Does Researcher Allegiance Bias Outcomes in Psychotherapy Research? A Quasi-Experimental Secondary Analysis.

Researchers who conduct studies comparing the efficacy of two treatments often find that their preferred treatment outperforms the comparison treatment. This finding has been labelled the allegiance association. Although this association is robust, it is unclear whether it reflects an allegiance bias on the part of the researchers or whether it is noncausal, with researchers being allied to the more effective treatments. This study applied a quasi-experimental method proposed by a previous study to 19 pairs of treatment comparison studies. Each member of a pair had used the same two psychotherapies to treat clients with the same disorder, but the researchers in each of the two studies had opposing allegiances. If the authors of one study in the pair concluded that their preferred treatment was superior and the authors of the other study concluded that their preferred treatment was superior or that the two treatments were equivalent, these patterns would suggest allegiance bias. In 10 of the 19 pairs, the patterns were consistent with the operation of an allegiance bias, indicating that although allegiance biases are not inevitable, they are ubiquitous. Practitioners and other psychotherapy research consumers should use caution when interpreting the findings from treatment comparison studies.

Staff Perspectives of Mass Casualty Incident Preparedness.

Introduction Mass casualty incidents (MCI) are low-frequency, high-risk events that disrupt the day-to-day operations of medical centers. Day-to-day protocols are insufficient for effectively managing MCI events, creating a need to develop and test MCI-specific protocols. The aim of this project was to utilize interviews to gain insight into staff experience and perspective on MCIs and their institution's response plans. Methods Staff members who participated in an MCI drill were asked semi-structured interview questions regarding their perspectives on their current priorities, the information needed to perform their role, and their greatest concerns about an MCI. This quality improvement (QI) project utilized a qualitative methodology to thematically organize the results of the staff responses. Results A total of 64 staff members with various levels of patient care experience were interviewed to reach thematic saturation. The use of staff interviews helped to identify the four primary themes that emerged, which were: 1) process, 2) supplies and resources, 3) communication, and 4) roles. Furthermore, each theme also included a number of subthemes. Conclusions This project demonstrated the importance of staff experiences related to MCI simulation training and preparedness, which may be useful for future training and emergency response planning. Additionally, the results may be helpful for other institutions when building a robust MCI simulation training program or designing an emergency response plan.

Construction and preliminary validation of Triarchic Psychopathy Scales from the HEXACO-100.

According to the triarchic model, psychopathy encompasses 3 distinct dispositional constructs: boldness, meanness, and disinhibition. Although the Triarchic Psychopathy Measure was designed to assess these 3 constructs, researchers have developed alternative triarchic scales using both omnibus measures of general personality and existing psychopathy scales. The components of the HEXACO model of personality may be especially capable of characterizing the dimensions of the triarchic model of psychopathy. The current study used a consensus-rating approach to create triarchic scales using items from the HEXACO-100. Data from 3 community and college student samples were used to examine the internal consistency, and convergent and discriminant validity of these newly developed HEXACO-Triarchic scales. The scales consistently demonstrated good internal consistency and displayed promising convergent and discriminant validity with theoretically predicted criterion variables. The lone exception was that HEXACO-Meanness and HEXACO-Disinhibition were similarly related to other triarchic measures of meanness. The implications of these findings for the integration of the HEXACO and triarchic models are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Clarification of Drug Allergy Information Using a Standardized Drug Allergy Questionnaire and Interview.

BACKGROUND: Vague, incomplete, or inaccurate drug-allergy histories can be detrimental to patient safety and affect patient care. There is an increased chance of medication errors if details of a drug allergy are not documented. Incomplete or inaccurate allergy histories may also result in increased time spent by health care providers to clarify an order in question. Published literature from the early 1990s showed that a patient interview can facilitate collection of more complete allergy information and could lead to the removal of a documented drug allergy in approximately one-third of patients. PURPOSE: This quality-improvement project was conducted to improve the process of collecting drug-allergy information at our institution. DESCRIPTION: The primary objective of this project was to determine the number of patients with a clinically relevant change in allergy history after a standardized drug-allergy questionnaire and interview compared with documentation prior to the interview. This was a descriptive, prospective quality improvement project of a standardized drug-allergy questionnaire and interview. Patients were asked about the history of their allergic reaction, including the drug, route, nature of reaction, treatment of reaction, and time since reaction. RESULTS: A total of 301 patient allergy profiles were reviewed. After screening, 202 patients were included and interviewed, for a total of 509 drug allergies. One hundred twenty-three patients (61%) had a need for a clinically relevant change in allergy history after an interview. A total of 228 changes were made to patient allergy profiles. Adding the allergy reaction accounted for 131 of the changes. Also, there were 185 allergies documented prior to the interview that were categorized as unclear/vague, which was significantly reduced to 112 after the interview (P < 0.0001). CONCLUSION: More complete drug-allergy information was obtained after executing a standardized drug-allergy questionnaire and interview.

Social anxiety, submissiveness, and shame in men and women: a moderated mediation analysis.

