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Otology & Neurotology : Official... Aug 2019By discussing the design, findings, strengths, and weaknesses of available studies investigating the influence of angular insertion depth on speech perception, we intend...
OBJECTIVE
By discussing the design, findings, strengths, and weaknesses of available studies investigating the influence of angular insertion depth on speech perception, we intend to summarize the current status of evidence; and using evidence based conclusions, possibly contribute to the determination of the optimal cochlear implant (CI) electrode position.
DATA SOURCES
Our search strategy yielded 10,877 papers. PubMed, Ovid EMBASE, Web of Science, and the Cochrane Library were searched up to June 1, 2018. Both keywords and free-text terms, related to patient population, predictive factor, and outcome measurements were used. There were no restrictions in languages or year of publication.
STUDY SELECTION
Seven articles were included in this systematic review. Articles eligible for inclusion: (a) investigated cochlear implantation of any CI system in adults with post-lingual onset of deafness and normal cochlear anatomy; (b) investigated the relationship between angular insertion depth and speech perception; (c) measured angular insertion depth on imaging; and (d) measured speech perception at, or beyond 1-year post-activation.
DATA EXTRACTION AND SYNTHESIS
In included studies; quality was judged low-to-moderate and risk of bias, evaluated using a Quality-in-Prognostic-Studies-tool (QUIPS), was high. Included studies were too heterogeneous to perform meta-analyses, therefore, effect estimates of the individual studies are presented. Six out of seven included studies found no effect of angular insertion depth on speech perception.
CONCLUSION
All included studies are characterized by methodological flaws, and therefore, evidence-based conclusions regarding the influence of angular insertion depth cannot be drawn to date.
Topics: Adult; Cochlea; Cochlear Implantation; Cochlear Implants; Deafness; Humans; Speech Perception; Treatment Outcome
PubMed: 31135680
DOI: 10.1097/MAO.0000000000002298 -
Psychotherapy Research : Journal of the... Apr 2020: Psychotherapists differ notably in the outcomes their patients achieve, and the characteristics that may explain these differences have attracted increasing interest....
: Psychotherapists differ notably in the outcomes their patients achieve, and the characteristics that may explain these differences have attracted increasing interest. We systematically review studies on therapist pre-treatment characteristics predicting patient outcomes. Systematic searches on databases for psychotherapy research, clinical psychology, and medical science for the years 2000-2018 identified published research examining therapist characteristics and psychotherapy outcomes. Of 2041 studies, 31 met inclusion criteria. : Findings show a few direct effects of therapist intrapersonal variables (e.g., self-relatedness, attachment) and several interaction effects with other constructs (e.g., patient pathology) on outcome. There is little support for the relevance of self-rated social skills. However, more consistent evidence has recently emerged for performance-based measurements of professional interpersonal skills, especially when elicited in challenging situations. Patient outcomes were also predicted by therapists' self-rated professional characteristics, such as their experienced difficulties in practice, coping mechanisms, and attitudes towards therapeutic work, indicating that therapist self-perception also matters, although not always in the direction expected. : More effective therapists seem characterized by professionally cultivated interpersonal capacities, which are likely rooted in their personal lives and attachment history. Research guidelines are proposed for moving this field forward (including larger samples, multilevel modeling, and in-depth qualitative work).
Topics: Humans; Professional-Patient Relations; Psychotherapists; Psychotherapy; Self Concept; Social Skills
PubMed: 31122157
DOI: 10.1080/10503307.2019.1620366 -
British Journal of Anaesthesia Aug 2019Pain is recognised to have both a sensory dimension (intensity) and an affective dimension (unpleasantness). Pain feels like a single unpleasant bodily experience, but...
BACKGROUND
Pain is recognised to have both a sensory dimension (intensity) and an affective dimension (unpleasantness). Pain feels like a single unpleasant bodily experience, but investigations of human pain have long considered these two dimensions of pain to be separable and differentially modifiable. The evidence underpinning this separability and differential modifiability is seldom presented. We aimed to fill this gap by evaluating the current evidence base for whether or not the sensory and affective dimensions of pain can be selectively modulated using cognitive manipulations.
