What Affects Perceived Trustworthiness of Online Medical Information and Subsequent Treatment Decision Making? Randomized Trials on the Role of Uncertainty and Institutional Cues.

Background. Online, algorithmically driven prognostic tools are increasingly important in medical decision making. Institutions developing such tools need to be able to communicate the precision and accuracy of the information in a trustworthy manner, and so many attempt to communicate uncertainties but also use institutional logos to underscore their trustworthiness. Bringing together theories on trust, uncertainty, and psychological distance in a novel way, we tested whether and how the communication of uncertainty and the presence of institutional logos together affected trust in medical information, the prognostic tool itself, and treatment decisions. Methods. A pilot and 2 online experiments in which UK (experiment 1) and worldwide (experiment 2) participants (Ntotal = 4,724) were randomized to 1 of 12 arms in a 3 (uncertainty cue) × 4 (institutional cue) between-subjects design. The stimulus was based on an existing medical prognostic tool. Results. Institutional trust was consistently associated with trust in the prognostic tool itself, while uncertainty information had no consistent effect. Institutional trust predicted the amount of weight participants reported placing on institutional endorsements in their decision making and the likelihood of switching from passive to active treatment in a hypothetical scenario. There was also a significant effect of psychological distance to (perceived hypotheticality of) the scenario. Conclusions/Implications. These results underline the importance of institutions demonstrating trustworthiness and building trust with their users. They also suggest that users tend to be insensitive to communications of uncertainty and that communicators may need to be highly explicit when attempting to warn of low precision or quality of evidence. The effect of the perceived hypotheticality of the scenario underscores the importance of realistic decision-making scenarios for studies and the role of familiarity with the decision dilemma generally. Highlights: In a world where information for medical decision making is increasingly going to be provided through digital, online tools, institutions providing such tools need guidance on how best to communicate about their trustworthiness and precision.We find that people are fairly insensitive to cues designed to communicate uncertainty around the outputs of such tools. Even putting "ATTENTION" in bold font or explicitly pointing out the weaknesses in the data did not appear to affect people's decision making using the tool's outputs. Institutions should take note, and further work is required to determine how best to communicate uncertainty in a way that elicits appropriate caution in lay users.People were much more sensitive to institutional logos associated with the outputs. Generalized institutional trust (rather than trust in the specific institution whose logo was shown) was associated with how trustworthy, accurate, and reliable the tool, its algorithm, and the numbers it produced were perceived to be. This underscores the role of societal trust in institutions at large.Finally, as a note to researchers, we found a significant effect of how hypothetical or believable participants felt the experimental scenario was. This is a variable that seems rarely controlled for in studies and yet played as much of a role as some of our variables of interest, so we suggest that it is measured in future experiments.

Social mindfulness and prosociality vary across the globe.

Humans are social animals, but not everyone will be mindful of others to the same extent. Individual differences have been found, but would social mindfulness also be shaped by one's location in the world? Expecting cross-national differences to exist, we examined if and how social mindfulness differs across countries. At little to no material cost, social mindfulness typically entails small acts of attention or kindness. Even though fairly common, such low-cost cooperation has received little empirical attention. Measuring social mindfulness across 31 samples from industrialized countries and regions (n = 8,354), we found considerable variation. Among selected country-level variables, greater social mindfulness was most strongly associated with countries' better general performance on environmental protection. Together, our findings contribute to the literature on prosociality by targeting the kind of everyday cooperation that is more focused on communicating benevolence than on providing material benefits.

Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience.

BACKGROUND: To implement total body irradiation (TBI) using volumetric modulated arc therapy (VMAT). We applied the Varian RapidArc™ software to calculate and optimize the dose distribution. Emphasis was placed on applying a homogenous dose to the PTV and on reducing the dose to the lungs. METHODS: From July 2013 to July 2014 seven patients with leukaemia were planned and treated with a VMAT-based TBI-technique with photon energy of 6 MV. The overall planning target volume (PTV), comprising the whole body, had to be split into 8 segments with a subsequent multi-isocentric planning. In a first step a dose optimization of each single segment was performed. In a second step all these elements were calculated in one overall dose-plan, considering particular constraints and weighting factors, to achieve the final total body dose distribution. The quality assurance comprised the verification of the irradiation plans via ArcCheck™ (Sun Nuclear), followed by in vivo dosimetry via dosimeters (MOSFETs) on the patient. RESULTS: The time requirements for treatment planning were high: contouring took 5-6 h, optimization and dose calculation 25-30 h and quality assurance 6-8 h. The couch-time per fraction was 2 h on day one, decreasing to around 1.5 h for the following fractions, including patient information, time for arc positioning, patient positioning verification, mounting of the MOSFETs and irradiation. The mean lung dose was decreased to at least 80 % of the planned total body dose and in the central parts to 50 %. In two cases we additionally pursued a dose reduction of 30 to 50 % in a pre-irradiated brain and in renal insufficiency. All high dose areas were outside the lungs and other OARs. The planned dose was in line with the measured dose via MOSFETs: in the axilla the mean difference between calculated and measured dose was 3.6 % (range 1.1-6.8 %), and for the wrist/hip-inguinal region it was 4.3 % (range 1.1-8.1 %). CONCLUSION: TBI with VMAT provides the benefit of satisfactory dose distribution within the PTV, while selectively reducing the dose to the lungs and, if necessary, in other organs. Planning time, however, is extensive.

