Modified Clavien-Dindo-Sink Classification System for operative complications in adult spine surgery.

OBJECTIVE: Currently there is no standardized mechanism to describe or compare complications in adult spine surgery. Thus, the purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery. METHODS: The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss' and Cohen's kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively. RESULTS: Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3. CONCLUSIONS: The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.

Grandiose narcissism indirectly associates with lower psychopathology across five countries.

Using five independent non-clinical cross-cultural samples (total N = 3649; overall Mage = 29.31; 31% male and 69% female), this study explored the extent to which Dark Triad traits were indirectly associated with symptoms of psychopathology through mental toughness. Although Machiavellianism and psychopathy have not been studied extensively in this context, previous research (both cross-sectional and longitudinal) reports that grandiose narcissism increases mental toughness contributing indirectly to positive outcomes such as lower anxiety, stress, and depression. Accordingly, this study examined Machiavellianism, psychopathy, and narcissism in the context of mental toughness and psychopathology. A particular focus was placed on investigating negative relationships between grandiose narcissism and psychopathology. Participants completed self-report measures assessing the Dark Triad, mental toughness, and psychopathology. In all samples, grandiose narcissism exerted moderate negative, indirect associations with anxiety, stress, and depression through mental toughness. Relationships between Machiavellianism and psychopathy and psychopathology were generally weak and positive but varied across countries. Findings provided further cross-cultural support for a mediation model in which grandiose narcissism is related to higher mental toughness and lower psychopathology. Outcomes from this study indicate that exploration of the link between grandiose narcissism and resilience traits such as mental toughness can provide important conceptual insights into the adaptive properties of narcissism, and help to explain why grandiose narcissism is associated with a decrease in some psychopathological symptoms.

Risk Factors For Prolonged Opioid Use After Spine Surgery.

STUDY DESIGN: Retrospective review. OBJECTIVE: Our purpose was to evaluate factors associated with increased risk of prolonged post-operative opioid pain medication usage following spine surgery, as well as identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. METHODS: The MarketScan commercial claims and encounters database includes approximately 39 million patients per year. Patients undergoing cervical and lumbar spine surgery between the years 2005-2014 were identified using CPT codes. Pre-operative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications, and diabetes were queried and documented. Patients who utilized opioids from 1-3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed pre- and post-operative narcotic medications up to 1 month prior to surgery. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. RESULTS: 553,509 patients who underwent spine surgery during the 10-year period were identified. 34.9% of patients utilized opioids 1-3 months pre-operatively. 25% patients were still utilizing opioids at 6 weeks, 17.3% at 3 months, 12.7% at 6 months, and 9.0% at 1 year after surgery. Pre-operative opioid exposure was associated with increased likelihood of post-operative use at 6-12 weeks (OR 5.45, 95% CI 5.37-5.53), 3-6 months (OR 6.48, 95% CI 6.37-6.59), 6-12 months (OR 6.97, 95% CI 6.84-7.11), and >12 months (OR 7.12, 95% CI 6.96-7.29). Mental health diagnosis, tobacco usage, diagnosis of chronic pain or CRPS, and non-narcotic neuromodulatory medications yielded increased likelihood of prolonged post-op opioid usage. CONCLUSIONS: Pre-operative narcotic use and several patient comorbidities diagnoses are associated with prolonged post-operative opioid usage following spine surgery. Chronic opioid use, diagnosis of chronic pain, or use of non-narcotic neuromodulatory medications have the highest risk of prolonged post-operative opioid consumption. Patients using opiates pre-operatively did have an increased 30 and 90-day readmission risk, in addition to a number of serious post-operative complications. This data provides spine surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers, and payers with information on complications associated with pre-operative opioid utilization.

The Revised Assessment of Sadistic Personality (ASP-8): Evidence for Validity across Four Countries.

