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Psychology, Health & Medicine Dec 2018Chronic non-cancer pain (CNCP) is a major health problem which psychosocial factors have significant implications in. There is a gap in regards to evidence for the...
Chronic non-cancer pain (CNCP) is a major health problem which psychosocial factors have significant implications in. There is a gap in regards to evidence for the prevention of chronicity specifically addressing psychological and social domains. Four databases were searched with terms related to "psychosocial", "acute pain", and "chronic pain". A total of 1,389 studies were identified in which titles, abstracts, and full texts were assessed for inclusion criteria. A data template was used to capture pertinent details, and overall themes and patterns were organized according to type of pain examined and psychosocial variables measured. Of the 18 articles that met inclusion criteria, fifteen (83%) of the articles reported an association between psychosocial factors and chronicity. A total of 5 of the studies (29%) demonstrated that depression was a possible predictor and 6 (35%) of the studies found fear-avoidance to be associated with chronicity. This review provides evidence that psychosocial factors are associated with chronicity within CNCP. These results suggest a need for targeting psychosocial predictors in prevention and early intervention through clinical guidelines and a national strategy to support a cultural change in pain care.
Topics: Acute Pain; Analgesics, Opioid; Avoidance Learning; Back Pain; Catastrophization; Chronic Pain; Depression; Disease Progression; Fear; Humans; Pain, Postoperative; Risk Factors
PubMed: 29490476
DOI: 10.1080/13548506.2018.1446097 -
MedEdPublish (2016) 2020This article was migrated. The article was marked as recommended. Medical education publishing is growing rapidly, with both increasing demand for publication space and...
This article was migrated. The article was marked as recommended. Medical education publishing is growing rapidly, with both increasing demand for publication space and increasing space availability. The increasing speed of publication, variable degrees of manuscript checking and increasing accessibility pose some challenges to compliance with ethical guidelines for academic publication. In this paper we review the literature and the websites of journals that publish medical education content and present a contemporary view on issues that should be considered by authors, reviewers, editors and readers of medical education publications. Based on this analysis, we present guidance on how to meet desired ethical standards when writing particular categories of manuscripts. Relying on self-judgement of the ethical status by authors may no longer be acceptable. The need to meet ethical guidelines in publishing must be balanced with the desire for freedom of speech and avoidance of editorial bias. Our intention is to provoke discussion and learning within the medical education community of practice.
PubMed: 38058855
DOI: 10.15694/mep.2020.000048.1 -
PloS One 2021Little research has focused on torture survivors' re-traumatization experiences in health and hospital units that treat somatic diseases, though any medical procedure...
Little research has focused on torture survivors' re-traumatization experiences in health and hospital units that treat somatic diseases, though any medical procedure can re-traumatize survivors. This study's purpose was to summarize qualitative research evidence on torture survivors' somatic healthcare experiences and to identify "triggers" or "reminders" that can lead to re-traumatization. The study's search strategies identified 6,326 citations and eight studies, comprising data from 290 participants, exploring encounters with healthcare providers from torture survivors' perspectives, which were included in the present research. Dallam's Healthcare Retraumatization Model was used as a framework for data extraction and analysis. Five main themes were elicited from the findings: (1) invisibility, silence, and mistrust; (2) healthcare providers' attitudes and a lack of perceived quality in healthcare; (3) disempowerment; (4) avoidance; and (5) satisfaction and gratitude. An analysis of the study's findings revealed that torture survivors do not receive adequate healthcare and may experience challenges during treatment that can result in re-traumatization. The findings of this literature review provide a basis for understanding the difficulties that survivors experience in receiving somatic healthcare, as well as an explanation of the re-traumatization process.
