Evaluating consumer satisfaction in residential continuing care settings

The outcome of the project reported on here is a client-centered consumer satisfaction questionnaire designed to evaluate new models of residential continuing care in Alberta, Canada. Satisfaction is defined as a multi-dimensional construct that is grounded in the consumer's experience. Consultation with the clients of the services during development of the instrument ensured that characteristics important to the clients were assessed. The result is an instrument with which to measure satisfaction that is fully client-centered and that, with appropriate modifications, can be used to monitor any client-centered program for cognitively-able continuing care clients.     

The lips of the dead and the "kiss of life": the contemporary deathbed and the aesthetic of CPR

Over the last four decades, cardiopulmonary resuscitation (CPR) has become the medical, legal and media standard for behaviour in the face of sudden death. The key therapeutic techniques of CPR: mouth–to–mouth ventilation, external–cardiac–compressions and defibrillation – with their origins in the eighteenth century, strange peregrinations in the nineteenth, and consolidation in the twentieth – are central to what may be seen as a newly dominant form of deathbed ritual.     

Semiparametric Inference Methods for General Time Scale Models

In this paper we consider semiparametric inference methods for the time scale parameters in general time scale models (Oakes, 1995, Duchesne and Lawless, 2000). We use the results of Robins and Tsiatis (1992) and Lin and Ying (1995) to derive a rank-based estimator that is more efficient and robust than the traditional minimum coefficient of variation (min CV) estimator of Kordonsky and Gerstbakh (1993) for many underlying models. Moreover, our estimator can readily handle censored samples, which is not the case with the min CV method.     

Open dialogues with good and poor outcomes for psychotic crises: examples from families with violence

In Open Dialogue the first treatment meeting occurs within 24 hr after contact and includes the social network of the patient. The aim is to generate dialogue to construct words for the experiences embodied in the patient's psychotic symptoms. All issues are analyzed and planned with everyone present. A dialogical sequence analysis was conducted comparing good and poor outcomes of first-episode psychotic patients. In good outcomes, the clients had both interactional and semantic dominance, and the dialogue took place in a symbolic language and in a dialogical form. Already at the first meeting, in the good outcome cases, the team responded to the client's words in a dialogical way, but in the case with the poor outcome, the patient's reflections on his own acts were not heard.     

Events and experiences impacting the development of clinical self confidence: a study of the first year of client contact

Research was conducted to identify the events and experiences influencing the development of clinical self-confidence during the first year of client contact for beginning marriage and family therapists. Thirty-nine recent graduates of a master's degree training program participated in a semistructured interview in which they were asked to describe the influences on their clinical self-confidence. Through qualitative analysis, four event and experience categories emerged as exerting the most influence on confidence at this stage of professional development: supervision, contact with clients, contact with peers, and personal life stress. The authors recommend providing strength-focused supervision, acknowledging the effects of client contact, encouraging peer contact, and attending to personal life stress.     

Impact of perceived second-hand consequences related to alcohol use on college students' drinking behavior intent: a test of feasibility

This article presents the results of an experiment designed to determine the impact of a group discussion about second-hand consequences of alcohol use on college students' intentions to consume alcohol. Participants were students enrolled in two large Community Health courses at a large Midwestern university (n = 184). After randomization of class sections into an intervention or a control group, intervention group students participated in a class discussion on the negative consequences college students experience as a result of other students' drinking behavior, prior to answering survey questions regarding their drinking behavior intent. Compared to controls who completed the questionnaire only, intervention group participants reported intent to limit themselves to fewer drinks per drinking occasion (p = .003) and fewer drinks per week (p = .004). The effects of the brief educational intervention were analyzed using structural equation modeling, to test the feasibility of a hypothesized intervention mechanism.     

Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.     

Aspects of guilt and self-reported substance use in adolescence

The use of addictive substances is undergoing moralization in American society-behaviors once viewed as personal preferences now carry moral significance. Research has shown that sociomoral emotions like guilt, thought to be reflective of one's internalized standards and societal mores, can be an important influence on behavior. The present study explored the relationship between college students' self-reports of adolescent substance use (cigarettes, alcohol, and marijuana) and scores on indices tapping different aspects of guilt (Standards, Situational, and Chronic Guilt). Participants were 230 undergraduate students (mean age = 19; 55 percent female; 69 percent White). Substance users had lower scores on Standards and Situational Guilt than non-users, but no difference was observed in Chronic Guilt. The present results suggest that a stronger internalization of societal standards, as reflected by higher scores on Standards and Situational Guilt, may prove a useful tool in the prevention of substance use.     

Setting a trap for aging-related genes in Drosophila

In the October 2002 issue of Aging Cell, Seroude et al. used an enhancer trap technique to identify Drosophila genes whose expression changes with age. In this Perspective, the author discusses the implications of these results, including the possibility of using the enhancer trap lines to identify biomarkers of aging.     

The relationship of trauma exposure to sex offending behavior among male juvenile offenders

The most common type of adult and juvenile sex offender treatment utilizes a Relapse Prevention (RP) model. In RP clients learn about their offense cycle with an emphasis on recognizing high-risk situations and negative emotional states that can be precursors or triggers to offending behavior. This study identifies ways that traumatic experiences and trauma-associated feelings can be offense triggers for juvenile sex offenders. Researchers interviewed the treating clinicians of 40 male juvenile sex offenders who received at least six months of RP sex offender treatment. Results showed that 95% of the youths had experienced a Post Traumatic Stress Disorder (PTSD) Criterion A traumatic event and that 65% met criteria for PTSD based on clinician judgments. Overall, clinicians identified prior trauma exposure as being related to the offense triggers in 85% of offenders. Specifically, the following trauma-related feelings were identified as offense triggers: intense fear in 37.5% of sex offenders, helplessness in 55%, and horror in 20%. Implications for sex offender treatment programs are discussed.