Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes.

OBJECTIVE: To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). METHODS: A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. RESULTS: A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. CONCLUSIONS: Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.

Systematic Review: Anxiety in Children and Adolescents With Chronic Medical Conditions.

OBJECTIVE: Youth with chronic medical conditions (CMCs) have been reported to be at increased risk for developing anxiety disorders. Importantly, suffering from anxiety may also have an impact on their disease-related outcomes. This study set out to systematically review the literature on anxiety and seven CMCs (asthma, congenital heart disease, diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis, and sickle cell disease) among youth. METHOD: A systematic review was performed according to the PRISMA statement. Searches were conducted across PubMed, PsycNET, Embase, and reference lists of the included studies (1990-2018). Three independent reviewers screened titles and abstracts and conducted full-text assessment. Studies were included if they reported the prevalence of anxiety or the association of anxiety on disease-related outcomes in children and/or adolescents with the focal CMCs. RESULTS: A total of 53 studies met the predetermined inclusion criteria. Across the CMCs, the prevalence of anxiety disorder was increased in youths with CMCs compared to the general population. Evidence for a relationship between anxiety and adverse disease-related outcomes was limited. For asthma, inflammatory bowel disease, and sickle cell disease, there was some evidence indicating that anxiety was associated with adverse outcomes; supported by two longitudinal studies, one in asthma and one in inflammatory bowel disease. For diabetes, results were inconsistent; with some studies indicating that anxiety was associated with worse and others with better treatment adherence. CONCLUSION: The prevalence of anxiety disorders in youth with CMCs is higher than that in the general population. Anxiety may also be associated with adverse disease-related outcomes for youths, but it is not possible to draw definitive conclusions. Longitudinal studies making use of parent/youth composite anxiety measures and a combination of parent/youth reported and objective measures of disease-related outcomes are needed. Given the burden of disease of anxiety disorders, regardless of the impact on the disease outcomes, screening for and treatment of anxiety is recommended in youths with CMCs.

Monitoring vital signs with time-compressed speech.

Spearcons-time-compressed speech phrases-may be an effective way of communicating vital signs to clinicians without disturbing patients and their families. Four experiments tested the effectiveness of spearcons for conveying oxygen saturation (SpO2) and heart rate (HR) of one or more patients. Experiment 1 demonstrated that spearcons were more effective than earcons (abstract auditory motifs) at conveying clinical ranges. Experiment 2 demonstrated that casual listeners could not learn to decipher the spearcons whereas listeners told the exact vocabulary could. Experiment 3 demonstrated that participants could interpret sequences of sounds representing multiple patients better with spearcons than with pitch-based earcons, especially when tones replaced the spearcons for normal patients. Experiment 4 compared multiple-patient monitoring of two vital signs with either spearcons, a visual display showing SpO2 and HR in the same temporal sequence as the spearcons, or a visual display showing multiple patient levels simultaneously. All displays conveyed which patients were abnormal with high accuracy. Visual displays better conveyed the vital sign levels for each patient, but cannot be used eyes-free. All displays showed accuracy decrements with working memory load. Spearcons may be viable for single and multiple patient monitoring. Further research should test spearcons with more vital signs, during multitasking, and longitudinally. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Spearcons for Patient Monitoring: Laboratory Investigation Comparing Earcons and Spearcons.

Objective We compared the effectiveness of single-tone earcons versus spearcons in conveying information about two commonly monitored vital signs: oxygen saturation and heart rate. Background The uninformative nature of many medical alarms-and clinicians' lack of response to alarms-is a widespread problem that can compromise patient safety. Auditory displays, such as earcons and spearcons (speech-based earcons), may help clinicians maintain awareness of patients' well-being and reduce their reliance on alarms. Earcons are short abstract sounds whose properties represent different types and levels of information, whereas spearcons are time-compressed spoken phrases that directly state their meaning. Listeners might identify patient vital signs more accurately with spearcons than with earcons. Method In Experiment 1 we compared how accurately 40 nonclinician participants using either (a) single-tone earcons differentiated by timbre and tremolo or (b) Cantonese spearcons recorded using a female Cantonese voice could identify both oxygen saturation and heart rate levels. In Experiment 2 we tested the identification performance of six further nonclinician participants with spearcons recorded using a male Cantonese voice. Results In Experiment 1, participants using spearcons identified both vital signs together more accurately than did participants using earcons. Participants using Cantonese spearcons also learned faster, completed trials faster, identified individual vital signs more accurately, and felt greater ease and more confident when identifying oxygen saturation levels. Experiment 2 verified the previous findings with male-voice Cantonese spearcons. Conclusion Participants identified vital signs more accurately using spearcons than with the single-tone earcons. Application Spearcons may be useful for patient monitoring in situations in which intermittently presented information is desirable.

Using a Sequence of Earcons to Monitor Multiple Simulated Patients.

OBJECTIVE: The aim of this study was to determine whether a sequence of earcons can effectively convey the status of multiple processes, such as the status of multiple patients in a clinical setting. BACKGROUND: Clinicians often monitor multiple patients. An auditory display that intermittently conveys the status of multiple patients may help. METHOD: Nonclinician participants listened to sequences of 500-ms earcons that each represented the heart rate (HR) and oxygen saturation (SpO2) levels of a different simulated patient. In each sequence, one, two, or three patients had an abnormal level of HR and/or SpO2. In Experiment 1, participants reported which of nine patients in a sequence were abnormal. In Experiment 2, participants identified the vital signs of one, two, or three abnormal patients in sequences of one, five, or nine patients, where the interstimulus interval (ISI) between earcons was 150 ms. Experiment 3 used the five-sequence condition of Experiment 2, but the ISI was either 150 ms or 800 ms. RESULTS: Participants reported which patient(s) were abnormal with median 95% accuracy. Identification accuracy for vital signs decreased as the number of abnormal patients increased from one to three, p < .001, but accuracy was unaffected by number of patients in a sequence. Overall, identification accuracy was significantly higher with an ISI of 800 ms (89%) compared with an ISI of 150 ms (83%), p < .001. CONCLUSION: A multiple-patient display can be created by cycling through earcons that represent individual patients. APPLICATION: The principles underlying the multiple-patient display can be extended to other vital signs, designs, and domains.