Shared decision-making and detection of comorbidities in an online acromegaly consultation with and without the Acromegaly Disease Activity Tool ACRODAT® using the simulated person approach.

OBJECTIVE: A patient-centered approach to the management of acromegaly includes disease activity control, shared decision-making and identification of comorbidities. The Acromegaly Disease Activity Tool (ACRODAT®) is intended to assist physicians in providing such holistic management. The present study investigated this claim using the simulated person (SP) approach. METHODS: We studied patient-doctor interaction via online video consultation in a randomized prospective study design with SPs trained to simulate a specific acromegaly profile. We analyzed the proportion of conversation time devoted to health content and the specific acromegaly and comorbidity relevant categories mentioned in the conversation. We collected physicians' feedback on the usefulness of ACRODAT®, SPs subjective perception of the quality of the conversation and compared consultations with and without ACRODAT® using a qualitative approach. RESULTS: The sample (N = 30) consisted of endocrinologists treating patients with acromegaly in Germany. For SP-physician interactions (N = 60), the proportion of time spent on conversation content (e.g. IGF-I, quality of life) was distributed according to the focus of the patient profile. Comorbidities were less well identified than the need for a change in therapy. Only 18.3% of the SPs were actively asked to participate in the decision-making process. ACRODAT® did not lead to any significant differences in the course of the discussion. CONCLUSIONS: Shared decision-making was underrepresented in this SP-physician interaction in acromegaly management. Physicians adapted the content of the discussion to the SP's needs, but did not adequately address comorbidities. According to the analysis criteria used, ACRODAT® did not contribute to a more holistic patient management in the present study.

The effect of coping strategies on health-related quality of life in acromegaly patients.

PURPOSE: Patients with acromegaly oftentimes exhibit a reduced physical and psychological health-related quality of life (HRQoL). Maladaptive coping styles are associated with poor HRQoL in a number of diseases and patients with pituitary adenomas in general exhibit less effective coping styles than healthy controls. This study aimed to assess coping strategies in acromegaly patients in order to explore leverage points for the improvement of HRQoL. METHODS: In this cross-sectional study, we administered self-report surveys for coping strategies and HRQoL (Short Form SF-36, Freiburg questionnaire on coping with illness, FKV-LIS) in patients with acromegaly. These were set into relation with a variety of health variables. RESULTS: About half of the 106 patients (44.3% female) with a mean age of 56.4 ± 1.3 years showed impaired physical and psychological HRQoL on average 11.2 years after the initial diagnosis. Body mass index, age at survey date and concomitant radiotherapy explained 27.8% of the variance of physical HRQoL, while depressive coping added an additional 9.2%. Depressive coping style and trivialization and wishful thinking were pivotal predictors of an impaired psychological HRQoL with a total explained variance of 51.6%, whereas patient health variables did not affect psychological HRQoL. CONCLUSION: Our results show that maladaptive coping styles have a substantial negative impact on psychological HRQoL in patients with acromegaly, whereas physical HRQoL is influenced to a lesser extent. Specialized training programs aimed at improving coping strategies could reduce long-term disease burden and increase HRQoL in the affected patients.

Emotional valence and spatial congruency differentially modulate crossmodal processing: an fMRI study.

Salient exogenous stimuli modulate attentional processes and lead to attention shifts-even across modalities and at a pre-attentive level. Stimulus properties such as hemispheric laterality and emotional valence influence processing, but their specific interaction in audio-visual attention paradigms remains ambiguous. We conducted an fMRI experiment to investigate the interaction of supramodal spatial congruency, emotional salience, and stimulus presentation side on neural processes of attention modulation. Emotionally neutral auditory deviants were presented in a dichotic listening oddball design. Simultaneously, visual target stimuli (schematic faces) were presented, which displayed either a negative or a positive emotion. These targets were presented in the left or in the right visual field and were either spatially congruent (valid) or incongruent (invalid) with the concurrent deviant auditory stimuli. According to our expectation we observed that deviant stimuli serve as attention-directing cues for visual target stimuli. Region-of-interest (ROI) analyses suggested differential effects of stimulus valence and spatial presentation on the hemodynamic response in bilateral auditory cortices. These results underline the importance of valence and presentation side for attention guidance by deviant sound events and may hint at a hemispheric specialization for valence and attention processing.

Does valence in the visual domain influence the spatial attention after auditory deviants? Exploratory data.

The auditory mismatch responses are elicited in absence of directed attention but are thought to reflect attention modulating effects. Little is known however, if the deviants in a stream of standards are specifically directing attention across modalities and how they interact with other attention directing signals such as emotions. We applied the well-established paradigm of left- or right-lateralized deviant syllables within a dichotic listening design. In a simple target detection paradigm with lateralized visual stimuli, we hypothesized that responses to visual stimuli would be speeded after ignored auditory deviants on the same side. Moreover, stimuli with negative valence in the visual domain could be expected to reduce this effect due to attention capture for this emotion, resulting in speeded responses to visual stimuli even when attention was directed to the opposite side by the auditory deviant beforehand. Reaction times of 17 subjects confirmed the speeding of responses after deviant events. However, reduced facilitation was observed for positive targets at the left after incongruent deviants, i.e., at the right ear. In particular, significant interactions of valence and visual field and of valence and spatial congruency emerged. Pre-attentive auditory processing may modulate attention in a spatially selective way. However, negative valence processing in the right hemisphere may override this effect. Resource allocation such as spatial attention is regulated dynamically by multimodal and emotion information processing.

Mood modulates auditory laterality of hemodynamic mismatch responses during dichotic listening.

Hemodynamic mismatch responses can be elicited by deviant stimuli in a sequence of standard stimuli even during cognitive demanding tasks. Emotional context is known to modulate lateralized processing. Right-hemispheric negative emotion processing may bias attention to the right and enhance processing of right-ear stimuli. The present study examined the influence of induced mood on lateralized pre-attentive auditory processing of dichotic stimuli using functional magnetic resonance imaging (fMRI). Faces expressing emotions (sad/happy/neutral) were presented in a blocked design while a dichotic oddball sequence with consonant-vowel (CV) syllables in an event-related design was simultaneously administered. Twenty healthy participants were instructed to feel the emotion perceived on the images and to ignore the syllables. Deviant sounds reliably activated bilateral auditory cortices and confirmed attention effects by modulation of visual activity. Sad mood induction activated visual, limbic and right prefrontal areas. A lateralization effect of emotion-attention interaction was reflected in a stronger response to right-ear deviants in the right auditory cortex during sad mood. This imbalance of resources may be a neurophysiological correlate of laterality in sad mood and depression. Conceivably, the compensatory right-hemispheric enhancement of resources elicits increased ipsilateral processing.

Alertness and visuospatial attention in clinical depression.

BACKGROUND: Cognitive deficits are a substantial burden in clinical depression. The present study considered dysfunction in the right-hemispheric attention network in depression, examining alertness and visuospatial attention. METHODS: Three computerized visuospatial attention tests and an alertness test were administered to 16 depressive patients and 16 matched healthy controls. RESULTS: Although no significant group effect was observed, alertness predicted reduced visuospatial performance in the left hemifield. Furthermore, sad mood showed a trend towards predicting left visual field omissions. CONCLUSIONS: Decreased alertness may lead to lower left hemifield visuospatial attention; this mechanism may be responsible for a spatial bias to the right side in depression, even though treatment of depression and anxiety may reduce this cognitive deficit.