-
Applied Clinical Informatics May 2024While clinical practice guidelines recommend that oncologists discuss goals of care with patients who have advanced cancer, it is estimated that less than 20% of... (Comparative Study)
Comparative Study
OBJECTIVES
While clinical practice guidelines recommend that oncologists discuss goals of care with patients who have advanced cancer, it is estimated that less than 20% of individuals admitted to the hospital with high-risk cancers have end-of-life discussions with their providers. While there has been interest in developing models for mortality prediction to trigger such discussions, few studies have compared how such models compare with clinical judgment to determine a patient's mortality risk.
METHODS
This study is a prospective analysis of 1,069 solid tumor medical oncology hospital admissions ( = 911 unique patients) from February 7 to June 7, 2022, at Memorial Sloan Kettering Cancer Center. Electronic surveys were sent to hospitalists, advanced practice providers, and medical oncologists the first afternoon following a hospital admission and they were asked to estimate the probability that the patient would die within 45 days. Provider estimates of mortality were compared with those from a predictive model developed using a supervised machine learning methodology, and incorporated routine laboratory, demographic, biometric, and admission data. Area under the receiver operating characteristic curve (AUC), calibration and decision curves were compared between clinician estimates and the model predictions.
RESULTS
Within 45 days following hospital admission, 229 (25%) of 911 patients died. The model performed better than the clinician estimates (AUC 0.834 vs. 0.753, < 0.0001). Integrating clinician predictions with the model's estimates further increased the AUC to 0.853 ( < 0.0001). Clinicians overestimated risk whereas the model was extremely well-calibrated. The model demonstrated net benefit over a wide range of threshold probabilities.
CONCLUSION
The inpatient prognosis at admission model is a robust tool to assist clinical providers in evaluating mortality risk, and it has recently been implemented in the electronic medical record at our institution to improve end-of-life care planning for hospitalized cancer patients.
Topics: Humans; Neoplasms; Male; Female; Middle Aged; Patient Admission; Risk Assessment; Aged; Hospitalization
PubMed: 38925539
DOI: 10.1055/s-0044-1787185 -
Neuroscience and Biobehavioral Reviews Jun 2024The sense of agency is the experience of being the author of self-generated actions and their outcomes. Both clinical manifestations and experimental evidence suggest... (Review)
Review
The sense of agency is the experience of being the author of self-generated actions and their outcomes. Both clinical manifestations and experimental evidence suggest that the agency experience and the mechanisms underlying agency attribution may be dysfunctional in schizophrenia. Yet, studies investigating the sense of agency in these patients show seemingly conflicting results: some indicated under-attribution of self-agency (coherently with certain positive symptoms), while others suggested over-attribution of self-agency. In this review, we assess whether recent theoretical frameworks can reconcile these divergent results. We examine whether the identification of agency abnormalities in schizophrenia might depend on the measure of self-agency considered (depending on the specific task requirements) and the available agency-related cues. We conclude that all these aspects are relevant to predict and characterise the type of agency misattribution that schizophrenia patients might show. We argue that one particular model, based on the predictive coding theory, can reconcile the interpretation of the multifarious phenomenology of agency manifestations in schizophrenia, paving the way for testing agency disorders in novel ways.
PubMed: 38925210
DOI: 10.1016/j.neubiorev.2024.105781 -
Annals of the New York Academy of... Jun 2024Considerable debate exists about the interplay between auditory and motor speech systems. Some argue for common neural mechanisms, whereas others assert that there are...
Considerable debate exists about the interplay between auditory and motor speech systems. Some argue for common neural mechanisms, whereas others assert that there are few shared resources. In four experiments, we tested the hypothesis that priming the speech motor system by repeating syllable pairs aloud improves subsequent syllable discrimination in noise compared with a priming discrimination task involving same-different judgments via button presses. Our results consistently showed that participants who engaged in syllable repetition performed better in syllable discrimination in noise than those who engaged in the priming discrimination task. This gain in accuracy was observed for primed and new syllable pairs, highlighting increased sensitivity to phonological details. The benefits were comparable whether the priming tasks involved auditory or visual presentation. Inserting a 1-h delay between the priming tasks and the syllable-in-noise task, the benefits persisted but were confined to primed syllable pairs. Finally, we demonstrated the effectiveness of this approach in older adults. Our findings substantiate the existence of a speech production-perception relationship. They also have clinical relevance as they raise the possibility of production-based interventions to improve speech perception ability. This would be particularly relevant for older adults who often encounter difficulties in perceiving speech in noise.
