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Journal of Clinical Medicine Feb 2024(1) Background: Clinically useful prediction models for chronic postsurgical pain (CPSP) in knee replacement (TKA) are lacking. (2) Methods: In our prospective,...
(1) Background: Clinically useful prediction models for chronic postsurgical pain (CPSP) in knee replacement (TKA) are lacking. (2) Methods: In our prospective, multicenter study, a wide-ranging set of 91 variables was collected from 933 TKA patients at eight time points up to one year after surgery. Based on this extensive data pool, simple and complex prediction models were calculated for the preoperative time point and for 6 months after surgery, using least absolute shrinkage and selection operator (LASSO) 1se and LASSO min, respectively. (3) Results: Using preoperative data only, LASSO 1se selected age, the Revised Life Orientation Test on pessimism, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-subscore pain and the Timed "Up and Go" Test for prediction, resulting in an area under the curve (AUC) of 0.617 and a Brier score of 0.201, expressing low predictive power only. Using data up to 6 months after surgery, LASSO 1se included preoperative Patient Health Questionnaire-4, Knee Injury and Osteoarthritis Outcome Score (KOOS)-subscore pain (pain) 3 months after surgery (month), WOMAC pain 3 and 6 months, KOOS subscore symptoms 6 months, KOOS subscore sport 6 months and KOOS subscore Quality of Life 6 months. This improved the predictive power to an intermediate one (AUC 0.755, Brier score 0.168). More complex models computed using LASSO min did little to further improve the strength of prediction. (4) Conclusions: Even using multiple variables and complex calculation methods, the possibility of individual prediction of CPSP after TKA remains limited.
PubMed: 38337556
DOI: 10.3390/jcm13030862 -
The Linacre Quarterly Feb 2024Dying in the United States is characterized as: medicalized, depersonalized, high technology, fragmented with frequent transitions among care settings, burdensome to...
Dying in the United States is characterized as: medicalized, depersonalized, high technology, fragmented with frequent transitions among care settings, burdensome to patients and families, driven by efficiency and effectiveness, and lacking in key areas, for example, access to palliative care and adequate pain and symptom treatment. Patients and families are often left with a choice of two extremes: vitalism or utilitarian pessimism (utilitarianism). The Catholic Church, however, rejects both of these extremes, and Catholic social teaching (CST) at end of life focuses on ordinary-extraordinary treatments/means, a culture of life and human dignity, accompaniment and community, and caring for whole persons through the end of life. The Catholic tradition of ordinary-extraordinary means is helpful to guide complex end-of-life decisions, regardless of one's religious beliefs, and offers a middle ground between vitalism and utilitarianism that can inform end-of-life care and decision-making for all patients in Catholic health care. While it does not provide answers, it offers guidance and enables conversations that are crucial for the dying and their families to make autonomous, informed decisions about end-of-life care. It provides an opportunity for the dying to let the care team, loved ones, and decision-makers know what a life with meaning, purpose, and passion is for them-and how they want to live and die. This article will summarize the problem, describe end-of-life Catholic teaching, and discuss how it offers a middle-ground. Arguments for and against vitalism and utilitarianism will be explored, including a discussion of CST's response to those receiving care in Catholic health care facilities who are outside the Catholic tradition and do not believe in the teaching. The last section describes a model of collaborative partnership where local parishes and Catholic health care come together to tackle the challenges of caring for and ministering to the seriously ill and those facing death.
PubMed: 38304889
DOI: 10.1177/00243639221141230 -
Frontiers in Psychology 2023This study aimed to investigate profiles of personality evaluated by temperament and character dimensions (TCI) in 638 adult and older adult patients (CP) who had...
INTRODUCTION
This study aimed to investigate profiles of personality evaluated by temperament and character dimensions (TCI) in 638 adult and older adult patients (CP) who had recently been diagnosed with breast, colon, lung, and other kinds of cancer (female and male subjects were assessed). Tests: Temperament and Character Inventory (TCI). Statistical analysis: cluster K-means analysis for personality traits.
RESULTS
Two different personality profiles emerged: "Low self-determination and pessimism" (Profile 1) and "Self-determination and self-caring (medium)" (Profile 2). The following significant differences were observed in the TCI dimensions between the two profiles: Temperament-Novelty-Seeking (NS) ( < 0.001); Harm-Avoidance (HA) ( < 0.001); Reward-Dependence (RD) ( < 0.001); Persistence (PS) ( < 0.001); Character-Self-Directness (SD) ( < 0.001); Cooperativeness (C) ( > 0.001); Self-Transcendence (ST) ( < 0.001). No differences in the two profiles were found between adult and elderly patients. Profile 1 - "Low self-determination and pessimism": Patients with this profile present low resistance to frustration, poor search for novelty and solutions (NS), anxiety and pessimism (medium HA), high social attachment and dependence on the approval of others (medium-high RD), and low self-determination (PS) as temperament dimensions; and medium-low self-direction, low autonomy and ability to adapt (SD-medium-low), medium cooperativeness (C), and low self-transcendence (ST) as character dimensions. Profile 2 - "Self-determination and self-caring (medium)": Patients with this profile have resistance to frustration, ability to search for novelty and solutions (medium-NS), low anxiety and pessimism (HA), low social attachment and dependence on approval (medium-low-RD), and determination (medium-high PS) as dimensions of temperament; and autonomy and capacity for adaptation and self-direction (SD), capacity for cooperation (high-CO), and self-transcendence (medium-high-ST) as character dimensions.
