Patient Perceptions of Surveillance of Small Abdominal Aortic Aneurysms in the Over 85s.

BACKGROUND: Recently instigated local practice for patients with small abdominal aortic aneurysms (AAAs) involves contacting all patients, aged ≥85 years, to discuss with them the advantages and disadvantages of removal from surveillance. However, reasons why patients opt to remain on, or come off, surveillance, are currently unknown. The present study's objective is to explore patient perception of surveillance decision-making. METHODS: A mixed-methods exploratory evaluation was undertaken using patient feedback obtained from a telephone survey. All patients aged ≥85 years, who had a consultation regarding ongoing surveillance of small AAAs (30-49 mm), and consented, were contacted by researchers, who conducted semi-structured interviews concerning factors influencing decision-making. RESULTS: A total of 24 patients (20 male; mean age = 86.9 years) were interviewed; 16 of 24 (66%) had opted to remain on surveillance, with no age difference between those opting in or out. Most felt surveillance was important (91%), and that it made them feel safer (73%). The majority (73%) thought they knew what happened when their AAA reached threshold (5.5 cm), what happened when a threshold AAA is not fixed (64%), and how major AAA surgery is (59%). However, actual knowledge was poor: most (91%) correctly understood surgery was major, but 56% thought that threshold AAA meant certain death or rupture; and 38% thought immediate surgery was required. Thematic analysis expounded patients' beliefs regarding surveillance, which were summarized in 3 distinct subgroups: reliance on professionals' opinions, needing peace of mind, and poor understanding. CONCLUSIONS: While most patients find surveillance reassuring, patient knowledge of AAA management at threshold is poor, potentially impacting surveillance decision-making. Elderly patients, with small AAAs contemplating ongoing surveillance, need to be better informed about AAA management at threshold to support shared decision-making.

Effect of instructions on the microstructure of human schedule performance.

Three experiments examined the effect of instructions on human free-operant performance on random ratio (RR) and random interval (RI) schedules. Both rates of responding, and the microstructure of behavior, were explored to determine whether bout-initiation and within-bout responding may be controlled by different processes. The results demonstrated that responding in acquisition (Experiments 1 and 2) and extinction (Experiment 3) was impacted in line with given instructions. During acquisition, rates were higher on RR compared to RI for accurate and minimal instructions. During extinction, rates decreased when there were minimal instructions. However, instructions had a greater impact on within-bout responding, than they did on bout-initiation responding. Overall rates of responding, and within-bout rates, varied in line with the nature of the instructions, but bout-initiation responding did not (Experiments 1 and 2). Resistance to extinction was increased by instructions in terms of overall responding and within-bout rates, but not in terms of bout-initiation rates (Experiment 3). These data are consistent with the hypothesis that bout-initiation responding may be less impacted by instructions than within-bout responding, speculatively, the former is stimulus-driven, automatic/habitual, and less accessible to conscious processing. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stimulus control and delayed outcomes in a human causality judgment task.

Three experiments examined the impact of delayed outcomes on stimulus control of causal judgments using an interdimensional generalization procedure. Human participants rated the causal effectiveness of responses on multiple schedules, and then underwent a generalization test. In Experiment 1, a 3 s unsignaled outcome delay reduced ratings of causal effectiveness, relative to an immediate outcome, but had higher ratings compared to a component lacking outcomes. In a generalization test, incremental generalization gradients, indicating inhibitory control, were found for the stimulus associated with delayed outcomes when comparison was with immediate outcomes; but decremental gradients, indicating excitatory control, were found when the comparator lacked outcomes. In Experiment 2, signaled 3 s outcome delays produced higher causal ratings than unsignaled delays; with unsignaled delays producing incremental (inhibitory) and signaled delays producing decremental (excitatory), generalization gradients when compared against each other. In Experiment 3, relative to immediate outcomes, unsignaled delays produced incremental (inhibitory) gradients and signaled delays produced no gradient. These findings suggest similar factors may control judgments of causality as control conditioned responding. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relationship between depression, anxiety, and attendance at pelvic-floor muscle training sessions.