PubMed: 38924165
DOI: 10.1111/nyas.15179 -
Cognitive Science Jun 2024Previous research suggests that curiosity is sometimes induced by novel information one has no relevant knowledge about, but it is sometimes induced by new information...
Previous research suggests that curiosity is sometimes induced by novel information one has no relevant knowledge about, but it is sometimes induced by new information about something that one is familiar with and has prior knowledge about. However, the conditions under which novelty or familiarity triggers curiosity remain unclear. Using metacognitive confidence judgments as a proxy to quantify the amount of knowledge, this study evaluates the relationship between the amount of relevant knowledge and curiosity. We reviewed previous studies on the relationship between subjective curiosity and confidence and reanalyzed existing large-sample data. The findings indicate that the relationship between curiosity and confidence differs depending on the nature of the stimuli: epistemic versus perceptual. Regarding perceptual stimuli, curiosity is stronger when individuals have lower confidence levels. By contrast, for epistemic stimuli, curiosity is stronger when individuals have higher confidence levels. These results suggest that curiosity triggered by perceptual stimuli is based on perceived novelty, whereas that triggered by epistemic stimuli is based on familiarity with prior knowledge.
Topics: Humans; Metacognition; Exploratory Behavior; Judgment; Knowledge; Recognition, Psychology; Perception
PubMed: 38923077
DOI: 10.1111/cogs.13474 -
La Medicina Del Lavoro Jun 2024This study, conducted on a sample of Italian occupational physicians (OPs), aimed to gather data regarding professional activity and their needs in managing workers with...
BACKGROUND
This study, conducted on a sample of Italian occupational physicians (OPs), aimed to gather data regarding professional activity and their needs in managing workers with multiple sclerosis.
METHODS
A convenience sample of OPs recruited by e-mail invitation to the list of Italian Society of Occupational Medicine members was considered. A total of 220 OPs participated between July and October 2022. An ad hoc questionnaire was developed based on previous survey experiences. It investigated, among others, the characteristics of OP respondents, the evaluation of fitness for work issues, and the OP training and updating needs on multiple sclerosis and work.
RESULTS
Ninety-one percent of OPs had to assess the fitness for work of workers with multiple sclerosis during their activity. Sixty-four percent experienced particular difficulties in issuing a fitness for work judgment. Regarding the level of knowledge on multiple sclerosis, 54% judged it sufficient. The "Assessment of fitness for work for the specific task" and the "Role of the OPs in identifying reasonable accommodations" were the most interesting training topics regarding MS management in work contexts chosen by the respondents.
CONCLUSIONS
The interest in the work inclusion and job retention of people with disability, particularly the aspects linked to the Identification and implementation of reasonable accommodations, will require integration with the occupational safety and health protection system and will undoubtedly impact the OP's activities.
Topics: Humans; Italy; Multiple Sclerosis; Male; Female; Middle Aged; Adult; Occupational Medicine; Surveys and Questionnaires; Work Capacity Evaluation; Occupational Health Physicians
PubMed: 38922836
DOI: 10.23749/mdl.v115i3.16038 -
Acta Psychiatrica Scandinavica Jun 2024Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.
BACKGROUND
Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.
METHODS
We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design.
RESULTS
Combined data from focus groups (n = 19 participants) and two surveys (n = 139 MHPs and n = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships.
CONCLUSIONS
To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.
PubMed: 38922817
DOI: 10.1111/acps.13725 -
Journal of Gambling Studies Jun 2024All humans must engage in decision-making. Decision-making processes can be broadly classified into internally guided decision-making (IDM), which is determined by...
