Tratamientos de soporte vital al final de la vida: costos y aspectos éticos. Punto de vista en una unidad de cuidados intensivos basado en la metodología Q / Life-support treatments at end of life: Costs and ethical aspects. Point of view in an intensive care unit based on Q methodology

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Patient Factors that Impact upon Cognitive Behavioural Therapy for Psychosis: Therapists' Perspectives.

BACKGROUND: Randomized controlled trials have established that cognitive behavioural therapy (CBT) is effective in helping people with psychosis, though there is enormous variability in outcome. It is not clear what patient factors contribute to good outcomes. In fact, most studies considering client factors have excluded people with psychosis. It is clinicians who are deciding who is likely to benefit from CBT for psychosis (CBTp), though little is understood in terms of their views on who benefits from CBTp. AIMS: This study investigated clinicians' views on client characteristics that influence outcome in CBTp. METHOD: A Q-set of 61 client characteristics was developed from a literature search and interviews with clinicians experienced in working with CBT and/or psychosis. Twenty-one participants (familiar with psychosis and CBT through education, profession, practice or knowledge) rated the items based on their importance in effecting a positive outcome, on a forced normal distribution. RESULTS: 21 completed Q-sorts yielded four factors, named as: acceptance and application of the cognitive model; attending to the present; secure base; meaningful active collaboration. CONCLUSIONS: Items regarding therapeutic alliance were highly endorsed throughout all factors. Some empirically-based items were not endorsed, although overall, clinician responses were consistent with prior research.

Preliminary validation of a romantic attachment orientation measure from the California Adult Q-Sort.

We present data on the preliminary validation of a measure of romantic attachment orientation from the California Adult Q-Sort (CAQ). The CAQ is found in several longitudinal data sets, and researchers can use the CAQ to answer questions about changes in romantic attachment across the lifespan. Expert raters nominated CAQ items that were characteristic of attachment anxiety and avoidance. In a sample of observers and targets, we compared ratings based on composites of these CAQ items to self- and observer-reports from a widely used scale of adult attachment. These expert-generated measures of CAQ-attachment orientation correlated highly with ECR measures of attachment orientation, suggesting that items from the CAQ can reliably measure an individual's attachment orientation.

Using the California Q-sort Measure of Life History Strategy to Predict Sexual Behavioral Outcomes.

The validity of the California Q-set measure of life history (LH) strategy was examined by conducting secondary analyses on longitudinal data that included the Q-sort measure of LH strategy at multiple ages (base year N = 106) and six measures of reproductive behavior. LH strategy Q-sort ratings showed stability from ages 14-23. Additionally, the ratings were found to be good prospective and age concurrent predictors of six reproductive behaviors. LH strategy as rated at age 14 was found to be a significant predictor of age of sexual debut, number of sexual partners, frequency of intercourse, number of abortions, age at birth of first child, and likelihood for having contracted venereal disease as measured up to age 32. Future research should test the further utility of the measure focusing on ways to reduce its cumbersomeness without reducing its ability to predict behavioral outcomes.

Test-retest reliability and discriminant validity of the SWAP-200 in a psychoanalytic treatment sample.

To assess the test-retest reliability of the Shedler-Westen Assessment Procedure-200 (SWAP-200) personality disorder, high functioning, and Q-factor (trait/symptom) scales, we correlated the reports of 47 psychoanalysts describing a patient at the beginning of analysis and at 6 months of analysis. Since the length of psychoanalysis averages almost 6 years, and since personality disorders change slowly, we hypothesized that the test-retest reliabilities of the personality disorder scale scores would be higher than those of the Q-factor scales, which should change more quickly. The average personality disorder scale test-retest reliability was r = .82 and the average Q-factor scale test-retest reliability was r = .64. The values for mismatched cases were .02 and -.05, respectively. Analysts also provided a clinical Diagnostic and Statistical Manual (DSM-IV) diagnosis for each of 77 patients. The SWAP-200 scores for patients with an Axis I diagnosis of depression and for four of the five Axis II diagnoses with four or more cases provide support for the validity of the SWAP-200.

