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Biomedical subjects

G P Koocher

Publications and source records attributed to G P Koocher.

At least 19 recordsLinked to original sources
PubMed2002

Using the CABLES model to assess and minimize risk in research: control group hazards.

CABLES is both an acronym and metaphor for conceptualizing research participation risk by considering 6 distinct domains in which risks of harm to research participants may exist: cognitive, affective, biological, legal, economic, and social/cultural. These domains are described and illustrated, along with suggestions for minimizing or eliminating the potential hazards to human participants in biomedical and behavioral science research. Adoption of a thoughtful ethical analysis addressing all 6 CABLES strands in designing research provides a strong protective step toward safeguarding and promoting the well-being of study participants.

Behavioral Research↗
PubMed2001

Detecting suicide risk in a pediatric emergency department: development of a brief screening tool.

OBJECTIVE: To develop a brief screening tool that will allow emergency department (ED) staff to rapidly and accurately detect suicide risk in child and adolescent patients. DESIGN: Cross-sectional survey. Participants. One hundred forty-four children and adolescents, mean age of 13.6 years, presenting to an urban university teaching hospital pediatric ED for primarily psychiatric reasons. Data Collection. As part of a quality improvement initiative, we developed a 14-item screening survey (the Risk of Suicide Questionnaire [RSQ]) that was administered by a triage nurse to all pediatric mental health patients on admission to the ED. All patients were subsequently administered the 30-item Suicide Ideation Questionnaire (SIQ) by a mental health clinician, which served as the criterion standard assessment of suicidality. Other information collected included demographic and clinical characteristics. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve for responses to individual and combinations of RSQ items, relative to determinations of suicidality by the criterion standard SIQ. RESULTS: Four of the items from the RSQ had a predictive c statistic of 0.87, a sensitivity of 0.98, and a NPV of 0.97. Little improvement in predictive ability was obtained by including other RSQ items (c statistic for the most predictive 4-item model = 0.87; c statistic for the model containing all 14 items = 0.90). Among all possible combinations of 4 RSQ items, the combination of items inquiring about current suicidal behavior, past suicidal ideation, past self-destructive behavior, and current stressors yielded the highest sensitivity (0.98), NPV (0.97), and c statistic (0.87), as assessed by the criterion standard SIQ. CONCLUSIONS: A brief 4-item screening tool can be used by nonmental health clinicians to accurately detect suicidality in children and adolescents who visit an ED. Early and accurate identification of suicidality is a critical first step that could lead to better treatment and improved health outcomes for children and adolescents with mental health concerns.

Adolescent↗
PubMed1995

Psychological science and the use of anatomically detailed dolls in child sexual-abuse assessments.

Many devices are used in child assessment and treatment as communication aids, projective tools, and symbolic means of interaction. None are as hotly debated in their application among mental health professionals as dolls with genital details. Anatomically detailed (AD) dolls are often used in sexual-abuse evaluation and treatment with children, but such applications are controversial. This article is the product of a working group formed to review AD doll research and practice. This article reviews historical use of dolls in clinical inquiry and research on sexual behaviors in children, normative use of AD dolls in nonreferred children, differences in children's play behavior and emotional reactions to AD dolls, and memory and suggestibility issues relating to AD-doll use. Recommendations for future research are provided.

Child↗
PubMed1995

Confidentiality in psychological practice.

Confidentiality has long been a cornerstone of trust in the professional relationship between psychologists and their clients. Developments in computer technology, litigation, insurance reimbursement schemes, and changing lifestyles are forcing psychologists to reconsider and refine their approach to respecting this important ethical principle. This article review basic concepts on the matter, and discusses these in light of evolving issues in practice, technology, and the law. Some contrasts in legal and ethical aspects of confidentiality between Australia and the United States are discussed. Recommendations for enhancing attention to confidentiality in one's practice are included.

Access to Information↗
PubMed1994

The commerce of professional psychology and the new ethics code.

The 1992 version of the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct brings some changes in requirements and new specificity to the practice of psychology. The impact of the new code on therapeutic contracts, informed consent to psychological services, advertising, financial aspects of psychological practice, and other topics related to the commerce of professional psychology are discussed. The genesis of many new thrusts in the code is reviewed from the perspective of psychological service provider. Specific recommendations for improved attention to ethical matters in professional practice are made.

Advertising↗
PubMed1993

The institutional review board as a mirror of scientific and ethical standards.

Decisions by institutional review boards (IRBs) are presumed to reflect the norms and standards of the scientific community. Such criteria have shifted as changes have occurred in experimental interventions and protocols, codes of federal regulatory agencies, norms among investigators, and expectations of participants. The tension created by shifting norms and standards raises two questions: (a) Should IRBs evaluate the scientific (e.g., design) features of the proposed research, and (b) should consistent standards be expected even in areas that are in constant flux (e.g., AIDS research)? We discuss these questions and propose a mechanism to keep IRBs abreast of emergent issues and sensitized not only to the costs of doing research but also to the costs of not doing it.

