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JAMA Network Open Feb 2024
Topics: Humans; Pessimism; Prognosis; Neonatologists; Depression; Surveys and Questionnaires
PubMed: 38393732
DOI: 10.1001/jamanetworkopen.2024.0525 -
JAMA Network Open Feb 2024In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents.
OBJECTIVE
To examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication.
DESIGN, SETTING, AND PARTICIPANTS
This crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022.
INTERVENTIONS
Alternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing).
MAIN OUTCOMES AND MEASURES
The primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates.
RESULTS
Of 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P < .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, -0.34; -1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, -0.55; 95% CI, -1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P < .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16).
CONCLUSIONS AND RELEVANCE
When given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment.
TRIAL REGISTRATION
German Clinical Trials Register (DRKS): DRKS00024466.
Topics: Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Parents; Prognosis; Communication; Optimism; Pessimism; Cross-Over Studies; Adult; Middle Aged
PubMed: 38393728
DOI: 10.1001/jamanetworkopen.2024.0105 -
Journal of Medical Internet Research Feb 2024The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor...
BACKGROUND
The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients' needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions.
OBJECTIVE
The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance.
METHODS
A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20%) and men (63/79, 80%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients' perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices.
RESULTS
All the patients in this study owned a smartphone, while 30%-40% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35%-50% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components.
CONCLUSIONS
The patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729.
Topics: Female; Humans; Male; Middle Aged; Cardiac Rehabilitation; Coronary Artery Disease; Cross-Sectional Studies; Germany; Motivation; Spain; Telemedicine; Aged
PubMed: 38386376
DOI: 10.2196/53991 -
Scientific Reports Feb 2024The mood index [Formula: see text] was used to describe evaluator attitudes regarding the progress of a project that formed the basis of a construction period prediction...
The mood index [Formula: see text] was used to describe evaluator attitudes regarding the progress of a project that formed the basis of a construction period prediction model. The degrees of pessimism [Formula: see text] and optimism [Formula: see text] were introduced, and an analysis model was established using [Formula: see text] and [Formula: see text] to predict the construction period and completion probability Firstly, the absolute construction period of each process of tunnel No. 2 can be obtained according to the measured daily average footage of each process of tunnel No. 1. Secondly, the probability of the stoppage caused by different factors can be obtained after the statistical analysis of the factors responsible for the stoppage of tunnel No. 1. Finally, the expected construction period and completion probability of tunnel No. 2 under different pessimism and optimism conditions are obtained by using the progress risk analysis theory of emotional models and the program evaluation and review technique method. An engineering application showed that the expected construction period increased, and the completion probability decreased considerably with increasing pessimism; the opposite trend occurred as optimism increased. During the process of risk management and control, the prediction model can be used to perform precise quantitative analysis of the expected construction period and completion probability, reduce the blindness of construction management, control decisions of complex giant tunnel projects, and provide a more accurate basis for decision makers to judge risks. The findings of this study can be applied to hydraulic tunnels and can provide a reference for traffic tunnels, railway tunnels, and other similar projects.
Topics: Drinking; Probability; Risk Assessment; Text Messaging; Affect
PubMed: 38361119
DOI: 10.1038/s41598-024-54261-z -
Healthcare (Basel, Switzerland) Jan 2024The idea of artificially created social robots has a long tradition. Today, attitudes towards robots play a central role in the field of healthcare. Our research aimed...
The idea of artificially created social robots has a long tradition. Today, attitudes towards robots play a central role in the field of healthcare. Our research aimed to develop a scale to measure attitudes towards robots. The survey consisted of nine questions on attitudes towards robots, sociodemographic questions, the SWOP-K9, measuring self-efficacy, optimism, and pessimism, and the BFI-10, measuring personality dimensions. Structural relations between the items were detected using principal components analysis (PCA) with Varimax rotation. Correlations and Analysis of Variance were used for external validation. In total, 214 participants (56.1% female, mean age: 30.8 ± 14.4 years) completed the survey. The PCA found two main components, "Robot as a helper and assistant" (RoHeA) and "Robot as an equal partner" (RoEqP), with four items each explaining 53.2% and 17.5% of the variance with a Cronbach's α of 0.915 and 0.768. In the personality traits, "Conscientiousness" correlated weakly with both subscales and "Extraversion" correlated with RoHeA, while none the subscales of the SWOP-K9 significantly correlated with RoEqP or RoHeA. Male participants scored significantly higher than female participants. Our survey yielded a stable and convergent two-factor instrument that exhibited convincing validity and complements other findings in the field. The ASRS can easily be used to describe attitudes towards social robots in human society. Further research, however, should be carried out to investigate the discriminant and convergent validity of the ASRS.
PubMed: 38338172
DOI: 10.3390/healthcare12030286 -
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 -
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 -
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