单病例随机对照试验:通过研究单个案例,我们能学到什么?

Posted Posted in Assessment, Interventions

由来自苏格兰阿伯丁大学玛丽·约翰斯顿(Marie Johnston)和德里克·约翰斯顿(Derek Johnston)撰稿

从业者经常想要得到针对一个人、一个医疗团队、一家医院或一个地区等问题的答案。例如,了解一个肥胖的男人多久吃一次零食,何时何地吃零食,以及压力是否会使情况变得更糟可能是很重要的。或者你可能想知道医疗团队成员忽略手卫生,频率如果他们人手不足时是否情况会更糟,还有,病房的宣传是否对这种情况有所改善。或者您可能正在调查临床错误的来源,以检查这些错误在某些病房或某些级别的工作人员中是否更常见。或者,在政策层面上,调查一项新的规定,比如公共场所的禁烟令是否影响了吸烟率,可能是很有价值的。

你可以试着通过询问人们的想法或记忆来回答这些问题,但最好在关键时刻和地点提出或观察,以避免偏见和遗忘的问题。最近的技术进步,如使用智能手机进行数字监控,使得实时跟踪正在发生的事情变得更加容易,一项单病例随机对照试验的研究为你回答问题提供了可能性。

当问题可以反复评估以观察随时间的变化时,可以进行单病例随机对照试验的研究。然后我们可以描述这个问题,并检验在某些条件下它是好是坏。或者可以引入新的干预或治疗,并评估其是否具有所预期的效果。

对所收集数据的最简单评估是观察图表上的趋势,如下图所示。这是任何单病例随机对照试验分析中的一个重要步骤,并且是非常充分的。此外,还有更多用于单病例随机对照试验研究的统计分析方法。更复杂的方法还在继续发展(例如,评估动态变化的方法)。

(more…)

老年体育:多少运动量足够?

Posted Posted in Goal setting, Motivational interviewing, Self-monitoring

由澳大利亚悉尼大学安妮·蒂德曼(Anne Tiedemann)撰稿

“缺乏活动破坏了每个人的良好状态,而运动和有系统的体育锻炼可以挽救和保存它” …——柏拉图,公元前400年

众所周知,养成定期体育运动的习惯对健康和幸福十分重要。但是健康促进的信息常常针对儿童和青年人,较少关注体育运动对65周岁及以上人群的影响。然而,老年时期是形成每天运动习惯的关键时期。

(more…)

Raising weight in a consultation

Posted Posted in Communication

By Jane Ogden, University of Surrey, UK

Weight is a tricky problem to talk about in a consultation. Some patients may be sick of hearing the words ‘You could lose some weight’ every time they visit the clinic: regardless of whether they have come in because of a sore throat, a cervical smear or a potential heart problem. They may have experienced a lifetime of feeling stigmatised by the medical profession and think that all anyone ever sees is their body size. While this is so for some individuals, others may have never considered their weight as an issue, and could be insulted or surprised if it is raised. Some people may simply not want to hear the message and block out whatever is said, thinking for example ‘what do you know – you’re thin / fat / too young / too old’ or ‘science is always wrong.’ Raising the issue of weight therefore requires careful management of ‘when,’ ‘how’ and ‘what’ is said to an overweight person.

(more…)

Self-efficacy: The “can-do” belief that lets people change their lifestyles

Posted Posted in Motivation, Self-efficacy

By Ralf Schwarzer, Freie Universität Berlin, Germany and SWPS University of Social Sciences and Humanities, Poland

Changing behavior may often be desirable but difficult to do. For example, quitting smoking, eating healthily and sticking to a physical exercise regimen all require motivation, effort, and persistence. While many psychological factors play a role in behavior change, self-efficacy is one of the most important.

(more…)

Telling stories about caring for others

Posted Posted in Social Support

By Irina Todorova, Health Psychology Research Center in Sofia, Bulgaria

Taking care of aging loved ones, who are perhaps in frail health, can be a complicated and confusing experience that is both gratifying and frustrating. Medical science is helping people live longer, healthier lives, and in some cases can slow down the cognitive decline that frequently come with age. The way that families care for older members, as well as the meaning of aging, dementia and caregiving varies across cultural contexts. Most people are aging at home as members of their communities, which has psychosocial benefits for the older person as well as for the different generations of family members. At the same time, caring for people with declining health is accompanied with physical effort, psychological strain, grief related to ongoing loss and possibly financial difficulties for the caregiver. (more…)

Motivation and the first steps toward physical activity

Posted Posted in Goal setting, Motivation, Self-regulation

By Keegan Knittle, University of Helsinki, Finland

Here’s a familiar story from primary care: an individual who would clearly benefit from more physical activity comes into the clinic. We discuss their physical (in)activity, and in the end, the person says they just aren’t motivated to change. What’s a clinician supposed to do? How can we motivate this person to at least consider changing their behavior for the better? Or better yet, how can we help them to form good intentions for being active?

(more…)

Positive psychology interventions at work

Posted Posted in Intervention design, Interventions

By Alexandra Michel, Federal Institute for Occupational Health and Safety, Germany and Annekatrin Hoppe, Humboldt Universität, Germany

Employees spend a major part of their waking time at work. It is no surprise then that reducing demands and increasing resources (e.g., autonomy, social support, self-efficacy) at work are important in promoting employees’ work-life balance, well-being and health. Over the last years, research has examined not only ways to repair the negative consequences of work stress, but also ways to promote resources to improve employees’ well-being at work. Especially, introducing positive psychology interventions to the workplace is a new avenue in the occupational health psychology field. Positive psychology interventions focus on building resources and preventing resource loss, and include activities that aim to cultivate positive feelings, behaviors and cognitions. In this blog post, we highlight three approaches that can help employees to build their resources and foster well-being at work.

(more…)

Patient talk: What the doctor clearly says, and the patient clearly does not understand

Posted Posted in Communication

By Anne Marie Plass, University Medical Center of Göttingen, Germany

Sometime ago a dermatologist who works as a psoriasis (a chronic skin disorder) -specialist in a university hospital, complained to me about many patients who do not adhere to the therapy, even though a mutual goal has been set, and a shared decision has been made.

(more…)

What happens with medications when they go home?

Posted Posted in Medication adherence

By Kerry Chamberlain, Massey University, Auckland, New Zealand

What do people do with medications once they enter the home? Surprisingly, limited research has attempted to answer that question. Yet, it is important – most medications are consumed at home under the control of the consumer. Prescription medicines are regulated, but once prescribed and collected, they are presumed to be taken as directed. People also can access and use a wide range of over-the-counter medications (e.g., for pain relief), alternative medications (e.g., homeopathic preparations), and other health-related preparations that are less obviously medications (e.g., dietary supplements, probiotic drinks). However, we should note that access to all forms of medication can vary considerably between countries.

(more…)

How to set goals that work?

Posted Posted in Goal setting, Planning

By Tracy Epton, University of Manchester, United Kingdom

Goal setting is a popular technique

There are many different techniques that can be used to change behaviour (93 according to a recent list!). Goal setting is a well-known technique that most people have used at some point. Goal setting is used by charities (e.g., Alcohol Concern, a UK charity, asked people to set a goal to quit drinking for the month of January), as part of commercial weight loss programmes and even in fitness apps. One recent review looked at a 384 tests of the effectiveness of goal setting across a range of different fields to see if goal setting really works, which types of goals work best and if goal setting works for everyone.

(more…)