METHODS
A rigorous systematic search, based on a priori search terms and consultation with field experts, yielded 4270 articles. A detailed screening process was based on the following recommendations: (i) evaluation of effectiveness; (ii) examination of methodological rigour, including each study having an a priori intention to cognitively modulate one of the two dimensions of pain; and (iii) sound theoretical reasoning. These were used to ensure that included studies definitively answered the research question.
RESULTS
After in-depth critique of all 12 articles that met the inclusion criteria, we found that there is no compelling evidence that the sensory and affective dimensions of pain can be selectively and intentionally modulated using cognitive manipulations in humans.
CONCLUSIONS
We offer potential explanations for this discrepancy between assumptions and evidence and contend that this finding highlights several important questions for the field, from both the research and clinical perspectives.
Topics: Affect; Humans; Mind-Body Therapies; Pain; Pain Measurement; Pain Perception
PubMed: 31053232
DOI: 10.1016/j.bja.2019.03.033 -
International Journal of Medical... May 2019Health information exchange (HIE), the ability for health information technology (HIT) to share patient data, can improve the efficiency and effectiveness of healthcare;...
BACKGROUND
Health information exchange (HIE), the ability for health information technology (HIT) to share patient data, can improve the efficiency and effectiveness of healthcare; however, this ability may cause patient concern about their ability to control who can access their health records (i.e., privacy). These concerns may affect a patient's candor in their therapeutic patient-provider relationships, thereby undermining their care. While patient privacy concerns are often cited as a barrier to HIT implementation, the patient privacy perspective is not well understood. The purpose of this systematic review is to provide an in-depth exploration of the patient privacy perspective toward HIE, its antecedents, and its outcomes.
MATERIALS AND METHODS
A systematic review was conducted on seven health sciences and interdisciplinary databases. Empirical studies that assessed the patient perception of privacy in context of interoperable HIT were included. All included articles were independently screened, extracted, and analyzed by two reviewers. The results were extracted and categorized based on the dimensions outlined in the Antecedent Privacy Concern Outcomes macro-model (APCO).
RESULTS
Of the 1713 unique citations, 59 articles met the inclusion criteria which consisted of 39 (66.1%) quantitative studies, 15 (25.4%) qualitative studies, and 5 (8.5%) mixed methods studies. Fourteen articles (23.7%) were specifically focused on understanding privacy. The patient privacy perspective was operationalized in different ways, with privacy concern being the most common measure (25.4%). The percentage of participants expressing privacy concern ranged from 15% to 74%, depending on the study. Perceived quality of care was associated with lower privacy concerns. Privacy concerns were associated with privacy protective behaviours; however, the perceived benefit of HIE may mitigate the effects of privacy concern.
CONCLUSION
Using the APCO as a guide, this review found that the patient privacy perspective is dynamic, complex, and still not well understood. There may be an oversimplification of the patient privacy perspective and its impact given the paucity of privacy-focused research. The evidence suggests patient perceptions of healthcare and the value of HIE are important factors in mitigating privacy concerns and its effects. More in-depth privacy studies are required to further illuminate the nuances of the patient perspective and provide policy-makers with greater insights on the privacy barrier.
Topics: Health Information Exchange; Humans; Male; Patients; Perception; Privacy
PubMed: 30914173
DOI: 10.1016/j.ijmedinf.2019.01.014 -
Journal of Dairy Science May 2019We aimed to determine how research regarding farmers' personalities and attitudes as risk factors is reported (methodological approaches to assessing, extracting, and...
Invited review: Examining farmers' personalities and attitudes as possible risk factors for dairy cattle health, welfare, productivity, and farm management: A systematic scoping review.
