Formalizing psychological interventions through network control theory.

Despite the growing deployment of network representation to comprehend psychological phenomena, the question of whether and how networks can effectively describe the effects of psychological interventions remains elusive. Network control theory, the engineering study of networked interventions, has recently emerged as a viable methodology to characterize and guide interventions. However, there is a scarcity of empirical studies testing the extent to which it can be useful within a psychological context. In this paper, we investigate a representative psychological intervention experiment, use network control theory to model the intervention and predict its effect. Using this data, we showed that: (1) the observed psychological effect, in terms of sensitivity and specificity, relates to the regional network control theoretic metrics (average and modal controllability), (2) the size of change following intervention negatively correlates with a whole-network topology that quantifies the "ease" of change as described by control theory (control energy), and (3) responses after intervention can be predicted based on formal results from control theory. These insights assert that network control theory has significant potential as a tool for investigating psychological interventions. Drawing on this specific example and the overarching framework of network control theory, we further elaborate on the conceptualization of psychological interventions, methodological considerations, and future directions in this burgeoning field.

Network controllability measures of subnetworks: implications for neurosciences.

Objective:Recent progress in network sciences has made it possible to apply key findings from control theory to the study of networks. Referred to as network control theory, this framework describes how the interactions between interconnected system elements and external energy sources, potentially constrained by different optimality criteria, result in complex network behavior. A typical example is the quantification of the functional role certain brain regions or symptoms play in shaping the temporal dynamics of brain activity or the clinical course of a disease, a property that is quantified in terms of the so-called controllability metrics. Critically though, contrary to the engineering context in which control theory was originally developed, a mathematical understanding of the network nodes and connections in neurosciences cannot be assumed. For instance, in the case of psychological systems such as those studied to understand psychiatric disorders, a potentially large set of related variables are unknown. As such, while the measures offered by network control theory would be mathematically correct, in that they can be calculated with high precision, they could have little translational values with respect to their putative role suggested by controllability metrics. It is therefore critical to understand if and how the controllability metrics estimated over subnetworks would deviate, if access to the complete set of variables, as is common in neurosciences, cannot be taken for granted.Approach:In this paper, we use a host of simulations based on synthetic as well as structural magnetic resonance imaging (MRI) data to study the potential deviation of controllability metrics in sub- compared to the full networks. Specifically, we estimate average- and modal-controllability, two of the most widely used controllability measures in neurosciences, in a large number of settings where we systematically vary network type, network size, and edge density.Main results:We find out, across all network types we test, that average and modal controllability are systematically, over- or underestimated depending on the number of nodes in the sub- and full network and the edge density.Significance:Finally, we provide formal theoretical proof that our observations generalize to any network type and discuss the ramifications of this systematic bias and potential solutions to alleviate the problem.

O agir em competência para o cuidado especializado na saúde bucal / The competence to act in the specialized care in oral health care

O estudo possui o objetivo principal de ampliar a compreensão sobre a produção do "agir em competência" para o cuidado especializado na atenção à saúde bucal. A abordagem metodológica utilizou análises qualitativas e quantitativas. Um questionário online com 32 questões organizadas em cinco blocos temá-ticos foi respondido de forma anônima por estagiários de Odontologia nos serviços do Sistema Único de Saúde. Categorias temáticas e componentes analisadores foram sistematizados: protocolos, campos de estágio, atividades de educação à distância e dinâmicas pedagógicas. Os dados quantitativos foram analisados pela freqüência das respostas fechadas. Com relação às questões abertas o objetivo foi analisá-las procurando alcançar o sentido e não apenas o conteúdo do texto. Os resultados evidenciaram que a experiência de integração ensino-serviço analisada está proporcionando aprendizagens significativas sobre o funcionamento das redes de atenção especializada em saúde bucal e o desenvolvimento de competências para a resolução de problemas. A modificação de protocolos da atenção especializada em saúde bucal é uma experiência constante vivenciada pelos estagiários nos campos de estágio. Os aspectos da experiência com maior potencial inovador, político e pedagógico (os campos de gestão, as tutorias e a educação à distância) foram também os que apresentaram maior fragilidade (AU).

