Generalist, specialist, or expert in palliative care? A cross-sectional open survey on healthcare professionals' self-description.

BACKGROUND: In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs) if possible and by palliative care specialists if necessary. However, it still needs to be clarified what specialist expertise entails, what specialized care consists of, and which training or work experience is needed to become a palliative care specialist. In addition to generalists and specialists, 'experts' in palliative care are recognized within the nursing and medical professions, but it is unclear how these three roles relate. This study aims to explore how HCPs working in palliative care describe themselves in terms of generalist, specialist, and expert and how this self-description is related to their work experience and education. METHODS: A cross-sectional open online survey with both pre-structured and open-ended questions among HCPs who provide palliative care. Analyses were done using descriptive statistics and by deductive thematic coding of open-ended questions. RESULTS: Eight hundred fifty-four HCPs filled out the survey; 74% received additional training, and 79% had more than five years of working experience in palliative care. Based on working experience, 17% describe themselves as a generalist, 34% as a specialist, and 44% as an expert. Almost three out of four HCPs attributed their level of expertise on both their education and their working experience. Self-described specialists/experts had more working experience in palliative care, often had additional training, attended to more patients with palliative care needs, and were more often physicians as compared to generalists. A deductive analysis of the open questions revealed the similarities and distinctions between the roles of a specialist and an expert. Seventy-six percent of the respondents mentioned the importance of having both specialists and experts and wished more clarity about what defines a specialist or an expert, how to become one, and when you need them. In practice, both roles were used interchangeably. Competencies for the specialist/expert role consist of consulting, leadership, and understanding the importance of collaboration. CONCLUSIONS: Although the grounds on which HCPs describe themselves as generalist, specialist, or experts differ, HCPs who describe themselves as specialists or experts mostly do so based on both their post-graduate education and their work experience. HCPs find it important to have specialists and experts in palliative care in addition to generalists and indicate more clarity about (the requirements for) these three roles is needed.

A Meta-Analysis of the Effects of Taekwondo on Physical Self-Concept.

In this meta-analysis we explored whether Taekwondo practice has improved its participants' physical self-concepts. We also tested the mediating influence of factors in past research such as country, participant age, and measurement properties in their associations with these taekwondo effects. We reviewed extensive data collected from Chinese, English and Korean participants in articles listed in Cnki, Wanfang, PubMed, Web of Science, KISS, RISS, and DBPIA databases. First, we evaluated the methodological quality of these published articles with Review Manager 5.4 software according to the Cochrane System Evaluation Manual. Then, we used Comprehensive Meta-Analysis 3.7 software for statistical analysis. We based these analyses on nine research studies containing a total of 1154 participants. We found a significant association between taekwondo activity and an improved body self-concept (ES = .688, p < .001). Subgroup analyses showed a stronger association between these variables in Korea (ES = .90, p < .001) than in China (ES = .34, p < .001), a stronger association for children (ES = 1.04, p < .001) compared to adults (ES = .46, p < .001), and a stronger association with the modified version of the Physical Self-Description Questionnaire (PSDQ) (ES = .99, p < .001) than with the original PSDQ (ES = .57, p < .001). We concluded that practicing Taekwondo led to improved physical self-concept, especially in a younger population. In addition, the experimental design and measurement methods may influence the apparent link between these variables.

Improving patient self-description in Chinese online consultation using contextual prompts.

