This paper presents a cognitive behavioural perspective on factitious disorder. The DSM-IV definition will be given and aetiological and epidemiological information will be presented, whilst noting the difficulty in collecting data from this group. The difficulty in engaging the patient will be addressed. In assessing the patient, the role of early experiences, the beliefs about their feigning of symptoms, the gains from this behaviour and the reaction of others will be considered. The similarities with somatization and malingering will be discussed. A model of this disorder based on the Beckian approach will be given as will an explanation of why this disorder may become chronic. A treatment strategy will be suggested looking at helping the patient understand their disorder, discussing with them the pros and cons of alerting others to their feigning behaviour, helping them get their needs met in a more appropriate way, looking at the risks involved in the behaviour, and addressing issues of abuse.
Styling or product appearance is well known for holding great influence on its differentiation, branding, and overall success in the market. However, the styling process is difficult due to the intuitive and subjective way in which designers evaluate designs. In particular, negotiating iterations between designers and engineers is challenging since engineers have objective, data-driven approaches to rationalize decisions whereas designers rely on instinct and intuition. While the literature shows sustained interest in this issue and provides methods to analyze appearance objectively, many approaches rely on abstracted or simplified versions of a product's appearance as the basis for analyses, ignoring the holistic nature of product appearance. This article contributes by proposing an improvement employing digital shape comparison tools applied to three-dimensional (3D) geometry of products, and generating data on differentiation in product shape—that is, the holistic styling analysis (HSA). The HSA provides an objective assessment of difference in appearance to form the basis for designers to rationalize styling to other stakeholders during the design process. The HSA is tested through an automotive industry case study. Results show the method adds objectivity to decision-making by providing objective reference measures for differentiation in the styling of previous and competing products. Such measures can be used to inform styling goals and to identify intended degrees of difference in key features while highlighting areas to maintain consistency. As such, we contribute by providing a means for styling designers to use data to drive their activities in the same manner as other stakeholders.
IntroductionIrritable bowel syndrome (IBS) is characterised by symptoms such as abdominal pain, constipation, diarrhoea and bloating. These symptoms impact on health-related quality of life, result in excess service utilisation and are a significant burden to healthcare systems. Certain mechanisms which underpin IBS can be explained by a biopsychosocial model which is amenable to psychological treatment using techniques such as cognitive behavioural therapy (CBT). While current evidence supports CBT interventions for this group of patients, access to these treatments within the UK healthcare system remains problematic.Methods and analysisA mixed methods feasibility randomised controlled trial will be used to assess the feasibility of a low-intensity, nurse-delivered guided self-help intervention within secondary care gastrointestinal clinics. A total of 60 participants will be allocated across four treatment conditions consisting of: high-intensity CBT delivered by a fully qualified cognitive behavioural therapist, low-intensity guided self-help delivered by a registered nurse, self-help only without therapist support and a treatment as usual control condition. Participants from each of the intervention arms of the study will be interviewed in order to identify potential barriers and facilitators to the implementation of CBT interventions within clinical practice settings. Quantitative data will be analysed using descriptive statistics only. Qualitative data will be analysed using a group thematic analysis.Ethics and disseminationThis study will provide essential information regarding the feasibility of nurse-delivered CBT interventions within secondary care gastrointestinal clinics. The data gathered during this study would also provide useful information when planning a substantive trial and will assist funding bodies when considering investment in substantive trial funding. A favourable opinion for this research was granted by the Nottingham 2 Research Ethics Committee.Trial registration numberISRCTN: 83683687 (http://www.controlled-trials.com/ISRCTN83683687).
Introduction: This study assessed the feasibility of a nurse-delivered cognitive behavioural therapy (CBT) for the treatment of irritable bowel syndrome (IBS).
Methods and analysis:A mixed-method design was used. Twenty participants were randomly allocated to high-intensity CBT (n=5), guided self-help (n=5), self-help only (n=5) or treatment as usual (n=5). Ten intervention participants completed semi-structured interviews. Quantitative data were analysed using descriptive statistics; qualitative data were analysed using group thematic analysis.
Results:Barriers to the interventions used were negative preconceptions about treatment, factors relating to supporting materials and stigma.Treatment facilitators included therapist-facilitated relaxation, narratives located within self-help materials and social support mechanisms.
Conclusion:Further development of the low-intensity interventions in collaboration with service users is required to improve intervention acceptability and relevance.
Due to modern medicine, the lifespan of the average person is increasing, with a concomitant increase in the need for care. According to the German Federal Statistical Office, DeStatis, there will be a deficit of 260,000 caregivers by 2025, which is not only an issue in Germany, but worldwide. New technologies, including wearable devices, will be crucial to manage this challenge, but there is a huge amount of research and investment required to incorporate wearable assistive devices into the lives of elderly users. It is crucially important that any new devices are fit for purpose, taking into account the specific needs of elderly people. This chapter, therefore, summarises and reviews the current state of wearable assistive devices, formalises the current design practice with respect to user needs, and presents design considerations such as wearability and usability, in order to assist in the future development of wearable assistive devices for the aging population.
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