{"id":1513,"date":"2019-11-01T14:49:04","date_gmt":"2019-11-01T14:49:04","guid":{"rendered":"http:\/\/practicalhealthpsychology.com\/?p=1513"},"modified":"2025-11-04T14:24:18","modified_gmt":"2025-11-04T14:24:18","slug":"n-of-1-studies-what-can-we-learn-by-studying-a-single-case","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/lv\/2019\/11\/n-of-1-studies-what-can-we-learn-by-studying-a-single-case\/","title":{"rendered":"“N-of-1” dizaina p\u0113t\u012bjumi: ko var uzzin\u0101t, izp\u0113tot atsevi\u0161\u0137u gad\u012bjumu?"},"content":{"rendered":"

M\u0113rija D\u017eonstone (Marie Johnston) un Dereks D\u017eonstons (Derek Johnston), Aberd\u012bnas universit\u0101te, Skotija<\/b><\/p>\n

Vesel\u012bbas apr\u016bpes speci\u0101listiem nereti ir j\u0101atrod atbilde uz jaut\u0101jumu, kas skar vienu cilv\u0113ku, vienu vesel\u012bbas apr\u016bpes komandu, vienu slimn\u012bcu, vienu re\u0123ionu, u. tml. Piem\u0113ram, var b\u016bt svar\u012bgi noskaidrot, cik bie\u017ei cilv\u0113ks ar lieko svaru na\u0161\u0137\u0113jas, kad un kur vi\u0146\u0161 to dara, vai stress palielina tieksmi p\u0113c na\u0161\u0137iem. Var b\u016bt svar\u012bgi uzzin\u0101t, cik bie\u017ei vesel\u012bbas apr\u016bpes komandas locek\u013ci ir nev\u0113r\u012bgi pret roku higi\u0113nu, vai roku higi\u0113nas st\u0101voklis k\u013c\u016bst slikt\u0101ks darbinieku tr\u016bkuma apst\u0101k\u013cos, vai \u0161o st\u0101vokli var uzlabot ar noda\u013c\u0101s izvietotiem plak\u0101tiem, kas atg\u0101dina par roku higi\u0113nu. Var b\u016bt situ\u0101cija, kad j\u0101atrod kl\u012bnisk\u0101s prakses k\u013c\u016bdu c\u0113lo\u0146i, j\u0101p\u0101rbauda, vai k\u0101d\u0101 noda\u013c\u0101 k\u013c\u016bdu gad\u012bjumu nav vair\u0101k k\u0101 citur, vai st\u0101vokli ietekm\u0113 person\u0101la kvalifik\u0101cija. Politikas l\u012bmen\u012b var b\u016bt v\u0113rt\u012bgi izp\u0113t\u012bt, vai jauna regula, piem\u0113ram, sm\u0113\u0137\u0113\u0161anas aizliegums sabiedrisk\u0101s viet\u0101s, ir ietekm\u0113jusi sm\u0113\u0137\u0113\u0161anas bie\u017eumu.\u00a0<\/span><\/p>\n

Atbildes uz \u0161iem jaut\u0101jumiem var censties noskaidrot, p\u0113c laika aptauj\u0101jot cilv\u0113kus \u2012 vaic\u0101jot, k\u0101 vi\u0146i uzskata un ko atceras. Ta\u010du lab\u0101k, ja iesp\u0113jams jaut\u0101t vai nov\u0113rot uzreiz kritiskajos br\u012b\u017eos un viet\u0101s, lai samazin\u0101tu neobjektivit\u0101tes un aizmir\u0161anas risku. Jaun\u0101kie tehnolo\u0123iskie sasniegumi, piem\u0113ram, digit\u0101l\u0101 uzraudz\u012bba ar viedt\u0101lru\u0146u pal\u012bdz\u012bbu, \u013cauj viegl\u0101k izsekot notieko\u0161ajam re\u0101laj\u0101 laik\u0101, t\u0101d\u0113j\u0101di “N-of-1” dizaina p\u0113t\u012bjums var sniegt atbildes uz aktu\u0101lajiem jaut\u0101jumiem.<\/span><\/p>\n

