SD:10.55), together with a VAS a score of 7.3 (SD:1.01), on the ultrasound exam all patients presented changes compatible with a degenerative process. After four weeks, the values of the VISA-P scale increased 35.8% at four weeks, VAS decreased 55.4% and slight changes were appreciated in ultrasound values in 42.4% of patients. Conclusion Percutaneous needle electrolysis, together with eccentric overload exercise, represent a treatment which may be effective for most cases of chronic patellar tendinopathy.

Performance Feedback to Increase Use of Counseling Skills

Counseling is a critical component of audiological care and when implemented purposefully can yield multiple benefits for patients. Professional guidelines indicate that counseling is within the scope of practice for audiologists, yet research has shown that audiologists feel unprepared and are not comfortable providing adjustment counseling. This may be due to inadequate counseling training in audiology graduate programs. To identify ways to address this counseling training gap, this study examined the use of performance feedback to increase counseling skills among audiology graduate students. In this study, participants (n = 5) were recorded during clinical session encounters, and recordings were coded for time spent counseling. A licensed clinical psychologist reviewed the recordings and provided individual performance feedback to participants over the course of the study. Time spent counseling increased by the end of the study, although improvement varied across participants. Results suggest that performance feedback can be used as a method to increase counseling skills in audiology students. However, factors, such as participant motivation, feedback timing, and prerequisite counseling skills, may influence response to feedback. More research is needed on ways to maximize gains from feedback, as well as other methods to improve counseling skills in audiology students.