BACKGROUND: Online health care consultation has been widely adopted to supplement traditional face-to-face patient-doctor interactions. Patients benefit from this new modality of consultation because it allows for time flexibility by eliminating the distance barrier. However, unlike the traditional face-to-face approach, the success of online consultation heavily relies on the accuracy of patient-reported conditions and symptoms. The asynchronous interaction pattern further requires clear and effective patient self-description to avoid lengthy conversation, facilitating timely support for patients. METHOD: Inspired by the observation that doctors talk to patients with the goal of eliciting information to reduce uncertainty about patients' conditions, we proposed and evaluated a machine learning-based computational model towards this goal. Key components of the model include (1) how a doctor diagnoses (predicts) a disease given natural language description of a patient's conditions, (2) how to measure if the patient's description is incomplete or more information is needed from the patient; and (3) given the patient's current description, what further information is needed to help a doctor reach a diagnosis decision. This model makes it possible for an online consultation system to immediately prompt a patient to provide more information if it senses that the current description is insufficient. RESULTS: We evaluated the proposed method by using classification-based metrics (accuracy, macro-averaged F-score, area under the receiver operating characteristics curve, and Matthews correlation coefficient) and an uncertainty-based metric (entropy) on three Chinese online consultation corpora. When there was one consultation round, our method delivered better disease prediction performance than the baseline method (No Prompts) and two heuristic methods (Uncertainty-based Prompts and Certainty-based Prompts). CONCLUSION: The disease prediction performance correlated with uncertainty of patients' self-described symptoms and conditions. However, heuristic solutions ignored the context to decrease large amounts of uncertainty, which did not improve the prediction performance. By elaborate design, a machine-learning algorithm can learn the inner connection between a patient's self-description and the specific information doctors need from doctor-patient conversations to provide prompts, which can enrich the information in patient self-description for a better performance in disease prediction, thereby achieving online consultation with fewer rounds of doctor-patient conversation.

Clinical significance of self-descriptive apathy assessment in patients with neurological form of Wilson's disease.

BACKGROUND AND AIM: Apathy is one of the neuropsychiatric symptoms of Wilson's disease (WD) which typically affects the brain's fronto-basal circuits. Lack of agreed diagnostic criteria and common use of self-description assessment tools lead to underestimation of this clinical phenomenon. The aim of this study was to investigate whether subjective and informant-based clinical features of apathy in patients with WD enable clinicians to make a valid diagnosis. METHODS: Multiple aspects of goal-oriented behavior were assessed in 30 patients with the neurological form of WD and 30 age-matched healthy participants using two questionnaires, the Lille Apathy Rating Scale (LARS) and the Dysexecutive Questionnaire (DEX). Both included a self-descriptive and a caregiver/proxy version. Cognitive functioning was estimated with the use of Addenbrooke's Cognitive Examination-Revised. RESULTS: Patients obtained significantly worse scores on all clinical scales when more objective measures were considered. Features of apathy and executive dysfunction were revealed in patients' caregiver versions of LARS and DEX, which may indicate poor self-awareness of patients with WD. Roughly 30% of participants were likely to present with clinically meaningful symptoms, independent of cognitive dysfunction. CONCLUSIONS: Methods relying on self-description appear inferior to informant-based scales when diagnosing apathy. More objective criteria and measurement tools are needed to better understand this clinical syndrome.

Relationship of a big five personality questionnaire to the symptoms of affective disorders.

Online assessments allow cost-effective, large-scale screening for psychiatric vulnerability (e.g., university undergraduates or military recruits). However, conventional psychiatric questionnaires may worsen mental health outcomes due to overmedicalizing normal emotional reactions. Personality questionnaires designed for occupational applications could circumvent this problem as they utilise non-clinical wording and it is well-established that personality traits influence susceptibility to psychiatric illness. Here we present a brief, free-to-use occupational personality questionnaire, and test its sensitivity to symptoms of Bipolar Disorder (BD) and Major Depressive Disorder (MDD) in an online sample. Our study used a cross-sectional, self-report design to assess the relationship between self-reported symptoms of affective disorders and scores on the personality dimensions of openness, conscientiousness, extraversion, agreeableness and neuroticism. We used SEM to compare affective symptoms in 8,470 individuals (mean age 25.6 ± 7.0 years; 4,717 male) with scores on an online adaption of the TSDI, a public-domain 'Big Five' personality questionnaire. ROC curve analyses assessed cut off scores for the best predictors of overall vulnerability to affective disorders (represented by a composite screening score). Neuroticism was the most robust predictor of QIDS-16 depression symptoms and MDQ Hypomania symptoms (ß = 0.68 and 0.39 respectively, p < .0001). Extraversion was the most robust predictor of HCL-16 Hypomania symptoms (ß = 0.34, p < .0001). ROC curve analyses suggest if the TSDI was used for screening in this sample, neuroticism cut offs of approximately 58 for men and 70 for women would provide the most useful classification of overall vulnerability to affective disorders.