OBJECTIVES: Psychological comorbidities are associated with non-attendance for pelvic-floor muscle training (PFMT) appointments and non-engagement with ongoing treatment. However, little direct work has examined the precise relationship between these variables. DESIGN: A prospective observational study of consecutively referred women patients with Pelvic-floor Dysfunction. Patients were assessed at intake for age, BMI, pelvic symptoms (measured by the Queensland Pelvic Symptom Scale), and anxiety and depression (measured by the Hospital Anxiety and Depression Scales). SETTING: A women's health physiotherapy outpatient unit of a metropolitan hospital. PARTICIPANTS: 433 consecutively-referred women with pelvic-floor dysfunction (PFD). INTERVENTIONS: Six sessions of PFMT, lasting over a period of 6 months. MAIN OUTCOME MEASURES: Attendance at PFMT sessions was the outcome, and was related to intake patient age, BMI, pelvic symptoms, as well as anxiety and depression. RESULTS: Psychological symptoms of depression and anxiety predicted attendance at PFMT sessions, over and above physical symptoms. Depression was the key predictor of non-attendance, with anxiety having a more complex relationship with attendance. There were few differences between these psychological variables and the different types of PFD, or between type of PFD and PFMT attendance. CONCLUSIONS: The findings add to the literature suggesting that consideration of patients' psychological state is important when designing treatment-regimes. CONTRIBUTION OF THE PAPER.

Social Media Use as an Impulsive 'Escape From Freedom'.

It has been suggested that avoiding choice represents an anxiety-avoidance strategy, which has not been investigated in the context of social media. To this end, the current study explored the relationship between social media dependency and a preference for 'forced' choice, along with its association with anxiety, intolerance of uncertainty, and experiential avoidance. The sample comprised 151 volunteer participants (18-32 years) who completed a psychometric test battery, including: the Bergen Social Media Addiction Scale; Spielberger Trait Anxiety Inventory; Intolerance of Uncertainty Scale; and Brief Experiential Avoidance Questionnaire. They also undertook a behavioural assessment based on a paradigm developed for pigeons, in which they selected either a situation with a free choice of alternatives, and one with a forced choice. Intolerance of uncertainty mediated the relationship between social media dependency and anxiety. In addition, those with lower social media dependency preferred being able to choose the contingency they worked on, while those with higher scores exhibited no such preference. This partly confirmed that social media dependency is associated with a reduced preference for freedom, but does not suggest social media dependency actively produced a preference for a lack of freedom. The speed of decision making was also faster in those with high social media dependency scores, in line with previous findings that they show higher levels of impulsive behaviours. The results suggest that anxiety and social media dependency are related, and fear of uncertainty and is linked with digital experiential avoidance.

Focused-attention mindfulness increases sensitivity to current schedules of reinforcement.

Four experiments explored the impact of focused-attention mindfulness training on human performance on free-operant schedules of reinforcement. In each experiment, human participants responded on a multiple random ratio (RR), random interval (RI) schedule. In all experiments, responding was higher on RR than RI schedules, despite equated rates of reinforcement. A 10-min focused-attention mindfulness intervention (focused attention) produced greater differentiation between schedules than relaxation training (Experiments 1, 2, and 4), or no intervention (Experiment 3). Focused-attention mindfulness improved learning when the schedules associated with components of the multiple schedule were reversed. This occurred irrespective of whether the focused-attention mindfulness was before (Experiment 2) or after (Experiments 3 and 4) initial training, or whether compared to relaxation (Experiments 2 and 4) or no intervention (Experiment 3). In Experiment 4, following multiple RR, RI training, focused-attention mindfulness increased sensitivity to contingency reversal and did not interfere with previous training in a group that did not receive a contingency reversal. In contrast, relaxation training did not facilitate reversal learning and interfered with previous learning. The results suggest that focused-attention mindfulness improves awareness of operative contingencies by focusing participants on the present, rather than reducing interference from previous learning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal relationship between problematic internet use with loneliness during and after COVID-19 social restrictions: Short title: Internet use and loneliness.