OBJECTIVES: Research suggests a positive relationship between social anxiety and shame; however, few studies have examined this relationship or potential mechanisms. Common behaviours of persons with social anxiety disorder (SAD), such as submissive behaviours, may be more consistent with societal expectations of women than men and therefore more likely to be associated with shame in socially anxious men than women. We examined the hypothesis that submissive behaviours would mediate the relationship between social anxiety and shame in men, but not in women, with SAD. DESIGN: Moderated mediation was examined in a cross-sectional dataset. Gender was modeled to moderate the paths from social anxiety to submissive behaviours and from submissive behaviours to shame. We also examined an alternative model of the relationships among these variables and the potential contributory role of depression. METHODS: Men (n = 48) and women (n = 40) with SAD completed the Social Interaction Anxiety Scale, Submissive Behaviour Scale, Internalized Shame Scale, and Beck Depression Inventory. RESULTS: Analyses supported the hypothesized model. The relationship between submissive behaviours and shame was greater in men than women with SAD; the relationship between social anxiety and submissive behaviours was not. Controlling for depression, moderation remained evident although diminished. Results for the comparison model did not support gender moderation. CONCLUSIONS: Submissive behaviours mediated the relationship between social anxiety and shame in men, but not women, with SAD. These findings provide preliminary evidence for a model of shame in SAD and may help to further elucidate specific features of SAD that differ between men and women. PRACTITIONER POINTS: Although researchers have argued that the display of submissive behaviours might allow the socially anxious individual to limit or prevent attacks on the self, our results suggest that there are greater costs, with regard to feelings of shame, associated with such behaviours for men. In men with SAD, the greater shame associated with submissive behaviours can be understood when considering that socially anxious individuals appear to be particularly concerned with concealing aspects of the self believed to violate perceived societal norms and that traditional masculine gender roles revolve around the theme of dominance. Because the study was conducted in individuals with SAD, it is possible that the restricted range of social anxiety severity may have precluded the observation of gender differences in the relationship between social anxiety and submissive behaviour. Measures were administered in a cross-sectional design, which limits potential inferences of causality.

Irreversible third-degree heart block and pacemaker implant in a case of flecainide toxicity.

An 82-year-old white woman was seen in the emergency department (ED) after ingesting 400 mg of flecainide in an attempt to treat an episode of dizziness and palpitations that occurred while she was gardening. Consequently, she developed bradycardia, hypotension, and complete heart block. In addition to supportive care, she also received sodium bicarbonate, atropine, calcium gluconate, and dopamine in an effort to reverse the heart block. The patient continued to remain in heart block and was sent to the cardiac catheterization laboratory for placement of an external pacing wire, which stabilized the patient. After further evaluation, a permanent pacemaker was implanted during her admission. External pacing wires may be useful in the treatment of complete heart block in cases of flecainide poisoning when a patient is unresponsive to drug therapy provided in the ED.

Clinical impact of temporary therapy interruptions on anticoagulation control in patients treated with warfarin.

This retrospective cohort study was completed to describe the impact of short-term therapy interruptions on anticoagulation control in patients receiving warfarin. Patients seen in a pharmacist-managed anticoagulation clinic were included if they were on a stable warfarin dose and then underwent a planned interruption in therapy. Patients were excluded if phytonadione was administered before the interruption or if medications known to interact with warfarin were altered during the interruption. Data were analyzed for 2 groups: (1) patients with a single interruption in therapy (group 1) and (2) patients with a single interruption in therapy plus patients with an extended interruption in therapy (group 2). The primary endpoint was the change in weekly maintenance warfarin dose from preinterruption to postinterruption. Evaluation of 199 patients resulted in 31 interruptions in group 1 and 34 interruptions in group 2. A change in dose was required in 58% of patients in group 1 and 56% of patients in group 2. The mean absolute change in dose was 2.03 ± 2.79 mg (P < 0.003) in group 1 and 1.96 ± 2.72 mg (P < 0.002) in group 2. For the majority of patients, the dose change represented <10% of their preinterruption weekly dose. Of patients requiring a dose change, 50% required an increase in dose. In conclusion, close follow-up is warranted after a warfarin therapy interruption as dose adjustments will likely be needed to regain anticoagulation control and the direction of this dose change cannot be predicted.

Characterization of adsorbate-induced ordering transitions of liquid crystals within monodisperse droplets.

The ordering of liquid crystals (LCs) within micrometer-sized droplets is known to depend strongly on the presence of interfacial adsorbates, although the exact sequence of ordered equilibrium states that accompany a change in interfacial anchoring from tangential to perpendicular has not been established. In this paper, we report use of a methodology that permits the preparation of monodisperse LC droplets in aqueous phases to investigate ordering transitions in the LC droplets that accompany the adsorption of amphiphiles at the aqueous-LC droplet interface. By using an amphiphile that undergoes reversible adsorption at the aqueous-LC interface (sodium dodecylsulfate, SDS), we identified six distinct topologically ordered states of the LC droplets as a function of increasing concentration of SDS. We exploited the reversible adsorption of the SDS to LC droplets with diameters of 8.0+/-0.2 microm to confirm that these topological states are equilibrium ones. We also exposed LC droplets to a continuous gradient in concentration of SDS to document the continuous transitions between topological states and to confirm the absence of additional, intermediate topological states. The formation of the LC droplets as aqueous dispersions also enabled an investigation of ordering transitions in LC droplets driven by biomolecular interactions. Surprisingly, enzymatic hydrolysis of the phospholipid L-dipalmitoyl phosphatidylcholine (L-DLPC) by phospholipase A2 at the interfaces of the LC droplets was observed to trigger the same progression of topologically ordered states of the LC as was observed with SDS. Overall, the results presented in this paper resolve prior conflicting data in the literature by providing an unambiguous set of observations regarding topologically ordered states encountered in LC droplets. This paper provides a data set against which future theories and simulations of LCs can be compared to develop a fundamental understanding of the competition between volumetric and interfacial effects in droplets. The results also suggest that topological ordering transitions in LC droplets can be exploited to report interfacial enzymatic reactions.