scholarly journals What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus

2020 ◽  
Vol 90 (1) ◽  
pp. 49-56
Author(s):  
Andrea W.M. Evers ◽  
Luana Colloca ◽  
Charlotte Blease ◽  
Jens Gaab ◽  
Karin B. Jensen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Delphi Study ◽  
Information Needs ◽  
General Information ◽  
Future Research ◽  
Face To Face ◽  
Expert Meeting ◽  
Nocebo Effects ◽  
Clinical Conditions ◽  
Training Modules

<b><i>Introduction:</i></b> Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. <b><i>Objective:</i></b> There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. <b><i>Methods:</i></b> Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. <b><i>Results:</i></b> There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. <b><i>Conclusions:</i></b> The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients’ needs, and on developing standardized disclosure training modules for clinicians.

Women And Depression: Future Research, Clinical Practice, And Public Policy

2002 ◽  
Author(s):  
Carolyn M. Mazure ◽  
Laura J. Bierut ◽  
Steven D. Hollon ◽  
Susan G. Kornstein ◽  
Charlotte Brown
Keyword(s):  
Public Policy ◽  
Clinical Practice ◽  
Future Research

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

The Social Consequences of Phubbing

2020 ◽  
pp. 157-174 ◽  
Author(s):  
Mariek Vanden Abeele
Keyword(s):  
Literature Review ◽  
Social Relationships ◽  
Empirical Work ◽  
Social Consequences ◽  
Future Research ◽  
Expectancy Violations ◽  
Face To Face ◽  
Comprehensive Literature Review ◽  
The Social

Recent empirical work suggests that phubbing, a term used to describe the practice of snubbing someone with a phone during a face-to-face social interaction, harms the quality of social relationships. Based on a comprehensive literature review, this chapter presents a framework that integrates three concurrent mechanisms that explain the relational impact of phubbing: expectancy violations, ostracism, and attentional conflict. Based on this framework, theoretically grounded propositions are formulated that may serve as guidelines for future research on these mechanisms, the conditions under which they operate, and a number of potential issues that need to be considered to further validate and extend the framework.

scholarly journals SAT0623-HPR THE LIVED EXPERIENCES OF COGNITIVE DYSFUNCTION IN ADULTS WITH FIBROMYALGIA: A QUALITATIVE SYSTEMATIC REVIEW

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1271.1-1272
Author(s):  
S. Derham ◽  
J. Lewis ◽  
E. Dures ◽  
F. Cramp
Keyword(s):  
Clinical Practice ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Lived Experiences ◽  
Critical Appraisal ◽  
Negative Impact ◽  
Practice Research ◽  
Future Research ◽  
Poor Sleep ◽  
Cognitive Changes

Background:Adults with fibromyalgia frequently report symptoms of cognitive dysfunction, often referred to as fibrofog. However primary research exploring cognitive dysfunction in the lives of adults with fibromyalgia is very limited (Kravitz and Katz, 2015).Objectives:The aim of this review was to (i) synthesise the qualitative literature on the lived experiences of cognitive dysfunction in adults with fibromyalgia, (ii) develop common themes through thematic analysis and (iii) identify knowledge gaps to inform future research and clinical practice in this area.Methods:Seven electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Amed, Scopus and OpenGrey), reference lists of key articles and two high impact qualitative journals were searched from 1990 to November 2018. Articles were eligible for inclusion if they reported primary qualitative data exploring the experiences of cognitive dysfunction in adults with fibromyalgia. Included studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist and extracted data analysed using narrative synthesis. SD conducted critical appraisal and data extraction on all included studies. FC, JL and ED reviewed five papers each. All papers were reviewed by two co-authors. Of the 1413 records identified, 15 studies were selected for inclusion.Results:These studies included 208 women and 22 men with fibromyalgia, aged 18 to 72 years and representing seven different countries. Duration of diagnosis was four months to 34 years. Fourteen studies used interviews and one used focus groups. None of the included studies focussed exclusively on cognitive function in adults with fibromyalgia. Three studies identified themes specific to cognitive dysfunction and fibromyalgia symptoms. The remaining 12 studies presented relevant data intertwined with the overall lived experiences of fibromyalgia.Cognitive dysfunction, as a part of fibromyalgia, was often unpredictable. Problems with memory and concentration that were most commonly reported were emotionally distressing and affected functional and vocational activities. Participants found communication effortful, with a negative impact on work, leisure and social activities. Stress, fear and worry around perceived cognitive changes were commonly expressed. Lost employment or changed work roles and relationships, due to cognitive difficulties, had negative impacts for many participants. The terms cognitive dysfunction and fibrofog were used interchangeably within the studies, but lacked common definition. This introduced uncertainty around whether participants and authors were describing the same phenomenon.Conclusion:Adults with fibromyalgia experience unpredictable and emotionally impactful difficulties related to cognitive dysfunction. Functional impact was broad-reaching, particularly around work ability and lost employment opportunities. It is unclear how cognitive symptoms in fibromyalgia related to co-morbid symptoms such as pain, fatigue and poor sleep. Further research focusing on the full impact of cognitive function on the lives of adults with fibromyalgia is recommended to inform clinical practice. Research to establish clarity of definition of the terms cognitive dysfunction and fibrofog within fibromyalgia is highly recommended.References:[1]Kravitz H, Katz R. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatology International. 2015;35(7):1115-25.Acknowledgments:This work is supported by the National Institute for Heath Research [ICA-PCAF-2018-01-078 to SD]Disclosure of Interests:Sandra Derham: None declared, Jenny Lewis: None declared, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses., Fiona Cramp: None declared