We aimed to determine how research regarding farmers' personalities and attitudes as risk factors is reported (methodological approaches to assessing, extracting, and processing data and analyzing risk factors) and to explore evidence for the effect of farmers' attitudes and personalities on dairy cattle health, welfare, productivity, and management. Therefore, we conducted a systematic review of studies on personality and attitude as risk factors for dairy cattle health, welfare, productivity, and farm management. Database searches captured 1,144 records, and 38 were finally included in the review. Thirty-three manuscripts assessed farmers' attitudes, 1 assessed their personalities, and 4 assessed both as risk factors. These potential risk factors were checked for relationships with more than 50 different outcome variables regarding farm management (17 manuscripts), animal health (13 manuscripts), animal productivity (11 manuscripts), and animal welfare (4 manuscripts). The approaches to assessing risk factors and processing and interpreting data varied greatly; thus, drawing conclusions regarding the effects of attitude and personality as risk factors is impeded because manuscripts are difficult to compare. Our findings highlight the need for harmonization of attitudes and personality assessments in future research. Furthermore, researchers should carefully consider which depth of detail to apply when planning and evaluating related research. Nevertheless, results highlight the importance of the effect of personality and attitude on outcomes. Farmers' personality and attitudes are associated with dairy cattle health, welfare, productivity, and management. In general, attitudes indicating higher degrees of technical knowledge, affection with problems, perceived responsibility, perception of control of a situation, a better human-animal relationship, or a positive evaluation of the benefits of management decisions tended to affect outcomes in a beneficial way. "Agreeableness" and "conscientiousness" were shown to promote better farm performance, whereas "neuroticism" had a negative effect. Therefore, further research on attitude and personality and their consideration by professionals and decision-makers within the dairy sector and politics is strongly recommended. This might provide the chance to better understand the needs of dairy farmers and therefore develop tailored advice and support strategies to improve both satisfactory and constructive cooperation.
Topics: Animal Welfare; Animals; Attitude; Cattle; Dairying; Decision Making; Efficiency; Farmers; Farms; Health Status; Humans; Perception; Personality; Risk Factors
PubMed: 30852027
DOI: 10.3168/jds.2018-15037 -
Journal of Robotic Surgery Jun 2019A systematic review was undertaken to assess the technology used to create stereovision for human perception. Adverse effects associated with artificial stereoscopic...
A systematic review was undertaken to assess the technology used to create stereovision for human perception. Adverse effects associated with artificial stereoscopic technology were reviewed with an emphasis on the impact of surgical performance in the operating room. MEDLINE/PubMed library databases were used to identify literature published up to Aug 2017. In the past 60 years, four major types of technologies have been used for reconstructing stereo images: anaglyph, polarization, active shutter, and autostereoscopy. As none of them can perfectly duplicate our natural stereoperception, user exposure to this artificial environment for a period of time can lead to a series of psychophysiological responses including nausea, dizziness, and others. The exact mechanism underlying these symptoms is not clear. Neurophysiologic evidences suggest that the visuo-vestibular pathway plays a vital role in coupling unnatural visual inputs to autonomic neural responses. When stereoscopic technology was used in surgical environments, controversial results were reported. Although recent advances in stereoscopy are promising, no definitive evidence has yet been presented to support that stereoscopes can enhance surgical performance in image-guided surgery. Stereoscopic technology has been rapidly introduced to healthcare. Adverse effects to human operators caused by immature technology seem inevitable. The impact on surgeons working with this visualization system needs to be explored and its safety and feasibility need to be addressed.
Topics: Depth Perception; Humans; Imaging, Three-Dimensional; Motion Sickness; Robotic Surgical Procedures; Surgeons; Surgery, Computer-Assisted
PubMed: 30847653
DOI: 10.1007/s11701-018-00900-3 -
Journal of Endourology Sep 2018Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions.
METHODS
Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis.
RESULTS
Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system.
CONCLUSION
Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.
Topics: Blood Loss, Surgical; Humans; Imaging, Three-Dimensional; Laparoscopy; Operative Time; Urologic Surgical Procedures; Warm Ischemia
PubMed: 29969912
DOI: 10.1089/end.2018.0411 -
International Journal of Audiology Sep 2018To develop a decision aid for tinnitus care that would meet international consensus for decision aid quality.