The use of interviews in Q methodology: card content analysis.

BACKGROUND: Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. APPROACH: The purpose of this review is to explore the use of interviews in a Q methodological study. RESULTS: An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined. DISCUSSION: The use of interviews can increase the validity of a Q methodological study by providing the participant's rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.

Development of the Samuels Scale to rate pain management documentation.

Charting deficits and nominal-level data create difficulties when rating pain management documentation (PMD) quality. Researchers developed an interval level rating scale using Q-methodology. Pain entries (340), sorted into patterns, were rank ordered by nine pain management experts and distributed across a 7-point scale. Rankings demonstrated agreement (intraclass correlation coefficient = .96). One factor explained 77.19% of the variance. Reliability and validity were supported. Interval level data enable more robust testing of interventions to improve PMD outcomes.

Use of Q-methodology to identify nursing faculty viewpoints of a collaborative BScN program experience.

The McMaster Mohawk Conestoga Collaborative Bachelor of Science in Nursing Program, established in 2000, brought together three nursing programs from one university and two colleges. The existing university curriculum, which used a problem-based, small-group and student-centred approach, was implemented at all three sites. Considerable adjustments were required by faculty as they adapted to a collaborative approach in implementing this nursing curriculum. Q-methodology was used to identify nursing faculty viewpoints about the collaborative program experience. Sixty-one participants from the three sites completed a 50-item Q-sort representing their statements about collaboration. Data were analyzed using PQMethod version 2.11. Six salient viewpoints were identified: Champions of Collaboration, Proponents of Scholarship and Clinical, Critics of Collaboration, Defenders of McMaster Curriculum, Acceptors of Collaboration and Detractors of the Partnership. On the whole, the collaboration has been a success and a spirit of cooperation prevails. However, a number of faculty issues were identified that should be addressed. The results will be of value to other collaborative nursing programs as they work together to foster faculty commitment and collegiality.

Maternal sensitivity and attachment security in Thailand: cross-cultural validation of Western measures.

The purpose of this study was to examine the psychometric properties of Thai versions of the Maternal Behavior Q-Sort (MBQS), Caldwell's HOME, and the Attachment Q-set (AQS). A sample of 110 Thai mother-infant dyads were studied. The Content Validity Index (CVIs) of the Thai MBQS, HOME and AQS were between 91% and 99%. Internal consistency of the HOME was .71. Interobserver reliability of the MBQS, HOME, and AQS were .95, .87, and .87, respectively. Convergent validity was supported by finding a positive correlation between the MBQS and the HOME (r = .29, p < .001). A positive correlation of .45 (p < .001) between the scores of the MBQS and the AQS indicated concurrent validity of these scales. Study findings indicate the Thai MBQS, HOME, and AQS are reliable and valid in this Thai sample and suggest that the Thai versions reflect concepts similar to those in the original English versions.

Q methodology--a journey into the subjectivity of human mind.

AIMS: This paper introduces a relatively new research methodological tool, known as Q method, useful in exploring issues related to human subjectivity. DESCRIPTION: Q methodology is unique as it combines the strengths of both qualitative and quantitative research traditions. The sequential steps involve generation of ideas about the research topics, clarification and refinement of the ideas, and rank ordering these ideas by the respondents in a quasinormal distribution. The data are extracted with by-person factor analysis and useful in exploring arrays of attitude either cross-sectionally or longitudinally over a period of time. CONCLUSION: Q methodology can be used to analyse opinions, perceptions, and attitudes in both clinical and non-clinical settings. It is a preferred method of human subjectivity study as it provides more in-depth analysis of complex subjectivity issues.

Refining the measurement of axis II: a Q-sort procedure for assessing personality pathology.