Topics: Avoidance Learning; Female; Health Facilities; Health Personnel; Humans; Male; Psychophysiologic Disorders; Qualitative Research; Stress Disorders, Post-Traumatic; Survivors; Torture
PubMed: 33539415
DOI: 10.1371/journal.pone.0246074 -
The Cochrane Database of Systematic... May 2017Tracheal intubation during induction of general anaesthesia is a vital procedure performed to secure a patient's airway. Several studies have identified difficult... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tracheal intubation during induction of general anaesthesia is a vital procedure performed to secure a patient's airway. Several studies have identified difficult tracheal intubation (DTI) or failed tracheal intubation as one of the major contributors to anaesthesia-related mortality and morbidity. Use of neuromuscular blocking agents (NMBA) to facilitate tracheal intubation is a widely accepted practice. However, because of adverse effects, NMBA may be undesirable. Cohort studies have indicated that avoiding NMBA is an independent risk factor for difficult and failed tracheal intubation. However, no systematic review of randomized trials has evaluated conditions for tracheal intubation, possible adverse effects, and postoperative discomfort.
OBJECTIVES
To evaluate the effects of avoiding neuromuscular blocking agents (NMBA) versus using NMBA on difficult tracheal intubation (DTI) for adults and adolescents allocated to tracheal intubation with direct laryngoscopy. To look at various outcomes, conduct subgroup and sensitivity analyses, examine the role of bias, and apply trial sequential analysis (TSA) to examine the level of available evidence for this intervention.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, BIOSIS, International Web of Science, LILACS, advanced Google, CINAHL, and the following trial registries: Current Controlled Trials; ClinicalTrials.gov; and www.centerwatch.com, up to January 2017. We checked the reference lists of included trials and reviews to look for unidentified trials.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) that compared the effects of avoiding versus using NMBA in participants 14 years of age or older.
DATA COLLECTION AND ANALYSIS
Two review authors extracted data independently. We conducted random-effects and fixed-effect meta-analyses and calculated risk ratios (RRs) and their 95% confidence intervals (CIs). We used published data and data obtained by contacting trial authors. To minimize the risk of systematic error, we assessed the risk of bias of included trials. To reduce the risk of random errors caused by sparse data and repetitive updating of cumulative meta-analyses, we applied TSA.
MAIN RESULTS
We identified 34 RCTs with 3565 participants that met our inclusion criteria. All trials reported on conditions for tracheal intubation; seven trials with 846 participants described 'events of upper airway discomfort or injury', and 13 trials with 1308 participants reported on direct laryngoscopy. All trials used a parallel design. We identified 18 dose-finding studies that included more interventions or control groups or both. All trials except three included only American Society of Anesthesiologists (ASA) class I and II participants, 25 trials excluded participants with anticipated DTI, and obesity or overweight was an excluding factor in 13 studies. Eighteen trials used suxamethonium, and 18 trials used non-depolarizing NMBA.Trials with an overall low risk of bias reported significantly increased risk of DTI with no use of NMBA (random-effects model) (RR 13.27, 95% CI 8.19 to 21.49; P < 0.00001; 508 participants; four trials; number needed to treat for an additional harmful outcome (NNTH) = 1.9, I = 0%, D = 0%, GRADE = moderate). The TSA-adjusted CI for the RR was 1.85 to 95.04. Inclusion of all trials resulted in confirmation of results and of significantly increased risk of DTI when an NMBA was avoided (random-effects model) (RR 5.00, 95% CI 3.49 to 7.15; P < 0.00001; 3565 participants; 34 trials; NNTH = 6.3, I = 70%, D = 82%, GRADE = low). Again the cumulative z-curve crossed the TSA monitoring boundary, demonstrating harmful effects of avoiding NMBA on the proportion of DTI with minimal risk of random error. We categorized only one trial reporting on upper airway discomfort or injury as having overall low risk of bias. Inclusion of all trials revealed significant risk of upper airway discomfort or injury when an NMBA was avoided (random-effects model) (RR 1.37, 95% CI 1.09 to 1.74; P = 0.008; 846 participants; seven trials; NNTH = 9.1, I = 13%, GRADE = moderate). The TSA-adjusted CI for the RR was 1.00 to 1.85. None of these trials reported mortality. In terms of our secondary outcome 'difficult laryngoscopy', we categorized only one trial as having overall low risk of bias. All trials avoiding NMBA were significantly associated with difficult laryngoscopy (random-effects model) (RR 2.54, 95% CI 1.53 to 4.21; P = 0.0003; 1308 participants; 13 trials; NNTH = 25.6, I = 0%, D= 0%, GRADE = low); however, TSA showed that only 6% of the information size required to detect or reject a 20% relative risk reduction (RRR) was accrued, and the trial sequential monitoring boundary was not crossed.
