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Adequate pain management is eminently relevant for elderly and more vulnerable patients with hip fractures in the setting of pre and postoperative pain. This study compares postoperative hip fracture patients treated with standard pain management with a variety of medications or an approach with only one option in each medication category (nonopioid: acetaminophen; opioid: fentanyl TTS 12,5 mcg/hour; rescue medication: piritramide) to simplify the treatment algorithm for nurses and improve patient well-being. Double-blind randomized controlled trial. The sample was cognitively intact patients (N = 141) with hip fractures in a tertiary university hospital. Administration of fentanyl 12 mcg/hour transdermal therapeutic system was administered by the nurses in the postanesthesia care unit (PACU) to address basal wound pain to improve patient well-being and patient treatment in the PACU for 24 hours to better control for early complications. Well-being was equally increased in both groups in comparison to our preintervention data from 35.7% to over 60% and did not differ significantly between the intervention and control group. No statistically significant differences in numeric rating scale scores, rescue opioid dosage (piritramide i.v.) or in complications were present. This one-size-fits-all simplified pain management approach did not improve patient well-being or any other outcome but highlighted the importance of adequate pain management and a sufficient nurse-to-patient ratio. [ABSTRACT FROM AUTHOR]

Air medical transportation (AMT) of patients plays a critical role in the prehospital care of the ill patient. Despite its importance, there is no requirement in emergency medicine training programs to have direct experience or education on the topic, and data detailing current AMT experiences across programs are limited. A survey detailing program characteristics, AMT experience characteristics, and curriculum factors relating to AMT experience was sent to all 275 credentialed emergency medicine residency training programs in the United States. Our outcomes were to describe the characteristics of AMT and non-AMT programs (proportions) and to evaluate associations (odds ratios with 95% confidence intervals) between program characteristics and 1) AMT experience opportunity and 2) level of resident participation among AMT programs. Two hundred (73%) programs responded, with 135 of 200 (68%) offering some type of AMT experience. The majority of programs offering AMT were 3 years (113 [84%]), university based (63 [47%]), and located in small urban areas (57 [42%]). When AMT was offered, most programs reported that the overall resident participation was low (≤ 20%). Programs that did not offer shift reduction or additional pay for participation in AMT were significantly more likely to have low participation than those with incentives (odds ratio = 4.8; 95% confidence interval, 1.8-15.3). Around one third of AMT experiences allowed for direct patient care. Less than half of the responding programs reported a dedicated AMT curriculum. The majority of emergency medicine residency training programs offer an AMT experience, but this experience is highly variable, and overall participation by residents is low. Given the importance of AMT in the care of emergency patients, standardization and increased access to AMT experience and education should be considered by emergency medicine training programs moving forward. [ABSTRACT FROM AUTHOR]

Placebo and nocebo responses are modulated by the treatment expectations of participants and patients. However, interindividual differences predicting treatment expectations and placebo responses are unclear. In this large-scale pooled analysis, we aim to investigate the influence of psychological traits and prior experiences on treatment expectations. This paper analyses data from six different placebo studies (total n = 748). In all studies, participants' sociodemographic information, treatment expectations and prior treatment experiences and traits relating to stress, somatization, depression and anxiety, the Big Five and behavioral inhibition and approach tendencies were assessed using the same established questionnaires. Correlation coefficients and structural equation models were calculated to investigate the relationship between trait variables and expectations. We found small positive correlations between side effect expectations and improvement expectations (r = 0.187), perceived stress (r = 0.154), somatization (r = 0.115), agitation (r = 0.108), anhedonia (r = 0.118), and dysthymia (r = 0.118). In the structural equation model previous experiences emerged as the strongest predictors of improvement (β = 0.32, p =.005), worsening (β = −0.24, p =.005) and side effect expectations (β = 0.47, p =.005). Traits related to positive affect (β = − 0.09; p =.007) and negative affect (β = 0.04; p =.014) were associated with side effect expectations. This study is the first large analysis to investigate the relationship between traits, prior experiences and treatment expectations. Exploratory analyses indicate that experiences of symptom improvement are associated with improvement and worsening expectations, while previous negative experiences are only related to side effect expectations. Additionally, a proneness to experience negative affect may be a predictor for side effect expectation and thus mediate the occurrence of nocebo responses. • 'No pain, no gain': Positive and negative expectations are positively correlated. • Higher negative affect is associated with increased side effect expectations. • Previous treatment experiences are strong determinants of treatment expectations. [ABSTRACT FROM AUTHOR]