The measurement of personality disorders (PDs) has proven to be a difficult enterprise. This article describes two initial studies of the validity and reliability of the Shedler-Westen Assessment Procedure (SWAP), a Q-sort procedure that quantifies clinical judgment, which may be useful both for assessing personality pathology and for empirically refining Axis II categories and diagnostic criteria. In the first study, 153 clinicians from a random national sample used a version of the Q-sort to describe either a prototype or actual patient with either a borderline, antisocial, histrionic, or narcissistic personality disorder. Correlations between aggregated prototype and actual patient profiles provided evidence for convergent and discriminant validity, and a cluster-analytic procedure (Q-factor analysis) produced revised criteria for the four disorders that minimized the problem of comorbidity. In Study 2, a pilot sample of patients were interviewed using a clinical research interview that mirrors the way clinicians assess personality and PDs. The study yielded promising results with respect to the possibility of obtaining reliable Q-sort descriptions based on an interview that resembles a clinical interview rather than the direct-question format used in current Axis II structured interviews. It also produced strong correlations between Q-sort descriptions made by interview and those made independently by the treating clinician, further supporting the validity of the instrument. The findings suggest the potential utility of the SWAP as a measure of PDs and as a method for empirically refining Axis II categories and criteria.

The validity of the California Q-set Alexithymia Prototype.

The author examined the validity of the California Q-set Alexithymia Prototype (CAQ-AP), an observer- and self-report measure of the alexithymia construct. Alexithymia similarity scores (based on observer reports) were correlated with scores on several relevant self-report scales in a sample of 155 undergraduate college students. Alexithymia was positively correlated with neuroticism, depression, and anxiety; and negatively with extraversion, openness, and emotional expression. These correlations were statistically significant (P < 0.05) and in the expected direction. The CAQ-AP has passed its second validity check and, again, can be recommended as an observer measure of the alexithymia construct.

A California Q-set alexithymia prototype and its relationship to ego-control and ego-resiliency.

The primary purposes of the present study were to use the Q-sort method to develop a measure of alexithymia and to locate the construct within a two-dimensional (ego-control and ego-resiliency) model of personality. Thirteen professional judges described the characteristics of the alexithymic personality with the 100-item California Q-set. Scores from the sorts were aggregated to form the Alexithymia Prototype, which had a Spearman-Brown reliability of 0.99. Alexithymic people were described as having difficulties experiencing and expressing emotion, lacking imagination, and being literal, socially conforming, and utilitarian; they lack insight, are humorless, and experience meaninglessness; and anxiety and tension find outlet in bodily symptoms. This description is consistent, for the most part, with modern formulations of the alexithymia construct. In the language of the two-dimensional personality model, alexithymic individuals appear to be overcontrolling and lacking ego-resiliency (i.e., constricted, anxious, rigid, and withdrawn). We, therefore, compared the Alexithymia Prototype with two independently developed prototypes, Overcontrol and Ego-Resiliency. The Q-correlations between alexithymia and overcontrol and between alexithymia and ego-resiliency were 0.45 and -0.70, respectively. Although item analyses confirmed moderate overlap between alexithymia and overcontrol and considerable overlap between alexithymia and lacking ego-resiliency (ego-brittle), item differences suggest that alexithymia, indeed, is a unique personality construct.

Development of a California Q-set indicator of primary psychopathy.

Seven judges described the personality characteristics of the primary psychopath by sorting the 100 items of the California Q-set in a forced-normal distribution. Item scores resulting from these sorts were aggregated across judges to form a Psychopathy Prototype. The reliability of the seven-judge aggregate prototype was .90. To examine the reliability of scores derived from the prototype, the personalities of 65 target subjects were described by two peer judges using the California Q-set (Block, 1961). For each subject, Psychopathy Prototype scores were derived by correlating each judge's Q-sort profile with the Psychopathy Prototype. Findings indicated that the peer-generated psychopathy scores correlated r = .61 between judges. Using the Spearman-Brown formula, Psychopathy Prototype scores have reliabilities of .75, .82, and .86 when aggregated over two, three, and four peer judges, respectively. To further explore properties of the measure, the Psychopathy Prototype was compared with independently developed California Q-set prototypes describing the narcissist and the female hysteric. The results revealed some interesting contrasts among these concepts and serve to support our contention that the Psychopathy Prototype has utility in regard to distinguishing between pathologies with overlapping features.