Animal Experimentation↗
PubMed1991

Questionable methods in alcoholism research.

Alcoholism research paradigms that use substantial cash incentives to attract participants and that call for inducing alcoholics to consume ethanol in the laboratory raise significant ethical questions. Nonalcoholic family members observing such study methods may also suffer subtle emotional anguish by virtue of their participation. When using such questionable methods, investigators should be obligated to discuss their risk-benefit rationales and detail their precautionary behaviors to protect participants. Discussion of these ethical problems should be mandatory in any publications resulting from such research paradigms.

Adolescent↗
PubMed1991

Perceptions of medical compliance in children and adolescents with cystic fibrosis.

One hundred patients aged 5 through 20 years with cystic fibrosis, their parents, and their physicians were interviewed to assess patients' perceptions of compliance with prescribed treatments. Measures included self-administered questionnaires and the Medical Compliance Incomplete Stories Test. It was hypothesized that age-related differences in perceived compliance would be found and that such perceptions would vary as a function of four sociobehavioral factors (perceived severity of illness, optimism, level of independence in medical therapy, and degree of knowledge/understanding of illness). In addition, it was anticipated that the relationships between perceived compliance and the sociobehavioral factors would vary with age. Support for each hypothesis was found. Perceived compliance was related to age, with younger children showing greater perceived compliance to the medication regimen. Better perceived compliance was found to be associated with higher levels of optimism and child knowledge of the disease. Age differences in relationships between perceived compliance and optimism and child knowledge were found. Developmental implications for practice and future research are suggested.

Adolescent↗
PubMed1990

Typologies of nonadherence in cystic fibrosis.

The complex and arduous treatments required to maintain the health and prolong the life of patients with cystic fibrosis combine with other factors to create a climate within which the active following of prescribed medical treatment is often compromised. The authors' clinical experience and collection of descriptions of more than 1,200 critical incidents from 223 patients and members of their immediate families has led to the description of three basic typologies of nonadherence or noncompliance in the medical treatment of this illness. These are inadequate knowledge, psychosocial resistance, and educated nonadherence. Clinical use of this conceptual framework may enhance diagnostic and treatment efforts. Although the specific application described is concerned with cystic fibrosis, it seems reasonable to conclude that the same principles are applicable to other chronic illnesses of childhood.

Adolescent↗
PubMed1990

Children's competence to consent to medical procedures.

Children's competence to consent to medical treatment is discussed in terms of basic principles of child development and central concepts in the consent process. Case examples are presented to highlight current problems relevant to children's consent in medical treatment which pediatricians are likely to encounter.

Child↗
PubMed1987

Medical compliance and coping with cystic fibrosis.

This investigation evaluated the utility of a new assessment tool based on a competency/coping skills model in predicting medical compliance of adolescents with cystic fibrosis. The Medical Compliance Incomplete Stories Test (M-CIST) and an assessment of several coping behaviors identified as assisting chronically ill children in their adaptation were used with 40 adolescent inpatients aged 13-23. These data were compared to objective measures of the patient's medical compliance. The total M-CIST score was shown to be positively correlated with compliance and to significantly discriminate between compliant and non-compliant groups. Although the assessment of coping behaviors also discriminates significantly between the two groups, it provided no additional power when used in common with the M-CIST. The data identified differences in coping behaviors between compliant and non-compliant patients which may prove useful to clinicians treating adolescents with cystic fibrosis.

Adaptation, Psychological↗
PubMed1986

Psychosocial issues during the acute treatment of pediatric cancer.

Facilitating the psychosocial adjustment of the child with cancer begins at the time of diagnosis. This paper reviews the current status of psychosocial research and interventions useful during the acute phase of cancer treatment. Factors related to a favorable adaptation include the child's understanding of what is happening and the ability of the family to provide emotional support. Recent data suggest that a child's adjustment is closely linked to the social supports available to the parents and to parental distress levels. Continued progress has been made in the use of psychological techniques to control the behavioral side effects of chemotherapy and children's distress levels during painful medical procedures. New research has also identified a number of factors related to treatment refusal and noncompliance among adolescent cancer patients. These new developments provide a basis for programs aimed at preventing or reducing the psychosocial problems of the child and family facing pediatric cancer.

Adaptation, Psychological↗
PubMed1986

Predicting medical compliance among adolescents with cystic fibrosis.

This investigation evaluated the utility of a new assessment tool based on a competency/coping skills model in predicting medical compliance of adolescents with cystic fibrosis. The Medical Compliance Incomplete Stories Test (M-CIST) was administered to 40 adolescent and young adult inpatients aged 13 to 23. These data were compared to objective measures of the patient's medical compliance. The M-CIST was positively correlated with compliance (multiple R = .72, p less than .001) and discriminated compliant from noncompliant patients. Data derived from patients' responses on the assessment tool could also be used projectively to provide information useful to clinicians treating adolescents with cystic fibrosis.

Adolescent↗