This paper deals with the creation of a holistic and easy to use model for predicting energy use during machining operations. The created model offers the process planner the possibility to determine the electrical power demand of the machining operation before actual machining occurs. After checking the model results, the process planner is able to change many of the process parameters. With the new NC file, the model can be used again for evaluating the related energy demand. The first step for setting up such a model is to understand what factors influence the power demand for the machining operation. Step two is the measuring of these factors and setting up a suitable model with each variable that can influence the energy demand. In the end, the electrical energy demand for the machining process of a certain part can be predicted with sufficient accuracy. [ABSTRACT FROM AUTHOR]

Loneliness and paranoia are related, but the mechanisms that link them to each other remain unclear. Systematic reviews on loneliness propose a social–cognitive model in which loneliness leads to negative evaluations of other persons and a lack of interpersonal trust. However, the data discussed in these reviews are based on healthy individuals. Building on this model, the present study investigated 1) whether negative interpersonal schemata mediate the association between loneliness and paranoia and 2) whether a low level of perceived social support and less frequent social contact are related to loneliness. Using a cross-sectional design, sixty-five participants with a diagnosis of schizophrenia were recruited online and completed questionnaire-based measures of loneliness, paranoia, negative interpersonal schemata, perceived social support and frequency of social contact. Data were analyzed taking a path-analytic approach. The association between loneliness and paranoia was significantly and fully mediated by negative schemata of others. Moreover, a low level of perceived social support was significantly associated with loneliness, whereas self-reported frequency of social contact was not. The present results highlight the potential role of interpersonal negative schemata in the formation and maintenance of paranoia and elucidate the crucial role of loneliness in the way individuals construe themselves within a social environment. [ABSTRACT FROM AUTHOR]

Hypertension is often treated pharmacologically. Since there is evidence that the cardiovascular system is sensitive to placebo mechanisms, our aim was to conduct an effect size analysis of placebo groups in double-blinded randomized controlled parallel-group drug trials using beta-blockers to treat hypertensive patients. A comprehensive literature search via PubMed, PsycINFO, PSYNDEX, PQDT OPEN, OpenGREY, ISI Web of Knowledge, and the WHO International Clinical Trials Registry Platform provided the basis of our meta-analysis. Effect sizes were estimated using a random-effects model based on 23 studies covering a total of 11,067 participants. Main outcomes were systolic blood pressure (sBP) and diastolic blood pressure (dBP). Blood pressure was lowered in placebo groups with significant and robust effect sizes (Hedges’ g ). The estimates for sBP (−0.27, P < .001) and dBP (−0.49, P < .001) can be interpreted as small to moderate. The placebo response accounted for 34% of the drug response for sBP and 47% of the drug response for dBP. Our moderator analyses indicated that a higher study quality and more study site visits were marginally associated with a higher placebo response. In light of these strong placebo responses, placebo mechanisms need to be considered in order to improve antihypertensive treatment. [ABSTRACT FROM AUTHOR]

