In 1984 Jacobson and colleagues introduced the concept of reliable change, viz the amount of change on a measure that an individual needed to show to determine that it exceeded the extent of change likely due to measurement error alone. Establishing reliable change was a pre-requisite for determining clinical significance. This paper summarizes the rationale for determining reliable change as providing an individual-focused, idiographic alternative to the dominant nomothetic approach to clinical outcome research based on group mean data and statistical significance. The conventional computational steps for calculating an individual’s standardized difference (reliable change) score and the minimum raw change score on the measure (a reliable change index) required to classify individuals as reliably positively changed, indeterminate, or reliably deteriorated are described. Two methods for graphically representing reliable change are presented, and a range of possible uses in both research and practice settings are summarized. A number of issues and debates concerning the calculation of reliable change are reviewed. It is concluded that the concept of reliable change remains useful for both cognitive behavioural researchers and practitioners, but that there are options regarding methods of computation. In any use of reliable change, the rationale for selecting among method options and the exact computations used need clear and careful description so that we can continuously judge the utility and appropriateness of the use of reliable change and enhance its value to the field.

Background: Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review. Aims: The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome. Method: After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance. Results: The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB. Conclusions: Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.

Angiostrongylus cantonensis is a metastrongyloid nematode found widely in the Asia-Pacific region, and the aetiological agent of angiostrongyliasis; a disease characterized by eosinophilic meningitis. Rattus rats are definitive hosts of A. cantonensis, while intermediate hosts include terrestrial and aquatic molluscs. Humans are dead-end hosts that usually become infected upon ingestion of infected molluscs. A presumptive diagnosis is often made based on clinical features, a history of mollusc consumption, eosinophilic pleocytosis in cerebral spinal fluid, and advanced imaging such as computed tomography. Serological tests are available for angiostrongyliasis, though many tests are still under development. While there is no treatment consensus, therapy often includes a combination of anthelmintics and corticosteroids. Angiostrongyliasis is relatively rare, but is often associated with morbidity and sometimes mortality. Recent reports suggest the parasites’ range is increasing, leading to fatalities in regions previously considered Angiostrongylus-free, and sometimes, delayed diagnosis in newly invaded regions. Increased awareness of angiostrongyliasis would facilitate rapid diagnosis and improved clinical outcomes. This paper summarizes knowledge on the parasites’ life cycle, clinical aspects and epidemiology. The molecular biology of Angiostrongylus spp. is also discussed. Attention is paid to the significance of angiostrongyliasis in Australia, given the recent severe cases reported from the Sydney region.

Using a case-series design with double baseline and 10-week maintenance phase, 5 struggling readers from middle- to high-income families (age range 6.4–7.9 years) completed a 5-times-weekly intervention (96 sessions) administered by a parent. All participants completed the intervention with phonological decoding, text-reading accuracy and reading comprehension scores above the 30th percentile. Regular-word reading improved significantly, and 3 out of 5 participants achieved average levels at postintervention testing. Growth of 0.58 standard deviations (SD) was seen in one participant on a test of irregular-word reading. The other 4 participants made growth of > 0.8 SD. However, only 1 participant achieved average levels at postintervention testing on the irregular-word reading measure. Results provide preliminary support for the effectiveness of the intervention in improving word-level decoding and comprehension in struggling readers. Most important, the data provide preliminary evidence that some parents can function as paraprofessionals and provide effective reading intervention for struggling readers. Special education professionals may be able to work around limited funding for struggling readers by recruiting, training, and supervising parents.

Day treatment programs (DTP) for eating disorders are being recognised as having therapeutic benefits. However, research is needed to evaluate the effectiveness of DTP to establish their validity. This article reports on the evaluation of a pilot DTP in an Australian mental health setting, which utilised an integrative approach combining evidence-based treatments such as dialectical-behavioural therapy and intensive short-term dynamic psychotherapy offered in a group-based setting. Comparison of pre- and post-treatment data outcome measures for eating disorder pathology and comorbid symptoms was undertaken. Patient satisfaction was also evaluated using qualitative methods. Results indicated a significant reduction in depressive symptoms post-treatment, along with a high degree of satisfaction with the treatment. Limitations of this study, along with the implications of the findings and directions for future research, are discussed.

From Freud through to modern times researchers have aimed to develop a clearer understanding of therapeutic processes and outcomes. Despite this continued interest in the field, the representation of psychotherapy processes and the applicability of research findings and recommendations to the therapeutic field continue to prove difficult. Quantitative and qualitative studies each purport to provide answers, however, they differ greatly in their research methods and underlying ontological and epistemological views. Efficacy and effectiveness studies and the measures of statistical significance and clinical significance are explored with their inherent strengths and weaknesses highlighted. This paper presents the view that research into psychotherapy should enhance the experiences of both the therapist and client. For this to be achieved it is recommended that quantitative and qualitative data, or objective and subjective experiences, should collude rather than collide.

For the past two decades, prehospital trauma care has been addressed almost generically in terms of the related approaches to epidemiology, research, and management. However, evolving directions in research have helped emergency medical services (EMS) practitioners to delineate more focused treatment strategies according to the mechanism of injury, anatomic involvement, and the patient's clinical condition. Recent studies in the areas of trauma-associated circulatory arrest, severe blunt head injury, and post-traumatic hemorrhage following penetrating truncal injury suggest that current standard approaches to patient care should be reconsidered. In turn, this need for re-examination of trauma management strategies calls for the development of appropriate evaluation tools within EMS systems. Proper research design is dependent upon several key issues including: 1) the type of study (system study versus examination of a specific intervention); 2), the population under study; 3) physiological and anatomical scoring method; 4) prospective definitions of interventions and meaningful outcome variables (both morbidity and mortality; 5) relative outcome compared to known standards; and 6) prospective determination of statistical requirements.