Effectiveness of the nutrition referral system in a multidisciplinary pancreatic cancer clinic.

PURPOSE: Proactive nutrition screening and intervention is associated with improved outcomes for patients with pancreatic adenocarcinoma (PDAC). To better optimize nutrition amongst our PDAC population, we implemented systematic malnutrition screening in the Johns Hopkins pancreas multidisciplinary clinic (PMDC) and assessed the effectiveness of our nutrition referral system. METHODS: This was a single institution prospective study of patients seen in the PMDC, screened for malnutrition using the Malnutrition Screening Tool (MST) (score range=0 to 5, score > 2 indicates risk of malnutrition), and offered referrals to the oncology dietitian. Patients that requested a referral but did not attend a nutrition appointment were contacted by phone to assess barriers to seeing the dietitian. Univariate (UVA) and multivariable (MVA) analyses were carried out to identify predictors of referral status and appointment completion status. RESULTS: A total of 97 patients were included in the study, of which 72 (74.2%) requested a referral and 25 (25.8%) declined. Of the 72 patients who requested a referral, 31 (43.1%) attended an appointment with the oncology dietitian. Data on information session attendance was available for 35 patients, of which 8 (22.9%) attended a pre-clinic information session in which the importance of optimal nutrition was highlighted. On MVA, information session attendance was significantly associated with requesting a referral (OR: 11.1, 95% CI 1.12-1.0E3, p=0.037) and successfully meeting with the oncology dietitian (OR: 5.88, 95% CI 1.00-33.3, p=0.049). CONCLUSION: PMDC teams should institute educational initiatives on the importance of optimal nutrition in order to increase patient engagement with nutrition services.

Effectiveness of Buffered Lidocaine for Local Anesthesia During Liver Biopsy.

The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate. Immediately after they received the lidocaine injection, both groups were asked to rate their preprocedure anxiety and pain using a 0-10 visual analog scale. Mean postprocedure pain was statistically significantly different between the two arms with the intervention group reporting less pain (1.65 vs. 2.27, p = .037). Change in pain scores between the two groups were also statistically significantly different with the intervention group reporting a mean change in pain score of 0.93 compared to 1.63 in the control group (p = .021). However, no differences were found for reported anxiety. This study has shown that using sodium bicarbonate with lidocaine significantly decreased pain sensation at the injection site when used for deep visceral anesthesia during percutaneous liver biopsy.

Learning to Look at the Bright Side of Life: Attention Bias Modification Training Enhances Optimism Bias.

Identifying neurocognitive mechanisms underlying optimism bias is essential to understand its benefits for well-being and mental health. The combined cognitive biases hypothesis suggests that biases (e.g., in expectancies and attention) interact and mutually enforce each other. Whereas, in line with this hypothesis, optimistic expectancies have been shown to guide attention to positive information, reverse causal effects have not been investigated yet. Revealing such bidirectional optimism-attention interactions both on a behavioral and neural level could explain how cognitive biases contribute to a self-sustaining upward spiral of positivity. In this behavioral study, we hypothesized that extensive training to direct attention to positive information enhances optimism bias. To test this hypothesis, for 2 weeks, 149 participants underwent either daily online 80-trial attention bias modification training (ABMT) toward accepting faces and away from rejecting faces or neutral control training. Participants in the ABMT group were instructed to click as quickly as possible on the accepting face among 15 rejecting faces randomly displayed on a 4-by-4 matrix; participants in the control group were instructed to click on the five-petaled flower depicted among 15 seven-petaled flowers. Comparative optimism bias and state optimism were measured via questionnaires before training, after one training week, and after two training weeks. ABMT enhanced comparative optimism bias, whereas control training did not. Our findings reveal that ABMT toward positive social information causally influences comparative optimism bias and may, thereby trigger the biases' benefits for well-being and mental health. These results can (a) stimulate future neurophysiological research in the area of positive psychology; and (b) reveal an innovative low-cost and easy-to-access intervention that may support psychotherapy in times of rising numbers of patients with psychological disorders.