Objectives The goal of this study was to evaluate the feasibility and safety of a robotic-assisted platform (CorPath 200, Corindus Vascular Robotics, Waltham, Massachusetts) for treating peripheral artery disease. Background A robotic-assisted platform for percutaneous coronary intervention is available for treating coronary artery disease. Methods In this prospective single-arm trial, patients with symptomatic peripheral artery disease (Rutherford class 2 to 5) affecting the femoropoplital artery were enrolled. Endpoints evaluated were: 1) device technical success, defined as successful cannulation of the target vessel with the robotic system; 2) device safety, defined as absence of device related serious adverse event (hospitalization, prolonged hospitalization, life threatening, or resulted in death); and 3) clinical procedural success, defined as <50% residual stenosis without an unplanned switch to manual assistance or device-related serious adverse event in the periprocedural period. Results The study enrolled 20 subjects (65.5 ± 9.3 years of age; 70% male) with primarily Rutherford class 2 to 3 (90%) symptoms. A total of 29 lesions (lesion length: 33.1 ± 15.5 mm) were treated with the majority (89.7%) being located in the superficial femoral artery. Device technical success, safety and clinical procedural success were all 100% with provisional stenting required in 34.5% of lesions. Fluoroscopy time (7.1 ± 3.2 min) and contrast use (73.3 ± 9.2 ml) compared favorably with studies in similar patient cohorts. There were no adverse events associated with the use of the robotic system. Conclusions These data demonstrate the feasibility and safety of using a robotic-assisted platform for performing peripheral arterial revascularization. [ABSTRACT FROM AUTHOR]

The question of the relative importance of dysfunctional cognitive beliefs and metacognitions in the development and maintenance of obsessive-compulsive (OC) symptoms is still a matter of debate. This study aims to investigate the relevance of OC-specific metacognitions, such as thought fusion beliefs, beliefs about rituals and stop signals for OC symptoms. Patients with obsessive-compulsive disorder (OCD) ( n = 71), anxiety disorders ( n = 51), and depressive disorders ( n = 81), and a nonclinical sample ( n = 300), were assessed for (meta)cognitive beliefs and OC symptoms. Analyses of variances indicated that the OCD group reported significantly more positive beliefs about rituals and stop signals than did the other three groups, also when controlling for comorbidity of depression disorder. No differences were found with regard to thought fusion beliefs. In regression analyses in the OCD sample, OC-specific metacognitions such as thought fusion beliefs explained incremental variance in OC symptoms, when controlling for cognitive beliefs and general, non OC-specific metacognitions. Overall, these findings provide further evidence for the relevance of specific metacognitions to OCD. Metacognitive therapy might address these metacognitive beliefs and thereby lead to a reduction of OC symptoms in OCD patients. [ABSTRACT FROM AUTHOR]

Objectives The COhorte de Patients ARTériopathes (COPART) Risk Score is a risk score assessing the 1 year outcome of patients who received inpatient treatment because of their peripheral arterial occlusive disease (PAOD). The COPART Risk Score consists of six variables each of which is allocated a different number of points (age, history of myocardial infarction, C-reactive protein, ankle–brachial index, estimated glomerular filtration rate, medication with antiplatelet agents, statins and renin–angiotensin system inhibitors). Methods 129 consecutive claudicants were included in a prospective trial with an average follow up of 8.8 (± 0.7) years. All patients were hospitalized for their first endovascular procedure to the pelvic and/or femoropopliteal arteries. The endpoints were all cause mortality and cardiovascular (CV) death. The COPART Risk Score was calculated for the three patient cohorts (low risk: 52 patients [40.3%]; medium risk: 41 patients [31.8%]; high risk: 36 patients [27.9%]). Results During the follow up period 23.1% ( n = 12) of patients in the low risk group, 34.1% ( n = 14) of patients in the medium risk group, and 63.9% ( n = 23) of patients in the high risk group died. CV death occurred in 11.5% in the low, 22.0% in the medium, and 41.7% in the high risk groups. The three groups differed significantly with regard to all cause and CV mortality ( p < .0001 and p = .001). Conclusions The COPART Risk Score is a suitable instrument to predict long-term all cause and CV mortality in claudicants preceding their first peripheral intervention. [ABSTRACT FROM AUTHOR]