Psychological processing of transplantation in lung recipients: a quantitative study of organ integration and the relationship to the donor.

OBJECTIVES: Lung recipients undergo a complex psychological process, including organ integration and processing of attitudes towards the organ donor. DESIGN: Seventy-six lung recipients were asked to participate in a cross-sectional questionnaire study on the psychological processing of lung transplants. METHODS: The questionnaire consisted of statements describing aspects of organ integration and the patient's relationship with the donor. Furthermore, chronic stress/psychological distress (Screening Scale of the Trier Inventory; Symptom Checklist SCL-K-9) and the emotional effects of transplantation/immunosuppression (Transplant Effects Questionnaire; Medication Experience Scale for Immunosuppressants) were assessed. RESULTS: In general, lung recipients perceive the transplant as part of themselves (97.4%) and not as a foreign object (90%). One-third of patients still have frequent thoughts about the donor, whilst the majority (80.3%) do not believe that they have adopted the donor's characteristic traits. Factor analysis reveals the two-dimensional structure of the questionnaire items 'organ integration' (factor 1) and 'relationship to the donor' (factor 2). Poor organ integration predicts low adherence, low disclosure and high feelings of guilt, whilst a close donor relationship predicts chronic stress and psychological distress. CONCLUSIONS: Poor organ integration and a close relationship to the donor should be borne in mind in psychosocial treatment regarding the patient's adherence behaviour and psychological distress.

What do patients think after a lung transplantation about their self, lung and social network? A quantitative analysis of categorical interview data.

OBJECTIVE: Psychosocial aspects have been investigated in transplant medicine mainly by the means of various structured questionnaires. To date only few interview data are available on patients thoughts about their self, the transplanted lung or the medication, and the relationship between these thoughts and compliance or gender. METHODS: Twenty patients were interviewed after transplantation about their perceptions on self, body, transplanted lung, medication and social network. Their compliance was rated by the attending physicians. The overall interrater-reliability for the category groups was Kappa=.8. The article presents quantitative results of the content analysis. RESULTS: Statements were made most frequently about the patients' social network and their self, and significantly less frequently about their body, lung and medication. "Closeness", "distance" and "depression" where main issues that these patients were dealing with. "Closeness" and "distance" played major roles in interpersonal relationships as well as in the relationship to the new lung. Depression mainly had to do with health burdens and the psychosocial consequences of the transplantation (e.g. financial worries). Women made significantly more statements about their social network than men; furthermore they formulate more accented emotional evaluations. Patients with low compliance were more frequently preoccupied with their self, their body as well as the experience of "dependence" and "achievement" than patients with high compliance; also low compliant patients made more critical statements. CONCLUSIONS: For lung transplant recipients social relationships are the prime topic of their daily experience. With respect to compliance behaviour, special attention should be paid to the patients' self and body perception as well as to their experience of dependence. These results should be confirmed in studies with larger sample sizes.

Comparison of an auto-stereoscopic display and polarized stereoscopic projection for macroscopic pathology.

We investigated stereoscopic imaging for gross examination in telepathology. A conventional macroscopic station was equipped with two cameras mounted 6.5 cm apart and images were produced of 30 different routine pathology specimens. Still images were displayed on a three-dimensional auto-stereoscopic display with a lenticular plate (which did not require the viewer to wear special glasses) and as a three-dimensional projection that required the viewer to wear glasses with polarized lenses. Nine observers (pathologists, laboratory technicians and engineers) viewed the three-dimensional images first on the auto-stereoscopic display and then with polarized projection. The observers scored the images for spatial reproduction, surface structure, proportions, colour and sharpness (10 indices in total, each rated on a five-point Likert scale of 1-5, with lower scores indicating better quality). Results were compared with those from five observers who had previously viewed the corresponding two-dimensional images on a conventional (two-dimensional) display. The mean scores across each of the 10 indices were 2.9 (two-dimensional display), 2.1 (auto-stereoscopic display) and 1.6 (polarized projection). All observers stated that the polarized projection had superior image quality with regard to resolution, colour and surface structures. The results obtained in the present study with still images have encouraged us to integrate stereoscopy into a dynamic telepathology system.