All humans must engage in decision-making. Decision-making processes can be broadly classified into internally guided decision-making (IDM), which is determined by individuals' internal value criteria, such as preference, or externally guided decision-making (EDM), which is determined by environmental external value criteria, such as monetary rewards. However, real-life decisions are never made simply using one kind of decision-making, and the relationship between IDM and EDM remains unclear. This study had individuals perform gambling tasks requiring the EDM using stimuli that formed preferences through the preference judgment task as the IDM. Computational model analysis revealed that strong preferences in the IDM affected initial choice behavior in the EDM. Moreover, through the analysis of the subjective preference evaluation after the gambling tasks, we found that even when stimuli that were preferred in the IDM were perceived as less valuable in the EDM, the preference for IDM was maintained after EDM. These results indicate that although internal criteria, such as preferences, influence EDM, the results show that internal and external criteria differ.
PubMed: 38922495
DOI: 10.1007/s10899-024-10326-2 -
Cognitive Processing Jun 2024Following the conjecture made by (Bliznashki and Hristova in Appetite 167:105645, 2021), we test the hypothesis that liberal subjective decision criteria exhibited...
Following the conjecture made by (Bliznashki and Hristova in Appetite 167:105645, 2021), we test the hypothesis that liberal subjective decision criteria exhibited during a task involving discrimination between random and systematically correlated patterns should be associated with elevated levels of paranoid ideations. Study 1 establishes the proposed association in the presence of several control measures while also demonstrating that the relationship in question is significantly moderated by subjects' working memory spans and tendencies to be overconfident in their judgments. Study 2 provides further evidence that these effects are indeed specific to tasks involving discrimination between random and systematic patterns and that the observed results are not due to some form of (anti) acquiescence bias or other general trends. Certain specifics of the correlation matrices involving cognitive measures significantly related to the paranoia continuum suggest that our results are consistent with the Entropic Brain Hypothesis. Finally, a simulation study employing a Neural Network demonstrates that increased entropy and liberal decision criteria might be connected to each other with said connection being amenable to an interpretation within the Bayesian paradigm.
PubMed: 38922378
DOI: 10.1007/s10339-024-01204-1 -
Sports (Basel, Switzerland) Jun 2024This study aimed to analyze the effect of a flow training program based on mindfulness applied to young and adult elite handball athletes. A quantitative,...
This study aimed to analyze the effect of a flow training program based on mindfulness applied to young and adult elite handball athletes. A quantitative, quasi-experimental, descriptive data analysis approach was carried out. The sample included 105 athletes (51 female and 54 male). The athletes were divided into two groups: (i) experimental (n = 53) and (ii) control (n = 52). The results of the repeated ANOVA indicated that the experimental group achieved significant improvements compared to the control group in decision making (n = 0.086), mental well-being (n = 0.045), dispositional flow state (n = 0.103), non-judgment (n = 0.040), refocusing (n = 0.052), and mindful traits in daily life (n = 0.058). A Pearson analysis demonstrated a positive correlation between dispositional flow state and mindfulness in sport and mental well-being. The correlation analysis also showed an inverse correlation between decision making and sense of control and mindful traits in daily life. The findings revealed that the program can be effective in decision making, mental well-being, dispositional flow state, mindfulness in sport, and mindful traits in daily lives of athletes.
PubMed: 38921854
DOI: 10.3390/sports12060160 -
Healthcare (Basel, Switzerland) Jun 2024To provide high-quality nursing care, nursing education requires the basic quality of self-leadership from professional nurses so that they can make self-directed and...
To provide high-quality nursing care, nursing education requires the basic quality of self-leadership from professional nurses so that they can make self-directed and responsible judgments and decisions. Therefore, this study aimed to investigate relationships among self-leadership, positive psychological capital, consciousness of calling, and nursing professionalism in nursing students. A cross-sectional online survey of 202 students from two universities in South Korea was conducted between August and September 2022, using a convenience sampling method. A structured questionnaire was used to collect data. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and bootstrapping using Hayes' PROCESS macro for mediation. A significant positive correlation was found between self-leadership, positive psychological capital, consciousness of calling, and nursing professionalism. Positive psychological capital and consciousness of calling showed an indirect mediating effect on the relationship between self-leadership and nursing professionalism. To improve nursing professionalism, programs should be developed to educate nursing students, strengthen their self-leadership skills, and increase the influence of positive psychological capital and consciousness of calling for nursing. This will ultimately contribute to improving the quality of patient care by fostering competent nursing experts.
PubMed: 38921314
DOI: 10.3390/healthcare12121200