Abstract: In recent year’s metacognitive theories – particularly the self-regulatory executive function model proposed by Wells and colleagues – have emerged as a potentially useful perspective from which to extend current cognitive-behavioral models for the mood and anxiety disorders. Metacognitions refer to different beliefs individuals endorse about their thoughts, internal states, and effective coping strategies. Research has linked these attitudes to obsessive compulsive symptoms (OCS), yet it remains unclear whether there may be a differential association with the different OCS dimensions and hoarding. The current study aimed to investigate the specific relationships between the OCS dimensions, hoarding, and metacognitions controlling for general distress. The sample (N=160) was comprised of young adults at a large university in Germany. Although all symptom types were significantly linked with the various metacognitions assessed (all p’s<.05), a series of linear regression analyses provided support for more nuanced and particular relationships. The analyses conducted allowed us to examine the specificity of any associations, by factoring out any shared variance between the different OCS dimensions and hoarding. Results revealed that (1) positive beliefs about worry were significantly associated with obsessions and ordering; (2) negative beliefs about uncontrollability were significantly associated with obsessions and checking; (3) cognitive confidence was significantly associated with ordering and hoarding; (4) beliefs about the need to control thoughts were significantly associated with obsessions, ordering, and hoarding; and (5) cognitive self-consciousness was significantly linked with obsessions and ordering. Additional analyses were conducted to examine the relationships between metacognitions, hoarding-specific beliefs, and hoarding symptoms. Results are discussed from the perspective of current theoretical models of OCD and hoarding and future directions are also highlighted. [Copyright &y& Elsevier]

Abstract: Little is known about treatment mechanisms underlying acceptance strategies. Acceptance is a strategy that is expected to increase pain tolerance more than distraction, while distraction should lead to lower pain intensity. The effect of cognitive restructuring on experimental pain has not yet been investigated. The present study aimed to explore differential short-term effects of acceptance, distraction, and cognitive restructuring on pain tolerance and intensity. Pain was induced in a sample of 109 female students using a thermode. We conducted analyses of covariance with instruction as the independent variable and posttest scores on pain variables as dependent variables, covarying for pretest scores. In addition, adherence to instructions and credibility of instructions were included as covariates. Acceptance led to a higher increase in pain tolerance than did cognitive restructuring of pain-related thoughts. No differences were detected between either acceptance and distraction or distraction and cognitive restructuring with respect to pain tolerance. Distraction led to lower pain intensity compared to acceptance. Cognitive restructuring did not differ from either acceptance or distraction with respect to pain intensity. As a short-term strategy, cognitive restructuring was not as useful as acceptance in increasing pain tolerance. Further studies should evaluate the preconditions under which different strategies are most effective. Perspective: This study demonstrated that acceptance was superior to cognitive restructuring in increasing tolerance for experimentally induced pain, but was inferior to distraction with respect to decreasing pain intensity. Knowledge about the types of strategies that are useful in targeting diverse pain-related outcome measures is important for efforts to refine the treatment of chronic pain. [Copyright &y& Elsevier]

In coronary heart disease (CHD) and heart surgery, there is sound evidence for the relationship between patients'' expectations and treatment outcome, especially for outcome variables such as disability and quality of life. In addition, patients'' expectations have been shown to be modifiable through psychological interventions. Therefore, targeting patients'' expectations might offer a promising opportunity to enhance heart surgery outcome. However, few studies have tried to actively change patients'' expectations before surgery. The purpose of this clinical trial is to optimize patients'' outcome expectations before undergoing coronary artery bypass graft surgery (CABG) through a brief psychoeducational program. The present article describes the study protocol and reports preliminary data on feasibility. Using a randomized controlled design, 180 patients who are scheduled to undergo elective CABG are randomly assigned to either (1) standard medical care (SMC) alone, (2) to an additional expectation manipulation intervention during the 2 weeks before surgery, and (3) to an additional attention-control group (“supportive therapy”). The main goal is to test (a) whether expectation manipulation intervention can optimize patients'' expectations and (b) whether optimized expectations lead to enhanced surgery efficacy. The primary outcome variable is illness-related disability 6 months after surgery, whereas secondary outcome variables will be quality of life, return to work, physical activity, and medical outcome variables. First, feasibility data of 36 patients show that the patients appreciated the additional psychological intervention before CABG. Satisfaction of those who received psychological interventions was very high. [Copyright &y& Elsevier]

