Comparison of Clinical Decision Support Tools to Improve Pediatric Lipid Screening.

OBJECTIVE: To test whether different clinical decision support tools increase clinician orders and patient completions relative to standard practice and each other. STUDY DESIGN: A pragmatic, patient-randomized clinical trial in the electronic health record was conducted between October 2019 and April 2020 at Geisinger Health System in Pennsylvania, with 4 arms: care gap-a passive listing recommending screening; alert-a panel promoting and enabling lipid screen orders; both; and a standard practice-no guideline-based notification-control arm. Data were analyzed for 13 346 9- to 11-year-old patients seen within Geisinger primary care, cardiology, urgent care, or nutrition clinics, or who had an endocrinology visit. Principal outcomes were lipid screening orders by clinicians and completions by patients within 1 week of orders. RESULTS: Active (care gap and/or alert) vs control arm patients were significantly more likely (P < .05) to have lipid screening tests ordered and completed, with ORs ranging from 1.67 (95% CI 1.28-2.19) to 5.73 (95% CI 4.46-7.36) for orders and 1.54 (95% CI 1.04-2.27) to 2.90 (95% CI 2.02-4.15) for completions. Alerts, with or without care gaps listed, outperformed care gaps alone on orders, with odds ratios ranging from 2.92 (95% CI 2.32-3.66) to 3.43 (95% CI 2.73-4.29). CONCLUSIONS: Electronic alerts can increase lipid screening orders and completions, suggesting clinical decision support can improve guideline-concordant screening. The study also highlights electronic record-based patient randomization as a way to determine relative effectiveness of support tools. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04118348.

Training for Wisdom: The Distanced-Self-Reflection Diary Method.

How can people wisely navigate social conflict? Two preregistered longitudinal experiments (Study 1: Canadian adults; Study 2: American and Canadian adults; total N = 555) tested whether encouraging distanced (i.e., third-person) self-reflection would help promote wisdom. Both experiments measured wise reasoning (i.e., intellectual humility, open-mindedness about how situations could unfold, consideration of and attempts to integrate diverse viewpoints) about challenging interpersonal events. In a month-long experiment (Study 1), participants used either a third- or first-person perspective in diary reflections on each day's most significant experience. Compared with preintervention assessments, assessments made after the intervention revealed that participants reflecting in the third person showed a significant increase in wise reasoning about interpersonal challenges. These effects were statistically accounted for by shifts in diary-based reflections toward a broader self-focus. A week-long experiment (Study 2) replicated the third-person self-reflection effect on wise reasoning (vs. first-person and no-pronoun control conditions). These findings suggest an efficient and evidence-based method for fostering wise reasoning.

Self-distancing promotes positive emotional change after adversity: Evidence from a micro-longitudinal field experiment.

OBJECTIVE: This research examines changes in emotionality following adverse experiences in daily life. We tested whether daily self-distancing (vs. self-immersing) in reflections on adversity results in positive change in emotionality. Additionally, we probed the "dosage" effect of repeated self-distancing. METHOD: A micro-longitudinal field experiment combined 4-week daily diary and experimental manipulation of perspective during diary-based reflections on adverse experiences to explore the trajectory of change in emotionality. Each day, participants (N = 149) described and reflected on one significant event from that day and rated emotionality. We randomly assigned participants to reflect from a self-immersed or self-distanced perspective. RESULTS: Self-distanced participants showed a change toward positive emotionality while maintaining the same level of negative emotionality, whereas self-immersed participants did not show changes in positive or negative emotionality. We also observed that self-distancing reached its maximum effect ("dosage") for positive emotionality in the third week of the diary. CONCLUSIONS: Repeated self-distanced reflections can promote positive change in emotionality in the face of everyday adversity. Notably, repeated self-distancing effectiveness has a saturation point. In contrast, self-immersed reflections on adversity do not promote positive emotional change. Together, these observations raise the question how the default self-immersed reflection on traumatic experiences impacts personal growth.

Global Increases in Individualism.