Self-descriptions on LinkedIn: Recruitment or friendship identity?

We used quantitative semantics to find clusters of words in LinkedIn users' self-descriptions to an employer or a friend. Some of these clusters discriminated between worker and friend conditions (e.g., flexible vs. caring) and between LinkedIn users with high and low education (e.g., analytical vs. messy).

Exploring physical self-concept perceptions in athletes with intellectual disabilities: the participation of Unified Sports experiences.

OBJECTIVES: Self-description research on athletes with intellectual disabilities (ID) is under investigated. The specific aims in this paper are (a) to identify the differences in physical self-concept and body image by Unified Sports experiences, and (b) to investigate predictors of physical self-concept. METHODS: Participants included 89 Special Olympics athletes who had Unified Sports experiences (USE, n = 43) and those without USE (n = 46). Demographic, anthropometric, self-description data were collected during the questionnaire interview and physical examination. Analyses included descriptive and regression modeling to determine differences in the psychological attributes by USE and best subsets of predictors of each physical self-concept construct. RESULTS: The findings suggest that the participation of USE facilitated greater sport competence and there is no single predictor across the six physical self-concept constructs. CONCLUSION: The findings provide evidence that sports participation may have positive impacts on physical self-concept toward athletes with ID.

Swedish-Registered Nurse Anesthetists' Evaluation of Their Professional Self.

PURPOSE: This study aimed to explore how the nurse anesthetist values their professional self, compared with their peers, and also to explore whether professional self is affected by age, work experience, and/or gender. DESIGN: An explorative and prospective cross-sectional design. METHODS: During April 2011, a total of 108 registered nurse anesthetists from three different hospitals were surveyed using the Professional Self-Description Form with questions covering 21 items. FINDINGS: A total of 87 (80%) responded: 21 men and 66 women with a mean age of 45 years (range, 28 to 64 years) and mean professional experience of 12 years (range, 1 to 41 years). Four factors were found: professionalism, trait of character, scientific knowledge, and empathy, with Cronbach alpha of 0.96 overall. Analysis showed that perceived professional self depends on age and amount of work experience, but not on gender. CONCLUSIONS: The Professional Self-Description Form exhibits satisfactory internal consistency. Work experience and age influenced the development of professional self of nurse anesthetists.

Self-Description Questionnaire II (versión breve): evidencia de fiabilidad y validez en una muestra de adolescentes chilenos / Self-Description Questionnaire II (short version): evidence of reliability and validity in a sample of chilean adolescents

El objetivo de este estudio fue analizar la fiabilidad y validez de las puntuaciones de la versión breve del Self-Description Questionnaire II (SDQ-II-S) en población chilena. La muestra se compuso de 1255 adolescentes chilenos, con un rango de edad de 13 a 17 años (M=15.10; DT=1.30). El análisis factorial confirmatorio corroboró la estructura original de 11 factores correlacionados del SDQ-II-S. La multidimensionalidad del cuestionario también fue avalada por la pequeña magnitud de las correlaciones entre los 11 factores (M = 0.26). Los coeficientes alfa de Cronbach variaron desde 0.70 hasta 0.84, y se destacó una adecuada fiabilidad. Para profundizar en el análisis de la validez de constructo del SDQ-II-S, se relacionaron las puntuaciones de las diferentes escalas con puntuaciones en medidas de ansiedad (Inventario de Ansiedad Estado-Rasgo) y autoeficacia (Escala de Autoeficacia Percibida Específica de Situaciones Académicas). Los resultados pusieron de manifiesto que estos cuestionarios permiten analizar constructos diferenciados aunque relacionados. Los datos de este trabajo destacan que el SDQ-II-S presenta adecuadas propiedades psicométricas en población chilena, contrarrestando las carencias existentes en lo que respecta a la evaluación del autoconcepto, y resaltan interesantes aplicaciones tanto en el ámbito aplicado como en el de la investigación.