CONCLUSION
Personality screening allows a better understanding of the difficulties of the individual patient and the planning of targeted psychotherapeutic interventions that promote quality of life and good adaptation to the disease course.
PubMed: 38288360
DOI: 10.3389/fpsyg.2023.1289093 -
Micromachines Dec 2023With the CMOS technology downscaling to the deep nanoscale, the aging effects of devices degrade circuit performance and even lead to functional failure. The stress...
With the CMOS technology downscaling to the deep nanoscale, the aging effects of devices degrade circuit performance and even lead to functional failure. The stress analysis is critical to evaluate the influence of aging effects on digital circuits. Some related analytical work has recently focused on reliability-aware circuit analysis. Nevertheless, the aging dependence among different devices is not considered, which will induce errors of degradation evaluation in the digital circuit. In order to improve the accuracy of reliability-aware static timing analysis, an improved analytical method is proposed by employing logical resolving. Experimental results show that the proposed method has a better evaluation accuracy of aging path delay than traditional strategies. For aging timing evaluation on aging paths, excessive pessimism can be reduced by employing the proposed method. And, a 378× speedup is achieved while having a 0.56% relative error compared with precise SPICE simulation. Moreover, the circuit performance sacrifice of an aging-aware synthesis flow with the proposed method can be decreased. Due to the high efficiency and high accuracy, the proposed method can meet the speed demands of large-scale digital circuit reliability analysis while achieving transistor simulation accuracy.
PubMed: 38258204
DOI: 10.3390/mi15010085 -
Medical Decision Making : An... Feb 2024Lung cancer clinical guidelines and risk tools often rely on smoking history as a significant risk factor. However, never-smokers make up 14% of the lung cancer...
BACKGROUND
Lung cancer clinical guidelines and risk tools often rely on smoking history as a significant risk factor. However, never-smokers make up 14% of the lung cancer population, and this proportion is rising. Consequently, they are often perceived as low-risk and may experience diagnostic delays. This study aimed to explore how clinicians make risk-informed diagnostic decisions for never-smokers.
METHODS
Qualitative interviews were conducted with 10 lung cancer diagnosticians, supported by data from interviews with 20 never-smoker lung cancer patients. The data were analyzed using a framework analysis based on the Model of Pathways to Treatment framework and data-driven interpretations.
RESULTS
Participants described 3 main strategies for making risk-informed decisions incorporating smoking status: guidelines, heuristics, and potential harms. Clinicians supplemented guidelines with their own heuristics for never-smokers, such as using higher thresholds for chest X-ray. Decisions were easier for patients with high-risk symptoms such as hemoptysis. Clinicians worried about overinvestigating never-smoker patients, particularly in terms of physical and psychological harms from invasive procedures or radiation. To minimize unnecessary anxiety about lung cancer risk, clinicians made efforts to downplay this. Conversely, some patients found that this caused process harms such as delays and miscommunications.
CONCLUSION
Improved guidance and methods of risk differentiation for never-smokers are needed to avoid diagnostic delays, overreassurance, and clinical pessimism. This requires an improved evidence base and initiatives to increase awareness among clinicians of the incidence of lung cancer in never-smokers. As the proportion of never-smoker patients increases, this issue will become more urgent.
HIGHLIGHTS
Smoking status is the most common risk factor used by clinicians to guide decision making, and guidelines often focus on this factor.Some clinicians also use their own heuristics for never-smokers, and this becomes particularly relevant for patients with lower risk symptoms.Clinicians are also concerned about the potential harms and risks associated with deploying resources on diagnostics for never-smokers.Some patients find it difficult to decide whether or not to go ahead with certain procedures due to efforts made by clinicians to downplay the risk of lung cancer.Overall, the study highlights the complex interplay between smoking history, clinical decision making, and patient anxiety in the context of lung cancer diagnosis and treatment.