OBJECTIVE
To develop a decision aid for tinnitus care that would meet international consensus for decision aid quality.
DESIGN
A mixed methods design that included qualitative in-depth interviews, literature review, focus groups, user testing and readability checking.
STUDY SAMPLE
Patients and clinicians who have clinical experience of tinnitus.
RESULTS
A decision aid for tinnitus care was developed. This incorporates key evidence of efficacy for the most frequently used tinnitus care options, together with information derived from patient priorities when deciding which choice to make.
CONCLUSION
The decision aid has potential to enable shared decision making between clinicians and patients in audiology. The decision aid meets consensus standards.
Topics: Attitude of Health Personnel; Auditory Perception; Clinical Decision-Making; Consensus; Decision Support Techniques; Female; Focus Groups; Health Communication; Health Knowledge, Attitudes, Practice; Hearing; Humans; Interviews as Topic; Male; Middle Aged; Patient Education as Topic; Patient Participation; Predictive Value of Tests; Professional-Patient Relations; Qualitative Research; Tinnitus
PubMed: 29741407
DOI: 10.1080/14992027.2018.1468093 -
Frontiers in Psychology 2018Gifted students who also have learning disabilities (G/LD) are often overlooked when students are assessed either for giftedness or specific learning disabilities. The...
Gifted students who also have learning disabilities (G/LD) are often overlooked when students are assessed either for giftedness or specific learning disabilities. The cognitive and non-cognitive characteristics of these G/LD students are habitually discussed only briefly alongside identification and intervention issues and, beyond that, the relevance of non-cognitive characteristics is often left unconsidered. Accordingly, this study aims to conduct an in-depth review of the non-cognitive characteristics of these students for identification and intervention purposes. Detailed analysis was performed on 23 publications. High levels of negative emotions, low self-perception, and adverse interpersonal relationships, as well as high levels of motivation, coping skills and perseverance were found among these students. A common characteristic was a high degree of frustration with the academic situation. The study reveals that these students show considerably duality in their non-cognitive characteristics which requires tailored counseling skills to provide effective support for their learning needs.
PubMed: 29731728
DOI: 10.3389/fpsyg.2018.00504 -
Journal of Women's Health (2002) Sep 2018Excessive breast cancer screening with mammography or other modalities often burdens patients with false-positive results and costs. Yet, screening patients beyond the... (Review)
Review
BACKGROUND
Excessive breast cancer screening with mammography or other modalities often burdens patients with false-positive results and costs. Yet, screening patients beyond the age at which they will benefit or at too frequent intervals persists. This review summarizes the factors associated with overuse of breast cancer screening.
METHODS
We searched Medline and Embase from January 1998 to March 2017 for articles addressing the overuse of breast cancer screening and hand-searched the reference lists of included articles. Studies were included if they were written in English, pertained to a U.S. population, and identified a factor associated specifically with overuse of breast imaging. Paired reviewers independently screened abstracts, extracted data, and assessed quality.
RESULTS
We included 15 studies: 3 cohort, 5 cross-sectional, 6 surveys, and 1 in-depth interview. White women (non-Hispanic) were less vulnerable than other racial groups to overuse in 3 of 5 studies. Physician specialty was consistently associated with screening overuse in three of three studies. Abundant access to primary care and a patient desire for screening were associated with breast cancer screening overuse. Lower self-confidence, lower risk taking tendencies, higher perception of conflict in expert recommendations, and a belief in screening effectiveness were clinician traits associated with overuse of screening in the surveys.
CONCLUSIONS
The literature supports that liberal access to care and clinicians' recommendations to screen, possibly influenced by conflicting guidelines, increase excessive breast cancer screening. Overuse might conceivably be reduced with more concordance across guidelines, physician education, patient involvement in decision-making, thoughtful insurance restrictions, and limitations on the supply of services; however, these will need careful testing regarding their impact.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Medical Overuse; Practice Guidelines as Topic
PubMed: 29708809
DOI: 10.1089/jwh.2017.6689