Pattern activation/recognition theory of mind.

In his 2012 book How to Create a Mind, Ray Kurzweil defines a "Pattern Recognition Theory of Mind" that states that the brain uses millions of pattern recognizers, plus modules to check, organize, and augment them. In this article, I further the theory to go beyond pattern recognition and include also pattern activation, thus encompassing both sensory and motor functions. In addition, I treat checking, organizing, and augmentation as patterns of patterns instead of separate modules, therefore handling them the same as patterns in general. Henceforth I put forward a unified theory I call "Pattern Activation/Recognition Theory of Mind." While the original theory was based on hierarchical hidden Markov models, this evolution is based on their precursor: stochastic grammars. I demonstrate that a class of self-describing stochastic grammars allows for unifying pattern activation, recognition, organization, consistency checking, metaphor, and learning, into a single theory that expresses patterns throughout. I have implemented the model as a probabilistic programming language specialized in activation/recognition grammatical and neural operations. I use this prototype to compute and present diagrams for each stochastic grammar and corresponding neural circuit. I then discuss the theory as it relates to artificial network developments, common coding, neural reuse, and unity of mind, concluding by proposing potential paths to validation.

Accuracy of Physical Self-Description Among Chronic Exercisers and Non-Exercisers.

This study addressed the role of chronic exercise to enhance physical self-description as measured by self-estimated percent body fat. Accuracy of physical self-description was determined in normal-weight, regularly exercising and non-exercising males with similar body mass index (BMI)'s and females with similar BMI's (n=42 males and 45 females of which 23 males and 23 females met criteria to be considered chronic exercisers). Statistical analyses were conducted to determine the degree of agreement between self-estimated percent body fat and actual laboratory measurements (hydrostatic weighing). Three statistical techniques were employed: Pearson correlation coefficients, Bland and Altman plots, and regression analysis. Agreement between measured and self-estimated percent body fat was superior for males and females who exercised chronically, compared to non-exercisers. The clinical implications are as follows. Satisfaction with one's body can be influenced by several factors, including self-perceived body composition. Dissatisfaction can contribute to maladaptive and destructive weight management behaviors. The present study suggests that regular exercise provides a basis for more positive weight management behaviors by enhancing the accuracy of self-assessed body composition.

Fisicoculturistas consumidores de esteroides anabolizantes y sus relaciones con la autodescripción física y la ansiedad física social / Bodybuilders who consume anabolic steroids and its relationship with their physical self description and their physical social anxiety

Se determinan las características sobre ansiedad física social y la autodescripciónfísica en 55 varones físicoculturistas usuarios de esteroides anabolizantesy 95 no usuarios, valorado el consumo a través del Índice de Masa CorporalLibre de Grasa. En la escala SPAS los consumidores dan unos valores superiores a los no consumidores en la puntuación total y en la Expectativa antela Evaluación Negativa, y muy ajustadas las diferencias en el Confort con laPresencia Física. En Autodescripción, valorada mediante el Cuestionario deAutodescripción Física (PSDQ), se muestra que los no usuarios puntúan porencima. Sin embargo, no se dan diferencias en las puntuaciones globales en Autodescripción de la Forma Física. Se observan las correlaciones inversas ysignificativas entre las dos escalas; con la dimensión Autodescripción Físicay con Autodescripción de la Forma Física.

The characteristics of physical and social anxiety and the physical self description in 55 male bodybuilders who use anabolic steroids and 95 non users are determined, the consumption is being valued through the Fat Free Body Mass. On the SPAS scale the consumers give higher values to the non consumers in the total score, and in the Expectation towards a Negative Assessment, and very slight differences in the Comfort with their Physical Presence. In self description, valued through the PSDQ, it is shown that non users get a higher score in self description. Nevertheless, there are no differences given in the global scores in self description of the physical form. Inverse and significant correlations are observed between the two scales; with the dimension Physical Self Description, and with Self Description of the Physical Form.