Topics: Humans; Lung Neoplasms; Smoking; Risk Factors; Health Personnel
PubMed: 38240273
DOI: 10.1177/0272989X231220954 -
Journal of Nursing Measurement Jan 2024Powe conceptually defined "cancer fatalism" and developed the Powe Fatalism Inventory (PFI) to operationalize cancer fatalism. Researchers report disparate underlying...
Powe conceptually defined "cancer fatalism" and developed the Powe Fatalism Inventory (PFI) to operationalize cancer fatalism. Researchers report disparate underlying factor structures, and sparse evidence supports the validity and reliability of the PFI. Therefore, the purpose of this study was to examine the psychometric properties of the PFI. Specifically, we aimed to examine its (a) underlying dimensions, (b) internal consistency, and (c) construct validity. We recruited 400 post-menopausal women, 50-64 years old, for a study on mammographic breast density. Women completed the 15-item PFI and the 8-item Champion Breast Cancer Fear Scale (CBCFS). We conducted item analyses and exploratory factor analysis and evaluated different factor structures. We estimated internal consistency and conducted Pearson correlations between PFI and CBCFS scores to examine construct validity. We found a two-factor solution. Factor 1, Predetermination, had an eigenvalue of 5.2 and explained 43% of the variance with factor loadings ranging from -0.59 to -0.83. Factor 2, Pessimism, had an eigenvalue of 4.5 and explained 15.2% of the variance with factor loadings ranging from 0.63 to 0.77. Both factors together explained 58.2% of the variance. There were no cross-loading items and no item loadings below 0.4. The two subscales both had alphas of .89. Cancer fatalism scores were positively related to fear scores (317, < .001, 95% CI: .222, .406). Using PFI responses from postmenopausal women, we determined that the two-factor solution was the most parsimonious yet theoretically sound factor structure underlying the 15 items of the PFI. The subscales Predetermination (Factor 1; six items) and Pessimism (Factor 2; nine items) were internally consistent with the evidence of the construct validity.
PubMed: 38199759
DOI: 10.1891/JNM-2023-0010 -
Hormones and Behavior Mar 2024The cumulative negative effects of prolonged Hypothalamic-Pituitary-Adrenal axis (HPA axis) activation are associated with several age-related diseases. Some...
The cumulative negative effects of prolonged Hypothalamic-Pituitary-Adrenal axis (HPA axis) activation are associated with several age-related diseases. Some psychological traits such as optimism and pessimism have been shown to be related to both health and the stress response, although their relationship with the HPA axis is inconclusive. More stable HPA axis biomarkers, such as hair samples of cortisol (HC) and dehydroepiandrosterone (HDHEA), would help to clarify the association between these psychological traits and HPA axis functioning. The main aim of this study was to test the relationships between optimism and pessimism and chronic stress biomarkers measured in hair (HC and HDHEA). Additionally, a secondary objective was to explore sex differences in HC and HDHEA levels and their relationship with these psychological traits. We measured optimism, pessimism, and their combination (dispositional optimism) using the Life Orientation Test Revised (LOT-R) and chronic stress biomarkers (HC and HDHEA) in 119 healthy participants (46 men and 73 women) between 56 and 81 years old who belonged to a university program. Regression analyses controlling for perceived stress and BMI indicated that higher dispositional optimism was related to lower HC and HC:HDHEA (β = -0.256, p = .008 and β = -0.300, p = .002, respectively). More specifically, higher pessimism was related to higher HC (β = 0.235; p = .012) and HC:HDHEA (β = 0.240; p = .011), whereas higher optimism was associated with a lower HC:HDHEA(β = -0.205; p = .031). Moderation analyses showed no sex differences. To date, this is the first study to investigate the link between these traits and HC and HDHEA in older people. Our results confirm that positive and negative expectations about the future (i.e. optimism and pessimism) may play an important role in health due to their relationship with the HPA axis. They also strengthen the idea that the negative effects of pessimism have a greater weight than the protective effects of optimism in their relationship with HPA axis regulation.
Topics: Humans; Male; Female; Aged; Middle Aged; Aged, 80 and over; Hydrocortisone; Pessimism; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Biomarkers; Hair; Dehydroepiandrosterone
PubMed: 38194858
DOI: 10.1016/j.yhbeh.2023.105474 -
Journal of Substance Use and Addiction... Feb 2024Prior research has found that different ways of describing opioid-related impairment influences the types and degrees of stigmatizing beliefs held by the American... (Randomized Controlled Trial)
Randomized Controlled Trial
America's perceptions of opioid related impairment: A national randomized study examining how different individuals may stigmatize addiction in response to different terminology.