Two, three-month long longitudinal studies examined the temporal relationships between problematic internet use (PIU), internet usage, and loneliness ratings, during and after lockdown restrictions. Experiment 1 examined 32, 18-51 year old participants, over a three-month period of lockdown restrictions. Experiment 2 studied 41, 18-51 year old participants, over a three-month period following the lifting of lockdown restrictions. Participants completed the internet addiction test, UCLA loneliness scale, and answered questioned about their online usage, at two time points. All cross-sectional analyses revealed a positive relationship between PIU and loneliness. However, there was no association between online use and loneliness. Longitudinal relationships between PIU and loneliness differed during and after lockdown restrictions. During a period of lockdown, there were both positive associations between earlier PIU and subsequent loneliness, and between earlier loneliness and subsequent PIU. However, following the easing of lockdown restrictions, only the temporal relationship between earlier internet addiction and later loneliness was significant.

The effect of brief mindfulness training on the micro-structure of human free-operant responding: Mindfulness affects stimulus-driven responding.

BACKGROUND AND OBJECTIVES: The current study examines the extent to which mindfulness impacts on operant conditioning processes, and explores the suggestion that mindfulness training serves to make humans more sensitive to the current reinforcement contingencies with which they are presented. In particular, the effect of mindfulness on the micro-structure of human schedule performance was explored. It was expected that mindfulness might impact bout-initiation responding to a greater degree than within-bout responding, premised on the assumption that bout-initiation responses are habitual and not under conscious control, but within-bout responses are goal-directed and conscious. METHODS: Nonclinical participants experienced one of three brief (15min) interventions: focused attention breathing exercise (mindfulness), an unfocused attention breathing exercises, or no intervention. They then responded on a multiple random ratio (RR) random interval (RI) schedule. RESULTS: In the no intervention and unfocused attention groups, overall and within-bout response rates were higher on the RR than the RI schedule, but bout-initiation rates were the same on the two schedules. However, for the mindfulness groups all forms of responding were higher for the RR than the RI schedule. Previous work has noted that habitual, and/or unconscious or fringe-conscious events, are impacted by mindfulness training. LIMITATIONS: A nonclinical sample may limit generality. CONCLUSIONS: The current pattern of results suggests that this is also true in schedule-controlled performance, and offers an insight into the manner in which mindfulness alongside conditioning-based interventions, to bring all responses under conscious control.

Individuals with autism spectrum disorder are differentially sensitive to interference from previous verbal feedback.

LAY ABSTRACT: Individuals with autism spectrum disorder can find behavioural flexibility challenging, often exhibited in terms of repetitive behaviours or restricted ranges of interests and activities. An inability to shift efficiently from one situation to another is connected with problems in daily life, and identifying factors associated with this ability may help develop teaching strategies to improve behavioural flexibility. Some existing findings imply shifting performance for individuals with autism spectrum disorder is better with nonverbal, compared to verbal, feedback - even for those with strong verbal abilities. Unfortunately, there are few behavioural examinations that further explore these findings, which is the aim of this study. In this study, 28 children with a diagnosis of autism spectrum disorder and 28 typically developing children matched on cognitive and verbal abilities learned to sort cards according to one out of a possible three dimensions (colour, shape and number), and then had to relearn the sorting rule. One group of typically developing children, and one group of autism spectrum disorder children, received verbal feedback on their performance, and one group received nonverbal feedback. Children with autism spectrum disorder learned an initial categorisation rule as fast as matched typically developing children, and there was little difference in the impact of the type of feedback on acquisition. However, on shifting the classification rule, children with autism spectrum disorder showed slower rates of learning the new rule, which was worse when verbal feedback was used compared to nonverbal feedback. This finding has implications for the interpretations of set-shifting performance and for classroom use of feedback strategies.

