Upright posture improves affect and fatigue in people with depressive symptoms.

BACKGROUND AND OBJECTIVES: Slumped posture is a diagnostic feature of depression. While research shows upright posture improves self-esteem and mood in healthy samples, little research has investigated this in depressed samples. This study aimed to investigate whether changing posture could reduce negative affect and fatigue in people with mild to moderate depression undergoing a stressful task. METHODS: Sixty-one community participants who screened positive for mild to moderate depression were recruited into a study purportedly on the effects of physiotherapy tape on cognitive function. They were randomized to sit with usual posture or upright posture and physiotherapy tape was applied. Participants completed the Trier Social Stress Test speech task. Changes in affect and fatigue were assessed. The words spoken by the participants during their speeches were analysed. RESULTS: At baseline, all participants had significantly more slumped posture than normative data. The postural manipulation significantly improved posture and increased high arousal positive affect and fatigue compared to usual posture. The upright group spoke significantly more words than the usual posture group, used fewer first person singular personal pronouns, but more sadness words. Upright shoulder angle was associated with lower negative affect and lower anxiety across both groups. LIMITATIONS: The experiment was only brief and a non-clinical sample was used. CONCLUSIONS: This preliminary study suggests that adopting an upright posture may increase positive affect, reduce fatigue, and decrease self-focus in people with mild-to-moderate depression. Future research should investigate postural manipulations over a longer time period and in samples with clinically diagnosed depression.

Long-Term Outcomes in Patients Undergoing Consecutive Bioprosthetic Aortic Valve Replacement.

BACKGROUND AND AIM OF THE STUDY: Worldwide, there is increased use of bioprosthetic valves in the aortic position. Part of this increase has been patient-driven for quality of life reasons. More recently, bioprosthetic valves have been chosen by progressively younger patients, with a strategy of performing a valve-in-valve TAVI if the prosthesis should wear out. Thus, a review was undertaken of the present authors' experience with patients whose first two aortic valve replacements (AVRs) were with bioprosthetic valves. METHODS: Patients receiving consecutive bioprosthetic AVRs at the Green Lane Cardiothoracic Surgical Unit were identified from a departmental database. Data were retrieved from prospective databases, electronic and archived clinical records. Outcomes of interest were overall survival and freedom from a third or more AVR. RESULTS: A total of 267 patients met the inclusion criteria, with a mean follow up of 22.3 years. Concurrent procedures (e.g., coronary artery bypass grafting) were performed in 65.2% of patients that underwent two bioprosthetic AVRs, and in 79.8% of patients undergoing three or more bioprosthetic AVRs. Median survival of the cohort was 31.7 years. Age at operation was the best predictor of needing a third or more AVR. Receiver operating characteristic curve analysis identified that age <45 years at the first operation and <56 years at the second operation were the optimal cut-off point for the likelihood of needing a third or more aortic valve intervention. CONCLUSIONS: Overall survival for consecutive bioprosthetic AVRs was remarkably good. Data relating to consecutive bioprosthetic AVRs is of particular interest in the context of TAVI and valve-in-valve TAVI, which will likely significantly increase the number of patients receiving consecutive bioprosthetic valves. However, it must be noted that the majority of patients in this cohort required concurrent cardiac surgical procedures. The study results provided encouraging data for consecutive bioprosthetic AVRs, as well as data that may be of interest in the setting of TAVI being performed in younger cohorts of patients.

INTERACTION BETWEEN OBJECTIVE PERFORMANCE MEASURES AND SUBJECTIVE USER PERCEPTIONS IN THE EVALUATION OF MEDICAL DEVICES: A CASE STUDY.

OBJECTIVES: Medical technology is a large and expanding industry. Introducing new medical devices is important but several challenges exist in implementing the optimal method of evaluation. Both objective and subjective measures can be used for evaluation. The former is the mainstay of evaluation, yet subjective assessment is often the basis for the introduction of new medical technology. The aim of this study was to determine the interaction and concordance between objective and subjective assessment of new medical technology. METHODS: This study used both objective performance measures and subjective user perceptions in the evaluation of a new medical device designed to improve the accuracy of gravity-assisted delivery of intravenous fluids, compared with the current, widely used "roller-clamp" device. The concordance of objective and subjective assessments was evaluated using comparative analysis. RESULTS: Objective assessment of the accuracy of intravenous fluid delivery revealed no difference between the two devices (p = .636). Subjective assessment revealed that the new device was perceived to be significantly more accurate (p = .001). This lack of concordance can be partially explained by both device and demand characteristics. CONCLUSIONS: This case study reveals a significant discordance between the objective and subjective assessments. It provides some explanation for why new medical devices are adopted without objective evidence of benefit. This phenomenon has been termed "persuasive design" and its influence should be controlled for in the evaluation, purchase and introduction of new medical devices. This should help reduce the risk and associated cost of premature introduction.

A systematic review and meta-analysis of the Brief Illness Perception Questionnaire.

OBJECTIVE: This paper aims to systematically review the use and performance of the Brief Illness Perception Questionnaire (Brief IPQ). DESIGN: Electronic databases were searched for papers administering the Brief IPQ published in peer-reviewed journals. Data were extracted from the results for meta-analysis. MAIN OUTCOME MEASURES: Use by illness population, country, language and study design. The questionnaire's concurrent validity, predictive validity, sensitivity to change, discriminant validity and mean scores for different populations were summarised. RESULTS: The review included 188 papers. The Brief IPQ has been administered to patients from age 8 to over 80, with a wide range of illnesses, in 26 languages from 36 countries. Pooled correlations between illness perceptions and depression, anxiety, blood glucose levels and quality of life were consistent with previous research and theory (range .25-.49 for consequences, identity and emotional representations; -.12 to -.27 for personal control). All items were able to predict some outcomes up to one-year follow-up. Each subscale demonstrated sensitivity to change after intervention in randomised controlled trials with the personal control and causal items showing most frequent change. CONCLUSIONS: The Brief IPQ is widely used and has good psychometric properties. More studies should include and analyse the causal item.