Seeing through rose-colored glasses: How optimistic expectancies guide visual attention.

Optimism bias and positive attention bias have important highly similar implications for mental health but have only been examined in isolation. Investigating the causal relationships between these biases can improve the understanding of their underlying cognitive mechanisms, leading to new directions in neurocognitive research and revealing important information about normal functioning as well as the development, maintenance, and treatment of psychological diseases. In the current project, we hypothesized that optimistic expectancies can exert causal influences on attention deployment. To test this causal relation, we conducted two experiments in which we manipulated optimistic and pessimistic expectancies regarding future rewards and punishments. In a subsequent visual search task, we examined participants' attention to positive (i.e., rewarding) and negative (i.e., punishing) target stimuli, measuring their eye gaze behavior and reaction times. In both experiments, participants' attention was guided toward reward compared with punishment when optimistic expectancies were induced. Additionally, in Experiment 2, participants' attention was guided toward punishment compared with reward when pessimistic expectancies were induced. However, the effect of optimistic (rather than pessimistic) expectancies on attention deployment was stronger. A key characteristic of optimism bias is that people selectively update expectancies in an optimistic direction, not in a pessimistic direction, when receiving feedback. As revealed in our studies, selective attention to rewarding versus punishing evidence when people are optimistic might explain this updating asymmetry. Thus, the current data can help clarify why optimistic expectancies are difficult to overcome. Our findings elucidate the cognitive mechanisms underlying optimism and attention bias, which can yield a better understanding of their benefits for mental health.

The link between optimism bias and attention bias: A neurocognitive perspective.

Both optimism bias and reward-related attention bias have crucial implications for well-being and mental health. Yet, the extent to which the two biases interact remains unclear because, to date, they have mostly been discussed in isolation. Examining interactions between the two biases can lead to new directions in neurocognitive research by revealing their underlying cognitive and neurophysiological mechanisms. In the present article, we suggest that optimism bias and reward-related attention bias mutually enforce each other and recruit a common underlying neural network. Key components of this network include specific activations in the anterior and posterior cingulate cortex with connections to the amygdala. We further postulate that biased memory processes influence the interplay of optimism and reward-related attention bias. Studying such causal relations between cognitive biases reveals important information not only about normal functioning and adaptive neural pathways in maintaining mental health, but also about the development and maintenance of psychological diseases, thereby contributing to the effectiveness of treatment.

Neural correlates of immediate and prolonged effects of cognitive reappraisal and distraction on emotional experience.

Cognitive emotion regulation strategies are important components of cognitive-behavioral therapy (CBT). Additionally, up-regulation and difficulties in the down-regulation of negative feelings are associated with mental disorders. However, little is known about the lasting effects of cognitive emotion regulation strategies on emotional experience and associated neural activation. Therefore, this study investigated immediate and prolonged effects of emotion regulation using cognitive reappraisal and distraction on subjective report and its neural correlates. Twenty-seven healthy females took part in a 2-day functional magnetic resonance imaging study. They were instructed to either up-regulate or down-regulate their negative feelings using a situation-focused cognitive reappraisal strategy, to distract themselves by imagining a specific neutral situation, or to passively look at repeatedly presented aversive and neutral pictures. Re-exposure to the same stimuli without a regulation instruction was conducted one day later. Self-reported negative feelings and blood-oxygen-level-dependent responses served as main outcome variables. As expected, the results show successful immediate up- or down-regulation of negative feelings by cognitive reappraisal and down-regulation of negative feelings by distraction. Furthermore, these changes in negative feelings were correlated with amygdala activation. A lasting effect on emotional experience associated with stronger ventromedial prefrontal cortex activation was found for down-regulation of negative feelings via cognitive reappraisal. Compared to distraction, down-regulation via cognitive reappraisal led to reduced negative feelings and stronger dorso- and ventrolateral prefrontal cortex responses one day later. While cognitive reappraisal and distraction are both effective strategies during active regulation, only cognitive reappraisal had a lasting effect. These findings might have implications for CBT.