Effect of signaled reinforcement on response variability.

Three experiments examined the effect of signaling reinforcement on rats' lever pressing on contingencies that reinforced variable responding to extend the exploration of signaled reinforcement to a schedule that has previously not been examined in this respect. In Experiment 1, rats responding on a lag-8 variability schedule with signaled reinforcement displayed greater levels of variability (U values) than rats on the same schedule lacking a reinforcement signal. In Experiment 2, rats responding on a differential reinforcement of least frequent responses schedule also displayed greater operant variability with a signal for reinforcement compared with rats without a reinforcement signal. In Experiment 3, a reinforcement signal decreased the variability of a response sequence when there was no variability requirement. These results offer empirical corroboration that operant variability responds to manipulations in the same manner as do other forms of operant response and that a reinforcement signal facilitates the emission of the required operant.

Exploratory Study of Parenting Differences for Autism Spectrum Disorder and Attachment Disorder.

The current study explored similarities and differences in parenting stress (PSI) and behaviours in parent reports of autism spectrum disorder (ASD) and attachment disorder (AD). 155 parents whose children had developmental delays and disorders completed the social communication questionnaire, Randolph attachment questionnaire, strengths and difficulties questionnaire, PSI, and parent-child relationship inventory. Parents of children with AD reported greater levels of PSI than parents of children with ASD. Parents of children reaching criteria for both disorders reported the greatest levels of PSI. Limit setting was poorest in parents of children with both classifications, followed by parents of children with AD, and then ASD. Limit setting mediated the relationship between PSI and child behaviour problems for parents of children with ASD < but not for parents of children with AD. These findings suggest different areas of difficulty for parents of children with these conditions, which may be of help in designing interventions.

Change in depression predicts change in bladder symptoms for women with urinary incontinence undergoing pelvic-floor muscle training.

INTRODUCTION: To examine the relationship between depression and bladder symptoms, especially the impact of change in depression on changes in bladder symptoms, for women with urge and stress urinary incontinence undergoing a course of PFMT. METHOD: 106 adult females with pelvic-floor dysfunction (PFD), consecutively referred to an outpatient pelvic-floor muscle training (PFMT) programme for either urge, stress, or mixed incontinence, participated in a prospective observational study. Participants reported subjective views of their pelvic floor problems (Queensland), and their levels of depression (HADS_D), and data relating to age and BMI were collected. The trial was registered on clinicaltrials.gov (NCT02549157). RESULTS: There was a positive relationship between depression and bladder symptoms at intake. Levels of initial depression significantly predicted levels of bladder symptoms at completion of PFMT, and ability to complete the PFMT programme. Change in depression significantly predicted change in bladder symptoms, over and above intake patient characteristics and symptoms. DISCUSSION: These data imply a multidisciplinary focus, including psychological input, for PFD may be a highly effective strategy for its management.

Brief Report: Differential Persistence of Primary Reflexes for Children with Autism Spectrum Disorder: A Systematic Replication.

Primary reflexes are highly stereotypical, automatic movements comprising much of the motor repertoire of newborns. The current study examined rates of presence of five primary reflexes (snout, visual rooting, sucking, tactile rooting, and grasp) and variables predictive of their persistence for children with ASD (n = 35), developmental disability (n = 30), and typically developing children matched to participants with ASD on chronological age (n = 30). There was a higher prevalence of snout and visual rooting reflex among children with ASD. These data suggest that the persistence of primary reflexes holds promise as a biomarker for autism spectrum disorder (ASD).

Patient and economic benefits of psychological support for noncompliant patients.

The current paper provides an overview of treatment noncompliance at various points in the treatment pathway, especially with respect to treatment for Pelvic-floor Dysfunction (PFD). The effects of noncompliance on healthcare are considered, and examples of supporting patients psychologically to increase compliance are discussed. An outline of a method to identify costs of non-compliance, and where such costs most intensely impact the healthcare system, is provided. It is suggested that psychological support is effective in terms of increased compliance and improved healthcare economics. The model is presented for PFD, but the principles developed can be generalised to many aspects of healthcare.