scholarly journals Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs

2021 ◽  
Vol 18 (9) ◽  
pp. 4455
Author(s):  
Sasha Harris-Lovett ◽  
Kara L. Nelson ◽  
Paloma Beamer ◽  
Heather N. Bischel ◽  
Aaron Bivins ◽  
...  
Keyword(s):  
Information Needs ◽  
Community Dynamics ◽  
The United States ◽  
Lessons Learned ◽  
Future Research ◽  
Private Institutions ◽  
Community Members ◽  
Public And Private ◽  
College And University ◽  
University Systems

Wastewater surveillance for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging approach to help identify the risk of a coronavirus disease (COVID-19) outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, and nursing homes) scales. This paper explores the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. We present the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resources, and impacts from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Our analysis suggests that wastewater monitoring at colleges requires consideration of local information needs, sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members.

How Might We Screen for Psychological Factors in People With Pelvic Pain? An e-Delphi Study

2021 ◽  
Author(s):  
Angela Pontifex ◽  
Caris Savin ◽  
Caitlin Park ◽  
Alina Filipe Nunes ◽  
K Jane Chalmers ◽  
...  
Keyword(s):  
Focus Group ◽  
Pelvic Pain ◽  
Delphi Method ◽  
Delphi Study ◽  
Psychological Factors ◽  
Clinical Utility ◽  
Delphi Process ◽  
Future Research ◽  
Exclusion Criteria ◽  
Group Design

Abstract Objective Persistent pelvic pain is a complex condition often influenced by psychological factors that can alter treatment outcomes. These factors are potentially modifiable; however, currently there is no instrument to screen for them in these individuals. The purpose of this study was to determine (1) which psychological factors should be screened in individuals with persistent pelvic pain and (2) the most appropriate statements to represent these psychological factors. Methods The study used a focus group design followed by an electronic-Delphi (e-Delphi) process. A focus group consisting of 8 experts was conducted to determine the relevant psychological factors to screen. These results informed round 1 of the e-Delphi process, consisting of a panel of 14 pain/pelvic pain experts. The e-Delphi process consisted of 3 rounds of online surveys and 2 teleconference discussions to establish consensus on the most appropriate statement to screen for each of the psychological factors. Results The focus group identified 13 relevant psychological factors. During the e-Delphi process, relevant screening statements were assessed using a 100-point allocation system. Experts could reword and suggest new statements. Statements were assessed for consensus and stability and were eliminated as the rounds progressed if they met the exclusion criteria. At the termination of round 3, there were 15 statements remaining. Conclusions The final list of 15 statements will assist clinicians in screening for psychological factors and is an important step for clinicians in providing psychologically informed care to people with persistent pelvic pain. Future research should determine the psychometric properties of the statements to determine their clinical utility as a questionnaire. Impact This study has refined a list of statements to help screen for psychological factors in individuals with persistent pelvic pain. Developed robustly using an e-Delphi method, this list is an important first step forward for clinicians to provide psychologically informed care to these individuals.

scholarly journals Feasibility study of assessing the Preclinical Alzheimer Cognitive Composite (PACC) score via videoconferencing

2021 ◽  
Author(s):  
Giulia Seghezzo ◽  
Yvonne Van Hoecke ◽  
Laura James ◽  
Donna Davoren ◽  
Elizabeth Williamson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Clinical Practice ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Pearson Correlation ◽  
Cognitive Tests ◽  
Strong Positive Correlation ◽  
Pearson Correlation Coefficient ◽  
Face To Face ◽  
The Difference