“N-of-1” dizainu var izmantot gad\u012bjumos, kad p\u0113t\u0101mo jaut\u0101jumu iesp\u0113jams <\/span>apl\u016bkot atk\u0101rtoti<\/span><\/a>, lai konstat\u0113tu, k\u0101das izmai\u0146as rodas laika gait\u0101. Tad var aprakst\u012bt probl\u0113mu un p\u0101rbaud\u012bt, k\u0101 t\u0101 padzi\u013cin\u0101s vai samazin\u0101s saist\u012bb\u0101 ar noteiktiem apst\u0101k\u013ciem. To var izmantot ar\u012b, ievie\u0161ot jaunu intervences vai \u0101rst\u0113\u0161anas metodi, lai nov\u0113rt\u0113tu, vai metode pal\u012bdz sasniegt pl\u0101noto izn\u0101kumu.<\/span><\/p>\n

Vienk\u0101r\u0161\u0101kais sav\u0101kto datu nov\u0113rt\u0113jums ir tenden\u010du diagramma, k\u0101 par\u0101d\u012bts rakstam pievienotaj\u0101s ilustr\u0101cij\u0101s. Tas ir svar\u012bgs solis jebkur\u0101 “N-of-1” dizaina p\u0113t\u012bjum\u0101, un reizumis ar to var b\u016bt pietiekami. Papildu izv\u0113rt\u0113jumam var izmantot <\/span>statistisko anal\u012bzi<\/span><\/a>. Tiek att\u012bst\u012btas ar\u012b sare\u017e\u0123\u012bt\u0101kas metodes (piem\u0113ram, <\/span>dinamisko izmai\u0146u nov\u0113rt\u0113\u0161anas metode<\/span><\/a>).<\/span><\/p>\n

<\/p>\n

“N-of-1” dizaina p\u0113t\u012bjuma izmanto\u0161ana probl\u0113mas izv\u0113rt\u0113\u0161anai<\/b><\/p>\n

Var veikt p\u0113t\u012bjumu, lai noteiktu probl\u0113mas nopietn\u012bbu, bie\u017eumu vai izpausmju modeli laika gait\u0101. 1.\u00a0att\u0113l\u0101 redzams, ka trauksmes l\u012bmenis periodiski main\u0101s, bet \u0161aj\u0101s izmai\u0146\u0101s iesp\u0113jams saskat\u012bt noteiktu modeli. Re\u0123istr\u0113jot ar\u012b darba grafiku, var konstat\u0113t, ka redzamais modelis par\u0101da at\u0161\u0137ir\u012bbu starp ned\u0113\u013cas nogal\u0113m un piec\u0101m darba dien\u0101m, kas var nor\u0101d\u012bt, ka persona izj\u016bt trauksmi darb\u0101, bet ne m\u0101j\u0101s. \u0160\u0101da inform\u0101cija var\u0113tu izr\u0101d\u012bties noder\u012bga, izv\u0113loties <\/span>pacientam<\/span><\/a> optim\u0101lo \u0101rst\u0113\u0161anas metodi. Piem\u0113ram, re\u0123istr\u0113jot <\/span>paliat\u012bvaj\u0101 apr\u016bp\u0113 eso\u0161as sievietes<\/span><\/a> noska\u0146ojumu da\u017e\u0101dos diennakts laikos, tika atrasts modelis, ko var\u0113ja izmantot nom\u0101kt\u0101 garast\u0101vok\u013ca uzlabo\u0161anai.\u00a0<\/span><\/p>\n

“N-of-1” dizaina p\u0113t\u012bjumos apkopot\u0101 inform\u0101cija var izr\u0101d\u012bties pietiekama ne tikai tam, lai aprakst\u012btu probl\u0113mu, bet ar\u012b, lai pal\u012bdz\u0113tu izskaidrot nov\u0113roto. Piem\u0113ram, \u0101rstam var b\u016bt k\u0101da teorija par apst\u0101k\u013ciem, kas ietekm\u0113 nov\u0113rojamo probl\u0113mu, un ar p\u0113t\u012bjuma pal\u012bdz\u012bbu iesp\u0113jams p\u0101rbaud\u012bt, vai un k\u0101 \u0161\u012b <\/span>teorija izskaidro nov\u0113rot\u0101s par\u0101d\u012bbas<\/span><\/a>. Paliat\u012bvaj\u0101 apr\u016bp\u0113 eso\u0161\u0101s sievietes gad\u012bjum\u0101 vi\u0146as domu un darb\u012bbu re\u0123istr\u0113\u0161ana apstiprin\u0101ja teoriju, ka vi\u0146as garast\u0101vokli ietekm\u0113 domas, un kritisk\u0101s domas bija saist\u012btas ar agra r\u012bta aktivit\u0101t\u0113m.<\/span><\/p>\n