AUTHORS' CONCLUSIONS
This review supports that use of an NMBA may create the best conditions for tracheal intubation and may reduce the risk of upper airway discomfort or injury following tracheal intubation. Study results were characterized by indirectness, heterogeneity, and high or uncertain risk of bias concerning our primary outcome describing difficult tracheal intubation. Therefore, we categorized the GRADE classification of quality of evidence as moderate to low. In light of defined outcomes of individual included trials, our primary outcomes may not reflect a situation that many clinicians consider to be an actual difficult tracheal intubation by which the patient's life or health may be threatened.
Topics: Adolescent; Adult; Confidence Intervals; Humans; Intubation, Intratracheal; Laryngoscopy; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Randomized Controlled Trials as Topic; Risk Factors; Sensitivity and Specificity; Succinylcholine
PubMed: 28513831
DOI: 10.1002/14651858.CD009237.pub2 -
Clinical Psychology Review Apr 2019A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many...
A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many disorders is robust, the mechanisms that may explain this role are unclear. Cutting-edge research in cognitive science has the potential to elucidate such mechanisms and consequently improve our understanding of how disgust contributes to the etiology and maintenance of psychopathology. In this qualitative review, we systematically assess cognitive bias mechanisms that have been linked to disgust and its disorders. This review suggests that disgust-related biases may be observed in memory, interpretation, judgment of expectancies, and attention, as well as at implicit levels. Of these cognitive domains, the most robust bias appears to be observed at the level of attention. However, reliable moderators of attentional biases for disgust have not yet been identified, and this bias has not been systematically linked to other levels of analysis. Despite these limitations, the available research indicates that attentional avoidance rather than orienting or maintenance may be the most characteristic of disgust. Attentional avoidance of disgust may have important implications for etiological and treatment models of disorders characterized by excessive disgust reactions. The implications for advancing such models are discussed in the context of a combined cognitive bias hypothesis.
Topics: Attentional Bias; Avoidance Learning; Cognitive Dysfunction; Cues; Disgust; Humans; Mental Disorders; Mental Recall
PubMed: 29909923
DOI: 10.1016/j.cpr.2018.06.002 -
Revista de Neurologia Jan 2019Kahneman and Tversky's prospect theory has become the main model for the study of decision-making. One of its cornerstones, the loss aversion bias (greater sensitivity...
INTRODUCTION
Kahneman and Tversky's prospect theory has become the main model for the study of decision-making. One of its cornerstones, the loss aversion bias (greater sensitivity to losses than to gains), has been demonstrated from the behavioural perspective.
AIMS
To analyse the evidence from neuroeconomics and check whether it is consistent with the existence of a neural mechanism of loss aversion.
PATIENTS AND METHODS
A systematic review was performed, following the PRISMA guidelines, of the empirical studies found in PubMed and ScienceDirect, a total of 18 studies being included altogether.
RESULTS AND CONCLUSIONS
The results consistently point to the implication of two opposing neural systems in this bias: one appetitive, involving the striatum and the frontal regions, and one aversive, involving the amygdala and the insula, which interact with each other when it comes to making a decision about different monetary bets and display a higher sensitivity towards losses. Although their functioning is not yet clear, what does seem evident is that the consistent involvement of these structures lends support to prospect theory and the limited rationality approach.
Topics: Adolescent; Adult; Avoidance Learning; Brain Mapping; Decision Making; Economics, Behavioral; Female; Gambling; Games, Experimental; Humans; Male; Models, Neurological; Models, Psychological; Neuroimaging; Young Adult
PubMed: 30638254
DOI: No ID Found