Patient Satisfaction with Tele- and Video-Consultation in the COVID-19 Era - A Survey of Vascular Surgical Patients.

BACKGROUND: The COVID 19 pandemic has resulted in the increasing use of telemedicine due to the advantages of avoiding viral transmission. Evidence suggests that telemedicine, for certain conditions, may be as effective as face-to-face consultations; however, there is no research to date regarding vascular patients' acceptance or satisfaction with telemedicine during and after the COVID-19 pandemic. METHODS: A patient satisfaction interview was designed to survey three aspects of the service: patient acceptability of teleconsultations as a replacement to physical clinics; their views of teleconsultation during the pandemic; and the future role of teleconsultations postpandemic. Patients undergoing remote teleconsultation (either by telephone or video software), between April and June 2020 were suitable for inclusion. Patients were contacted by telephone in August 2020 to undertake the survey. Local "Research and Development" approval was obtained. RESULTS: A total of 333 patients had a consultation with a vascular consultant between April and June 2020, of which 178 were teleconsultations. Successful contact was made with 72 patients, of whom 68 agreed to participate; 10 patients had undergone video consultations, while the remainder had telephone consultations. Teleconsultations were widely viewed as acceptable, and over 90% of patients felt they were beneficial. 91% felt that not needing to travel for appointments was advantageous to them. The option of teleconsultation during the COVID pandemic was valued by 94% of the cohort. While all interviewees felt teleclinics should continue during the pandemic, the majority (74%) also wanted to use teleconsultations for clinic appointments after the pandemic. CONCLUSIONS: Telemedicine is viewed by vascular patients as generally acceptable and beneficial for use during the pandemic. The majority of patients wanted future telemedicine appointments postpandemic. Telemedicine services started as a result of the COVID-19 pandemic, which may have been viewed as a temporary measure, should be planned to continue long term.

Cluster randomised control trial of the effect on attendance and outcomes of multi-disciplinary teams involving psychologists during pelvic floor muscle training for pelvic floor dysfunction.

Pelvic floor muscle training (PFMT) is effective, acceptable to patients, and cost efficient as a treatment for Pelvic Floor Dysfunction (PFD). However, PFMT outcomes are mediated by patient variables, such as depression, anxiety, motivation, and health values. The current study examined whether multi-disciplinary provision of PFMT involving a psychologist would improve attendance and outcomes (Clinical Trial Registration: NCT02549157). 88 consecutively referred patients (age 28 - 85 years), with a variety of PFD, were randomised into two groups: PFMT treatment as usual (n = 47), and PFMT with a psychologist involved (n = 41). Patients received 6-month out-patient physiotherapy. More patients with the psychologist completed the course, and there were significantly greater improvements in subjective symptoms (Queensland scale), quality of life (EQ-5D), and anxiety (HADS), although not in objective measures (Oxford Grading) or depression (HADS). These results suggest that an MDT including a psychologist during PFMT intervention treatment may help some patients.IMPACT STATEMENTWhat is already known on this subject? Pelvic floor muscle training (PFMT) is effective, acceptable to patients, and cost efficient as a treatment for Pelvic Floor Dysfunction (PFD). However, PFMT outcomes are mediated by patient variables, such as depression, anxiety, motivation, and health values. The effectiveness of a multi-disciplinary team delivering both PFMT and psychological support simultaneously to women undergoing PFMT for PFD is unknown.What do the results of this study add? Psychological support delivered alongside PFMT increased patient attendance, improved subjective ratings of pelvic floor functioning, health-related quality of life, and reduced anxiety. This is one of the first demonstrations that this can be achieved through a multi-disciplinary team delivering their support simultaneously to the patients.What are the implications of these findings for clinical practice and/or further research? Improving subjective functioning and reducing attrition rates in PFD patients has cost implications in terms of reduced need for surgery, and making future surgery more effective. The inclusion of brief, easily delivered psychological support, integrated into the PFMT sessions in a multidisciplinary way may represent an extremely cost effective method of improving the service for these patients.