1. att\u0113ls. <\/b>“N-of-1” dizaina p\u0113t\u012bjums, lai aprakst\u012btu probl\u0113mu: trauksmes nov\u0113rt\u0113jums <\/i>\u2012 zil\u0101 kr\u0101s\u0101, darba dienas <\/i>\u2012 sarkan\u0101 kr\u0101s\u0101, 24 dienu periods<\/i><\/p>\n

\"\"<\/p>\n

“N-of-1” dizaina p\u0113t\u012bjuma izmanto\u0161ana, lai izv\u0113rt\u0113tu, k\u0101 konkr\u0113ts notikums vai par\u0101d\u012bba ietekm\u0113 probl\u0113mas smagumu<\/b><\/p>\n

Probl\u0113mas var mazin\u0101t vai padzi\u013cin\u0101t da\u017e\u0101di pl\u0101noti un nepl\u0101noti notikumi, piem\u0113ram, \u0123imenes locek\u013ca n\u0101ve vai k\u0101zas, raid\u012bjums vai raksts par k\u0101du vesel\u012bbas jaut\u0101jumu pla\u0161sazi\u0146as l\u012bdzek\u013cos, k\u0101 ar\u012b, piem\u0113ram, r\u016bpn\u012bcas sl\u0113g\u0161ana vai pat laika apst\u0101k\u013ci. 2.\u00a0att\u0113l\u0101 atainots, k\u0101 ned\u0113\u013cas laik\u0101 p\u0113c telev\u012bzijas raid\u012bjuma par gripu palielin\u0101j\u0101s \u0101rsta apmekl\u0113jumu skaits saist\u012bb\u0101 ar s\u016bdz\u012bb\u0101m par iesp\u0113jamu gripu, kas lika secin\u0101t, ka apmekl\u0113jumu skaita pieaugums nav izskaidrojams ar re\u0101lu epid\u0113miju, k\u0101 ar\u012b secin\u0101t, ka n\u0101kotn\u0113 vesel\u012bbas apr\u016bpes dienesti var\u0113tu paredz\u0113t \u0161\u0101du apmekl\u0113jumu skaita pieaugumu p\u0113c tam, kad pres\u0113 izskan\u0113tu inform\u0101cija par iesp\u0113jam\u0101m slim\u012bb\u0101m. Bet “N-of-1” datu anal\u012bze par izmai\u0146\u0101m sirdsdarb\u012bbas trauc\u0113jumu gad\u012bjumu statistik\u0101 k\u0101d\u0101 Anglijas slimn\u012bc\u0101 uzr\u0101d\u012bja sporta pas\u0101kuma ietekmi: \u0161o <\/span>gad\u012bjumu skaits bija pieaudzis saist\u012bb\u0101 ar noz\u012bm\u012bgu futbola sp\u0113li<\/span><\/a> 1998. gada pasaules kausa izc\u012b\u0146as laik\u0101.<\/span><\/p>\n

2. att\u0113ls. <\/b>“N-of-1” dizaina p\u0113t\u012bjums, lai nov\u0113rt\u0113tu konkr\u0113ta notikuma ietekmi: ik dienu notiek apm\u0113ram 40 apmekl\u0113jumi saist\u012bb\u0101 ar gripu, bet p\u0113c TV p\u0101rraides (par\u0101d\u012bta ar zilo bulti\u0146u) apmekl\u0113jumu bie\u017eums krietni pieaug<\/i><\/p>\n

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“N-of-1” dizaina p\u0113t\u012bjuma izmanto\u0161ana, lai izv\u0113rt\u0113tu intervences vai \u0101rst\u0113\u0161anas metodes efektivit\u0101ti<\/b><\/p>\n