Abstract Background The Preclinical Alzheimer Cognitive Composite (PACC) is a composite score which can detect the first signs of cognitive impairment, which can be of importance for research and clinical practice. It is designed to be administered in person; however, in-person assessments are costly, and are difficult during the current COVID-19 pandemic. Objective To assess the feasibility of performing the PACC assessment with videoconferencing, and to compare the validity of this remote PACC with the in-person PACC obtained previously. Methods Participants from the HEalth and Ageing Data IN the Game of football (HEADING) Study who had already undergone an in-person assessment were re-contacted and re-assessed remotely. The correlation between the two PACC scores was estimated. The difference between the two PACC scores was calculated and used in multiple linear regression to assess which variables were associated with a difference in PACC scores. Findings Of the 43 participants who were invited to this external study, 28 were re-assessed. The median duration in days between the in-person and the remote assessments was 236.5 days (7.9 months) (IQR 62.5). There was a strong positive correlation between the two assessments for the PACC score, with a Pearson correlation coefficient of 0·82 (95% CI 0·66, 0·98). The multiple linear regression found that the only predictor of the PACC difference was the time between assessments. Interpretation This study provides evidence on the feasibility of performing cognitive tests online, with the PACC tests being successfully administered through videoconferencing. This is relevant, especially during times when face-to-face assessments cannot be performed.

scholarly journals Associative learning and extinction of conditioned threat predictors across sensory modalities

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Laura. R. Koenen ◽  
Robert. J. Pawlik ◽  
Adriane Icenhour ◽  
Ljubov Petrakova ◽  
Katarina Forkmann ◽  
...  
Keyword(s):  
Visceral Pain ◽  
Neural Correlates ◽  
Imaging Studies ◽  
Somatic Pain ◽  
Healthy Humans ◽  
Sensory Modalities ◽  
The Face ◽  
Nocebo Effects ◽  
Conditioned Responses ◽  
Clinical Conditions

AbstractThe formation and persistence of negative pain-related expectations by classical conditioning remain incompletely understood. We elucidated behavioural and neural correlates involved in the acquisition and extinction of negative expectations towards different threats across sensory modalities. In two complementary functional magnetic resonance imaging studies in healthy humans, differential conditioning paradigms combined interoceptive visceral pain with somatic pain (study 1) and aversive tone (study 2) as exteroceptive threats. Conditioned responses to interoceptive threat predictors were enhanced in both studies, consistently involving the insula and cingulate cortex. Interoceptive threats had a greater impact on extinction efficacy, resulting in disruption of ongoing extinction (study 1), and selective resurgence of interoceptive CS-US associations after complete extinction (study 2). In the face of multiple threats, we preferentially learn, store, and remember interoceptive danger signals. As key mediators of nocebo effects, conditioned responses may be particularly relevant to clinical conditions involving disturbed interoception and chronic visceral pain.

scholarly journals The Infinity Formulation: how transdiagnostic behaviours and endeavours for behavioural change serve to maintain co-morbid mental health presentations

2021 ◽  
Vol 14 ◽  
Author(s):  
Alison Bennetts
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Cognitive Biases ◽  
Behavioural Change ◽  
Psychological Theory ◽  
Primary Treatment ◽  
Future Research ◽  
List Type ◽  
Cognitive Behavioural ◽  
Co Morbidity

Abstract Treatment recommendations for mental health are often founded on diagnosis-specific models; however, there are high rates of co-morbidity of mental health presentations and growing recognition of the presence of ‘transdiagnostic processes’ (cognitive, emotional or behavioural features) seen across a range of mental health presentations. This model proposes a novel conceptualisation of how transdiagnostic behaviours may maintain co-morbid mental health presentations by acting as a trigger event for the cognitive biases specific to each presentation. Drawing on existing evidence, psychological theory and the author’s clinical experience, the model organises complex presentations in a theory-driven yet accessible manner for use in clinical practice. The model offers both theoretical and clinical implications for the treatment of mental health presentations using cognitive behavioural approaches, positing that transdiagnostic behaviours be the primary treatment target in co-morbid presentations. Key learning aims (1) To understand the strengths and limitations of existing transdiagnostic CBT formulation models. (2) To learn about a novel, transdiagnostic and behaviourally focused formulation for use in clinical practice. (3) To understand how to use the tool in clinical practice and future research.

Effectiveness of Digital Health Interventions on Unintentional Injury, Violence, and Suicide: Meta-Analysis

2020 ◽  
pp. 152483802096734
Author(s):  
Mengtong Chen ◽  
Ko Ling Chan
Keyword(s):  
Interpersonal Violence ◽  
Care Delivery ◽  
Digital Health ◽  
Meta Analysis ◽  
Random Effect ◽  
Unintentional Injury ◽  
Health Interventions ◽  
Effect Sizes ◽  
Future Research ◽  
Face To Face

Digital technologies are increasingly used in health-care delivery and are being introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional injury, violence, and suicide. Future research should explore DHIs’ successful components to facilitate future implementation and wider access.

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