Abstract: The representation of pain diagnoses in current classification systems like International Classification of Diseases (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV does not adequately reflect the state of the art of pain research, and does not sufficiently support the clinical management and research programs for pain conditions. Moreover, there is an urgent need to harmonize classification of pain syndromes of special expert groups (eg, International Classification of Headache Disorders) and general classification systems (eg, ICD-11, DSM-V). Therefore, this paper summarizes new developments, and proposals for pain diagnoses in revised classification systems. A qualitative review of the literature concerning new proposals for classification of pain syndromes that are based on consensus groups was conducted. Selected proposals of national and international pain societies that are based on consensual processes are presented. These proposals can be condensed to be used in ICD-11 classification. The benefits of considering multidimensional and transdiagnostic processes for the classification process are also outlined. The manuscript provides options how to transform current pain-specific classification proposals to the revision of ICD-11. Perspective: Pain research and expertise must be more visible in the ICD-11 revision process. A general category for pain diagnoses as well as specific pain diagnoses under existing categories of organ-specific sections are needed. [Copyright &y& Elsevier]

Background: In children with loss of control (LOC) over eating, recent research has revealed evidence for distinct personality features, such as more impulsivity. The aim of this study was to assess parent- and child-report personality profiles in children with and without LOC over eating and to relate these profiles to general and eating-disorder psychopathology. Method: A total of 120 children (60 with LOC over eating; 68 girls) aged 8 to 13 years were recruited from the community. Clinical interview, self-report, and parent-report questionnaires were administered to assess personality as well as both general and eating-disorder psychopathology. Results: The group with LOC over eating showed lower self-directedness and cooperativeness compared to the group without LOC. The children with LOC were significantly more impulsive. Personality dimensions were significantly correlated with greater general but not eating-disorder psychopathology and frequency of LOC over eating. Conclusion: A distinct pattern of personality traits in children with LOC over eating was found that is partly in line with research on binge-eating disorder, bulimia nervosa, and obesity in adulthood. The findings suggest that longitudinal studies should examine whether certain patterns of personality in children with LOC over eating account for differences in psychopathology later in life. [Copyright &y& Elsevier]

Cognitive behaviour therapy, especially exposure and response prevention (ERP) is the treatment of choice for obsessive-compulsive disorder (OCD). However, a substantial number of patients refuse this method or fail to benefit enough. Metacognitive therapy (MCT) claims to successfully treat OCD without prolonged exposures. However, only case series and small, mostly uncontrolled trials have been published so far. The efficacy and feasibility of MCT for OCD compared to ERP were investigated in a pilot randomized trial. Thirty-seven outpatients with OCD according to DSM-IV criteria were randomly allocated to individual, weekly 14-sessions of therapy with either MCT or ERP. Analyses focused on treatment efficacy at post-treatment and 3-months follow-up, treatment fidelity and credibility. Participants showed a significant reduction in OCD symptoms in both treatment conditions and with no differences between MCT and ERP. Participants in the MCT condition required less face-to-face time with a therapist than those in the ERP condition. MCT and ERP were both effective with large effect sizes. There was no evidence that the two treatments lead to statistically different outcomes. Larger controlled trials are justified. • Compared the efficacy and feasibility of MCT for OCD to ERP. • ERP and MCT were both feasible and effective. • MCT may be an effective and economic alternative to ERP for OCD. [ABSTRACT FROM AUTHOR]

Assessment whether patients' wellbeing and disturbances in the post anaesthesia care unit could be influenced by the consecutive introduction of initially personalised music and then additionally various drink options. A pre-post-analysis by means of an anonymised survey with a validated questionnaire in a university hospital in central Europe. Main Outcome Measures. Wellbeing and disturbances in the post anaesthesia care unit. Patients' most frequently reported early postsurgical disturbances (n = 1335) were lack of wellbeing, dry mouth and pain in the surgical area. Reported rates of clinically relevant wellbeing were not statistically different in patients that were offered personalised music (46.5%) or additionally ice-tea (50.6%). No correlation could be found between wellbeing or physical discomfort and headphones or when ice-tea were offered. After a decade of increased efforts to improve patients' wellbeing in the postanaesthesia care unit we could not show further influence on it by the introduction of personalised music and ice-tea. We see the need for a more differentiated focus on this topic and the need for exploratory studies on patient perception. The most frequent claims were related to lack of wellbeing, pain in the surgical area and a dry mouth. [ABSTRACT FROM AUTHOR]