Individualism appears to have increased over the past several decades, yet most research documenting this shift has been limited to the study of a handful of highly developed countries. Is the world becoming more individualist as a whole? If so, why? To answer these questions, we examined 51 years of data on individualist practices and values across 78 countries. Our findings suggest that individualism is indeed rising in most of the societies we tested. Despite dramatic shifts toward greater individualism around the world, however, cultural differences remain sizable. Moreover, cultural differences are primarily linked to changes in socioeconomic development, and to a lesser extent to shifts in pathogen prevalence and disaster frequency.

Wise reasoning benefits from emodiversity, irrespective of emotional intensity.

[Correction Notice: An Erratum for this article was reported in Vol 148(5) of Journal of Experimental Psychology: General (see record 2019-25114-002). In the original article, all references to Study 6 in the text and Table 5 should be omitted. The resulting corrections are included in the erratum. All versions of this article have been corrected.] The role of emotions in wise reasoning is not well understood. On the one hand, work on emotional regulation suggests that downregulating intense emotions may lead to wiser reasoning. On the other hand, emerging work suggests that recognizing and balancing emotions provides critical insights into life experiences, suggesting an alternative path to wiser reasoning. We present a series of observational, diary, and experimental studies (N = 3,678 participants) addressing these possibilities, examining how wisdom-related characteristics of reasoning-epistemic humility, recognition of a world in flux, self-transcendence, recognition of diverse perspectives on an issue, and search for integration of diverse perspectives/compromise-relate to emotional intensity and to emodiversity (i.e., emotional richness and evenness) in a given situation. Across 5 studies, testing wisdom nominees and examining individual differences and manipulated wise reasoning, wisdom-related characteristics appeared in conjunction with emodiversity, independent of downregulated emotional intensity. The positive association between emodiversity and wisdom-related characteristics occurred consistently for daily challenges, unresolved interpersonal conflicts, as well as political conflicts. The relationship between emotional intensity and wisdom-related characteristics was less systematic, with some studies showing a positive (rather than negative) association between emotional intensity and wisdom. Together, these results demonstrate that wise reasoning does not necessarily require uniform emotional downregulation. Instead, wise reasoning can also benefit from a rich and balanced emotional life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Wisdom, bias, and balance: Toward a process-sensitive measurement of wisdom-related cognition.

[Correction Notice: An Erratum for this article was reported in Vol 115(6) of Journal of Personality and Social Psychology (see record 2018-63189-002). In the article, the original supplemental material has been revised to include a clarifying note to the Tests of model fit over larger sample (Samples C-G) section and post-peer review analyses added to the Post-peer review Factor Analytic Tests section. All versions of this article have been corrected.] Philosophers and behavioral scientists refer to wisdom as unbiased reasoning that guides one toward a balance of interests and promotes a good life. However, major instruments developed to test wisdom appear biased, and it is unclear whether they capture balance-related tendencies. We examined whether shifting from global, de-contextualized reports to state-level reports about concrete situations provides a less biased method to assess wise reasoning (e.g., intellectual humility, recognition of uncertainty and change, consideration of the broader context at hand and perspectives of others, integration of these perspectives or compromise), which may be aligned with the notion of balancing interests. Results of a large-scale psychometric investigation (N = 4,463) revealed that the novel Situated WIse Reasoning Scale (SWIS) is reliable and appears independent of psychological biases (attribution bias, bias blind spot, self-deception, and impression management), whereas global wisdom reports are subject to such biases. Moreover, SWIS scores were positively related to indices of living well (e.g., adaptive emotion regulation, mindfulness), and balancing of cooperative and self-protective interests, goals (influence-vs.-adjustment), and causal inferences about conflict (attribution to the self-vs.-other party). In contrast, global wisdom reports were unrelated or negatively related to balance-related measures. Notably, people showed modest within-person consistency in wise reasoning across situations or over time, suggesting that a single-shot measurement may be insufficient for whole understanding of trait-level wisdom. We discuss theoretical and practical implications for research on wisdom, judgment and decision making, well-being, and prosociality. (PsycINFO Database Record (c) 2018 APA, all rights reserved).