The aim of this study was to broaden the understanding of the role of the protocols in the production of an "act jurisdiction" to specialized care in oral health care. The methodological approach used qualitative and quantitative data. An online questionnaire with 32 questions structured into five thematic blocks was applied to the trainees to respond anonymously. Themes and components analyzers were systematized as: protocols, internship field, distance education activities and educational methods. Quantitative data were analyzed by frequency of closed answers. In relation to the open questions the objective was to analyze them deeply to achieve a sense, not only the text content. The results showed that the experience of learning-service integration is providing a meaningful learning about the operation of networks of specialized dental care and in the development of skills for solving problems. The modification of the specialized dental care protocols is a constant experience lived by the trainees in the fields of internship. The experience aspects with greater potential of either political or pedagogical innovation were the fields of management, mentoring and distance education. However they also exhibited the greatest weakness (AU).

Toward collecting a standardized nursing data set across the continuum: case of adult care nurse practitioner setting.

Viable strategies are needed to move toward collection of a standardized nursing data set across settings for eventual use in examining nursing effectiveness. One strategy is to introduce potential nurse adopters to subsets of valid setting-specific standardized terms and measures to support adoption and initial implementation. The present study was designed to identify the "most clinically useful" NANDA (North American Nursing Diagnoses Association) diagnoses, NOC (Nursing Outcomes Classifications) outcomes, and NIC (Nursing Intervention Classifications) interventions pertinent to the adult care nurse practitioner setting. Ultimately, clinicians must recognize, however, that they will need to use additional terms and measures outside the subsets to more fully describe the nursing care provided.

Establishing the validity, reliability, and sensitivity of NOC in an adult care nurse practitioner setting.

The purpose of this study was to provide evidence of the inter-rater reliability, validity, and sensitivity of a subset of Nursing Outcomes Classification (NOC) measures, including 26 found to be "most clinically useful" in a nurse practitioner setting (NPS). Selected NPS results are compared to those obtained from a larger 10-site study. Results indicated that the measures are valid, reliable, and sensitive as clinical measures of nursing outcomes. Proper education of users can enhance psychometrics. Suggestions for strengthening the measures and further study are outlined.

Assessing the reliability, validity, and sensitivity of nursing outcomes classification in home care settings.

The purpose of this study is to provide evidence of the validity, inter-rater reliability, and sensitivity of 36 clinically useful of Nursing Outcomes Classification (NOC) results for Home Care (HC) settings. The results of inter-rater reliability, criterion-related validity, and sensitivity evaluations of 36 NOC outcomes were compiled from a 10-site regional evaluation of the NOC. Findings of HC and all sites data were contrasted. More than 90% of the inter-rater reliability scores on the 36 NOC outcome label ratings were within one point, with a substantial number of absolute agreements. All but six of the criterion measures were significantly associated with the corresponding NOC outcomes, and most mean change scores were zero or positive. This was impressive evidence of the adequacy of these measures for reliable and valid use in practice.

Toward integrating a common nursing data set in home care to facilitate monitoring outcomes across settings.

The purpose of our research is to identify a realistic subset of North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC), and Nursing Interventions Classification (NIC) terms specific to the home care (HC) setting. A subset of 89 NOC outcomes were identified for study in HC through a baseline survey. Three research assistants then observed the care of 258 patients to whom the 89 NOC outcomes applied and recorded the associated NANDA and NIC terms. Follow-up surveys and focus groups were conducted with the nurses and research assistants. There were 81 different NANDA and 226 NIC labels used to describe study patients' care. Only 36 of the 89 NOC labels studied were deemed clinically useful for HC. We found that expert opinion about terminology usage before actual experience under practice conditions is unreliable.

The HANDS project: studying and refining the automated collection of a cross-setting clinical data set.

The consistent availability of a core set of clinical nursing data is essential to promote quality patient care. Although important work to improve terminology and enhance comparability of data is underway, the efforts do not address the immediate need for useful nursing data sets and valid methods of collection at the point of data entry. The Hands-on Automated Nursing Data System (HANDS) project is dedicated to refining a feasible methodology for gathering, storing, and retrieving a standardized nursing data set. To date the project team has developed and tested a prototype research tool that is automated and contains the structured terminologies (North American Nursing Diagnosis Association, Nursing Outcomes Classification, and Nursing Interventions Classification) to represent nursing diagnoses, outcomes, and interventions, respectively. The Phase I project development activities are reported in this article, along with Phase II and III plans for testing and refining the methodology under actual clinical conditions. Results and lessons learned during Phase I are reported.