Individual differences in proactive interference in rats (Rattus Norvegicus).

Individual differences in behaviors are seen across many species, and investigations have focused on traits linked to aggression, risk taking, emotionality, coping styles, and differences in cognitive systems. The current study investigated whether there were individual differences in proactive interference tasks in rats (Rattus Norvegicus), and tested hypotheses suggesting that these tasks should load onto a single factor and there should be clusters of rats who perform well or poorly on these tasks. The performance of 39 rats was tested across three learning tasks that all involved disengagement from an irrelevant previously learned stimulus to a relevant stimulus: latent inhibition (LI), partial reinforcement extinction effect (PREE), and reversal learning (RL). An exploratory factor analysis revealed the existence of one factor underlying performance. A cluster analysis revealed the existence of sets of rats displaying either weak LI and strong PREE and RL effects, or vice versa. These findings suggest that proactive interference may be based on a single underlying psychological system in rats.

Acceptability and effectiveness of a multidisciplinary team approach involving counselling for mesh-removal patients.

Patients with complications following mesh removal risk a variety of symptoms, and can view medical intervention negatively. This study explored the patient-acceptability of a Multidisciplinary Team (MDT), and whether the presence of a Counsellor would be accepted and effective. Twenty consecutively referred women, who had undergone mesh-removal but experienced complications were interviewed about their experiences, and completed the Queensland scale for pelvic floor symptoms, McGill Pain Questionnaire, and Hospital Anxiety and Depression Scales, before and after treatment. Patients had high levels of pelvic-floor symptoms, sensory and affective pain, anxiety, and depression. 70% reported a positive MDT experience; predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which commenced within one week of referral, typically lasted 1-4 sessions, and reduced pelvic-floor symptoms, affective pain, anxiety, and depression. Results suggest that the MDT approach is generally acceptable for this patient group, and that mesh-removal patients accept and benefit from input by a Counsellor.Impact statementWhat is already known on this subject? Concerns have been raised regarding the safety of mesh insertion. Multidisciplinary Teams (MDTs) are suggested to offer a strong approach to managing many women's health conditions, but no studies have examined mesh-removal patients, making generalisation difficult to the current patient group. Furthermore, it is unknown whether an MDT approach, including a Counsellor, would be acceptable to mesh-removal patients.What do the results of this study add? Patients had high levels of pelvic-floor symptoms, pain, anxiety, and depression. 70% reported the MDT experience as positive, predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which reduced pelvic-floor symptoms, affective pain, anxiety, and depression.What are the implications of these findings for clinical practice and/or further research? The Counselling provided as part of the MDT approach was able to commence quickly, did not require many sessions, and reduced reported pelvic-floor symptoms, affective pain, anxiety, and depression. These findings suggest that an MDT approach involving Counselling is generally acceptable, and that mesh-removal patients accept and benefit from the input of a Counsellor, as part of their treatment.

Loneliness and Current Environmental Context Are Associated With False Perceptions Regarding Social Relations.

ABSTRACT: The consequences of loneliness include anxiety, depression, and chronic illnesses, but little is known about its association with cognitive distortions. Three experiments investigated the effect of loneliness, and current context, on the content of false perceptions. A total of 446 participants completed psychometric tests (University of California, Los Angeles Loneliness Scale, Hospital Anxiety and Depression Scale, and a Schizotypy Scale) and a word detection task. The word detection task explored the effects of "lonely" and "neutral" contexts (experiments 1 and 2), as well as "positive social" contexts (experiment 3), on false perceptions. In all experiments, participants reporting higher loneliness reported more false perceptions with a lonely content, but only when in a context reflecting a lonely theme. The results show current environmental context and individuals' psychological state combine to affect false perception content. That such findings are found with loneliness, when controlling for depression, anxiety, and schizotypy, show the degree to which this state can distort cognition and perception.