“N-of-1” metodes var izmantot, izstr\u0101d\u0101jot <\/span>jaunas kl\u012bnisk\u0101s intervences vai vesel\u012bbas politikas pas\u0101kumus<\/span><\/a>. 3. att\u0113l\u0101 apskat\u0101ms, k\u0101 main\u0101s na\u0161\u0137u lieto\u0161anas paradumi pacientam ar aptauko\u0161anos: s\u0101kum\u0101 pacients na\u0161\u0137\u0113jas 7 reizes dien\u0101, bet p\u0113c intervences, kura att\u0113lota ar sarkanu bulti\u0146u (iesp\u0113jams, ka s\u0101kts izmantot pa\u0161uzraudz\u012bbas metodi), na\u0161\u0137\u0113\u0161an\u0101s rei\u017eu skaits samazin\u0101s l\u012bdz 2 reiz\u0113m dien\u0101.<\/span><\/p>\n

L\u012bdz\u012bgas metodes var izmantot, lai izp\u0113t\u012btu iedz\u012bvot\u0101ju <\/span>sm\u0113\u0137\u0113\u0161anas<\/span><\/a> paradumus un nov\u0113rt\u0113tu, vai tos maina t\u0101di politikas pas\u0101kumi k\u0101 sm\u0113\u0137\u0113\u0161anas aizliegums sabiedrisk\u0101s viet\u0101s, respekt\u012bvi, lai izv\u0113rt\u0113tu, <\/span>k\u0101 valsts politika ietekm\u0113 sm\u0113\u0137\u0113\u0161anu<\/span><\/a>.<\/span><\/p>\n

Labu “N-of-1” dizaina p\u0113t\u012bjuma rezult\u0101tu praktiska izmantojuma piem\u0113ru sniedz k\u0101da vesel\u012bbas apr\u016bpes iest\u0101\u017eu kopiena. Taj\u0101 tika izv\u0113rt\u0113ts, ka no 2001. l\u012bdz 2006. gadam iest\u0101d\u0113s ir tiku\u0161i novilcin\u0101ti zi\u0146ojumi par z\u0101\u013cu blakuspar\u0101d\u012bb\u0101m. Kaut ar\u012b novilcin\u0101\u0161ana bijusi da\u017e\u0101da, t\u0101 ir rad\u012bjusi probl\u0113mas pacientu dro\u0161\u012bbas programmas \u012bsteno\u0161an\u0101, un laika gait\u0101 st\u0101voklis nav uzlabojies. 2007. un 2008. gad\u0101 tika ieviesta programma, lai sekm\u0113tu labu sniegumu atz\u012b\u0161anu, un tas pan\u0101ca zi\u0146ojumu kav\u0113\u0161an\u0101s samazin\u0101\u0161anos n\u0101kamajos gados \u2012 \u0101rsti vairs nevilcin\u0101j\u0101s zi\u0146ot par blakuspar\u0101d\u012bb\u0101m, jo tas bija iek\u013cauts laba sniegumu v\u0113rt\u0113\u0161anas krit\u0113rijos.<\/span><\/p>\n

    \n
  1. att\u0113ls<\/b>: “N-of-1” dizaina p\u0113t\u012bjums, lai nov\u0113rt\u0113tu intervences efektu: <\/span>na\u0161\u0137\u0113\u0161an\u0101s bie\u017eums pirmaj\u0101s 15 dien\u0101s un t\u0101 samazin\u0101jums, s\u0101kot ar 16. dienu (par\u0101d\u012bta ar sarkanu bulti\u0146u), kad s\u0101kta uzkodu \u0113\u0161anas pa\u0161uzraudz\u012bba<\/span><\/i><\/b><\/li>\n<\/ol>\n

    \"\"<\/p>\n

    Iesp\u0113jam\u0101s gr\u016bt\u012bbas<\/b><\/p>\n

    Datu v\u0101k\u0161ana ne vienm\u0113r ir vienk\u0101r\u0161a. Bie\u017ea atk\u0101rtota m\u0113r\u012b\u0161ana var b\u016bt apgr\u016btino\u0161a, un \u0161\u012bs gr\u016bt\u012bbas var izrais\u012bt noteiktu datu iztr\u016bkumu. Ta\u010du pa\u0161reiz\u0113j\u0101 strauj\u0101 pieejamo digit\u0101lo un mobilo tehnolo\u0123iju \u2012 viedt\u0101lru\u0146u, n\u0113s\u0101jamo viedier\u012b\u010du un sensoru \u2012 att\u012bst\u012bba datu v\u0101k\u0161anu padara viegl\u0101ku un dro\u0161\u0101ku.\u00a0<\/span><\/p>\n

    Praktiski ieteikumi<\/b><\/p>\n