[Systemic lupus erythematosus with atrophic blanche-like palmar lesions]. / Systemischer Lupus erythematodes mit Atrophie blanche-artigen Läsionen an den Handflächen.

A 17 year-old female patient presented with porcelain-white scars on her palms which resembled malignant atrophic papulosis (Köhlmeier-Degos disease). We discuss the differentiation of this syndrome from the specific cutaneous manifestations of systemic lupus erythematodes, the pathogenetic background, and treatment options.

ABO mismatch increases transplant-related morbidity and mortality in patients given nonmyeloablative allogeneic HPC transplantation.

BACKGROUND: ABO mismatch has not been thought to affect the outcome of patients undergoing myeloablative conditioning and allogeneic HPC transplantation. Data on transplant-related complications after ABO-mismatched transplantation after nonmyeloablative conditioning are limited. STUDY DESIGN AND METHODS: Therefore, 40 patients were analyzed after nonmyeloablative conditioning with regard to ABO compatibility. Eleven received a minor and bidirectional and 8 a major ABO-mismatched graft. RESULTS: Four patients had evidence of hemolysis during engraftment, being lethal in one, and three developed pure RBC aplasia. Six patients in the ABO-mismatched group developed thrombotic microangiopathy, and three of them died. ABO-identical and ABO-mismatched patients had a similar incidence of GVHD. Viral infections occurred in both groups in equal shares. Patients with an ABO-mismatch had to be rehospitalized until Day 100 for a median of 19 days versus 0 days in the identical group (p < 0.05). Overall survival was 60 and 57 percent in the ABO-identical and ABO-mismatch groups, respectively. The probability of transplant-related mortality was 0 versus 28 percent in the identical group compared to patients with an ABO mismatch (p < 0.05). The probability of relapse or progression was 76 versus 25 percent in the ABO-identical group compared to the ABO-mismatched group, respectively. CONCLUSION: Significantly more patients with ABO mismatch showed transplant-associated complications and died as a result of transplant-related causes.

Rapid establishment of long-term culture-initiating cells of donor origin after nonmyeloablative allogeneic hematopoietic stem-cell transplantation, and significant prognostic impact of donor T-cell chimerism on stable engraftment and progression-free survival.

BACKGROUND: Nonmyeloablative allogeneic hematopoietic stem-cell transplantation (NST) allows establishment of donor hematopoiesis without eradication of recipient stem cells by chemoradiotherapy. Quantification of donor chimerism may predict graft failure and relapse. METHODS: We quantified donor long-term culture-initiating cells (LTC-IC) in nine patients during the early phase after NST and lineage-specific donor cells of myeloid (CD33+, CD34+, granulocytes) and lymphoid lineage (CD3+, CD4+, CD8+, CD56+) in 38 patients with a median follow-up of 40 weeks after NST. Conditioning therapy consisted of fludarabine 90 mg/m2 followed by total body irradiation of 2 Gy. RESULTS: Only rapid establishment of donor T-cell chimerism was essential for stable donor engraftment. Patients with less than 90% of donor T cells 4 weeks after NST had a significantly higher risk of relapse, graft rejection, or both (14 of 18 patients) than patients with donor T-cell chimerism of 90% and higher (3 of 20 patients). Although conditioning therapy was nonmyeloablative, a significant decrease of repopulating stem cells defined as LTC-IC was seen after 2 weeks followed by rapid recovery of LTC-IC to pretransplant values. Interestingly, all LTC-IC were from donor origin 2 and 4 weeks after NST, but rapid establishment of donor LTC-IC was not predictive for progression-free survival. CONCLUSIONS: Rapid establishment of lymphoid but not myeloid donor chimerism is a prognostic factor for stable donor engraftment after NST. It seems that an immunologic shield of alloreactive donor T cells is essential for early hematopoietic progenitors.

Continuous complete clinical and molecular remission in two patients with refractory lymphoid malignancies after autografting followed by allogeneic stem cell transplantation with reduced intensity conditioning.

We present a 60-year-old patient with primary refractory non-Hodgkin's lymphoma and a 58-year-old patient with multiple myeloma with relapse after first autologous stem cell transplantation (ASCT), who underwent ASCT followed by allogeneic stem cell transplantation (alloSCT) with reduced intensity conditioning consisting of fludarabine and a single dose of total body irradiation. For graft-versus-host disease prophylaxis cyclosporine and mycophenolate mofetyl were given. Complete donor chimaerism was observed on d 28 after SCT. Both patients achieved sustained complete haematological and molecular remission of the immunoglobulin kappa light chain (Igkappa) rearrangement and are alive and well 17 and 16 months after SCT respectively.