INTRODUCTION
Prior research has found that different ways of describing opioid-related impairment influences the types and degrees of stigmatizing beliefs held by the American public. In this study we examined the extent to which different characteristics of the American public (i.e., age, gender, race/ethnicity, religiosity, sexual orientation, political affiliation, personal history of addiction/mental health problem) are associated with holding different types and degrees of stigmatizing beliefs when asked to consider someone treated for opioid-related impairment. We also assessed whether any observed differences in stigmatizing beliefs related to participant characteristics are dependent on how an opioid-impaired patient is described in terms of both the nature of the impairment (e.g., as a "chronically relapsing brain disease", "brain disease", "disease", "illness", "disorder", or "problem") as well as the gender of the depicted opioid-impaired person.
METHODS
A nationally representative sample of the U.S. population (N = 3643) was randomized to one of six vignettes describing a patient being treated for opioid-related impairment that differed only in the way the impairment was described (as a "chronically relapsing brain disease", "brain disease", "disease", "illness", "disorder", or "problem"). Participants subsequently were asked to rate statements assessing five stigma dimensions (blame, prognostic pessimism, continuing care, dangerousness, and social distance).
RESULTS
Several characteristics were associated with different types and higher levels of stigmatizing beliefs: older age, male gender, White race, heterosexual orientation, being religious, Republican political affiliation, and having no prior alcohol/drug or mental health problem history (ps < 0.001). With very few exceptions, the way the opioid-impairment was described or whether the depicted patient was a man or a woman did not influence the strength of these associations.
CONCLUSIONS
Certain characteristics of members of the US population were associated with holding different types and degrees of stigmatizing attitudes when asked to consider someone receiving treatment for opioid-related impairment and these were largely unaffected by how the impairment was labeled or the opioid-impaired person's gender. Depending on the specific target of clinical and public health anti-stigma campaigns, both addiction terminology and the beliefs held by certain population sub-groups will need to be considered when creating opioid use disorder related anti-stigma campaigns.
Topics: Humans; Male; Female; Analgesics, Opioid; Stereotyping; Social Stigma; Behavior, Addictive; Brain Diseases
PubMed: 38176526
DOI: 10.1016/j.josat.2023.209288 -
BMC Psychology Jan 2024Exploring the levels of death anxiety and factors that can undermine its impact are crucial for the Lebanese nationals. Even though studies have shown various...
BACKGROUND
Exploring the levels of death anxiety and factors that can undermine its impact are crucial for the Lebanese nationals. Even though studies have shown various relationships between death anxiety and several factors, very few to no research has been done to show the relationship of death anxiety, gratitude and optimism. Therefore, the objectives of our study were to assess the mediating role of optimism in the association between gratitude and death anxiety, along with investigating the validity and reliability of the Arabic version of the Death Anxiety Scale.
METHODS
A one-time-point online survey was conducted among Arabic-speaking community adults from the general population of Lebanon (N = 601; mean age 29.91 ± 12.61; 62.7% females). The following scales were used: Scale of Death Anxiety, Optimism-Pessimism Short Scale-2, and Gratitude Questionnaire-Six-Item Form.
RESULTS
The results of the mediation analysis showed that optimism fully mediated the association between gratitude and death anxiety. Higher gratitude was significantly associated with more optimism; higher optimism was significantly associated with less death anxiety. Finally, higher gratitude was not directly associated with death anxiety.
CONCLUSION
Our study reveals the relationship between gratitude and death anxiety and the mediating role of optimism. Our results need to be confirmed in a longitudinal study, but point to the importance of assessing optimism in prevention and management of persons with death anxiety.
Topics: Adult; Female; Humans; Adolescent; Young Adult; Male; Longitudinal Studies; Reproducibility of Results; Earthquakes; Optimism; Anxiety
PubMed: 38167169
DOI: 10.1186/s40359-023-01509-4 -
European Journal of Cardiovascular... Jan 2024Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its...
AIMS
Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its effectiveness in promoting health behaviour change. The current study was proposed to evaluate the feasibility of MI on adherence to care practices, emotional intelligence (EI), and dispositional optimism among patients with permanent pacemakers.
METHODS AND RESULTS
This study was a parallel arm randomized controlled trial. Seventy clients with permanent pacemakers were randomly allocated to a six-session MI intervention (n = 35) or a waiting list control group (n = 35). A statistically significant improvement in the mean scores of adherence to care practices, EI, and dispositional optimism, along with a significant reduction in pessimism, was registered among the study group compared with the control group.
CONCLUSION
Following the intervention for 1- and 2-month follow-up measurements, there were statistically significant improvements in self-care practice adherence. After 1 month of intervention, there were statistically significant gains in EI and dispositional optimism, but at the 2-month follow-up measurement, this improvement had somewhat lessened. The findings suggest that MI may be a feasible and practical approach for improving adherence to care practices, EI, and dispositional optimism in patients with permanent pacemakers.
REGISTRATION
ClinicalTrials.gov: NCT05883514.
PubMed: 38165278
DOI: 10.1093/eurjcn/zvad113