Subclinical sadism, characterized by infliction of cruelty, aggression, or humiliation on another for subjugation or pleasure, provides important information in the prediction of aversive behaviors that have implications for individuals' and society's well-being worldwide. Given sadism's universal relevance, it is imperative that researchers ensure valid and reliable trait measurement not only among English-speaking individuals, but also cross-nationally among countries in which sadism remains relatively understudied. The objective of the current research was to validate the revised version of the Assessment of Sadistic Personality (ASP-8) (Plouffe et al., 2017) across samples of Russian (n = 1087, Mage = 37.36, SD = 10.36), Greek (n = 1195, Mage = 35.64, SDage = 13.08), Serbian (n = 443, Mage = 28.10, SDage = 6.60), and British (n = 511, Mage = 28.50, SDage = 11.62) adults. Overall, results supported the reliability, dimensionality, and scalar/partial scalar measurement invariance of the ASP-8 across cross-national samples. Convergent and discriminant validity were mostly supported through correlations with general personality traits, the Dark Triad, emotional intelligence, mental toughness, depression, anxiety, stress, satisfaction with life, aggression, and attitudes toward social groups. Based on our findings, we recommend the use of the ASP-8 in future investigations of aversive traits.

Opioid Use, Perioperative Risks, and Associated Postoperative Complications in Foot and Ankle Surgery.

INTRODUCTION: Opioid abuse has become a national crisis. Published data demonstrate that patients undergoing foot and ankle surgery are left with excess narcotic medications postoperatively. The purpose of our study was to evaluate factors associated with prolonged postoperative opioid use following foot and ankle surgery and identify associations between preoperative opioid use and postoperative complications. METHODS: MarketScan commercial claims and encounters database was searched to identify foot and ankle patients. Preoperative comorbidities were queried and documented. Patients utilizing opioids 1 to 3 months prior to surgery were identified. Adjusted odds ratios and 95% CIs were calculated using multivariable logistic regression to determine associations between opioid use (preoperatively and postoperatively), readmission, and complications. RESULTS: A total of 112 893 patients were included in the study. Preoperative use had a statistically significant association with postoperative use out to 1 year. Tobacco use, chronic pain, mental health diagnosis, and nonopioid medications had a statistically significant association with postoperative use. Preoperative opioid use had a statistically significant association with readmission and postoperative complications. CONCLUSION: Our study found a number of factors associated with prolonged postoperative opioid use (preoperative use, tobacco use, chronic pain, mental health disorders, and certain nonopioid medications). We identified an association between preoperative opioid use and postoperative complications and readmission. LEVELS OF EVIDENCE: Prognostic Level IV Evidence.

Humor Styles Are Related to Loneliness Across 15 Countries.

The relationships between self-report loneliness and the four humor styles of affiliative, aggressive, self-defeating, and self-enhancing were investigated in 15 countries (N = 4,701). Because loneliness has been suggested to be both commonly experienced and detrimental, we examine if there are similar patterns between humor styles, gender, and age with loneliness in samples of individuals from diverse backgrounds. Across the country samples, affiliative and self-enhancing humor styles negatively correlated with loneliness, self-defeating was positively correlated, and the aggressive humor style was not significantly related. In predicting loneliness, 40.5% of the variance could be accounted. Younger females with lower affiliative, lower self-enhancing, and higher self-defeating humor style scores had higher loneliness scores. The results suggest that although national mean differences may be present, the pattern of relationships between humor styles and loneliness is consistent across these diverse samples, providing some suggestions for mental health promotion among lonely individuals.

Dark triads, tetrads, tents, and cores: Why navigate (research) the jungle of dark personality models without a compass (criterion)?

This comprehensive review summarizes and evaluates the present state of the Dark Triad research literature (or more broadly, the dark personality trait literature), and as such serves both a pedagogical purpose, by providing an introduction or primer on the dark personality literature and a scientific purpose by directing future research on key issues that still have not been sufficiently addressed. In this review, we discuss and critique current operational conceptualizations of what it means for a personality trait to be classified as 'dark'. Also discussed is the Dark Core, as well as quantitative issues such as limitations of commonly used statistical treatments, such as multivariate analyses, bifactor modeling, and composite measures, and proposed solutions to some of these issues. Based on a comprehensive and critical appraisal of the literature, future directions are suggested to drive the dark trait field towards a more organized, parsimonious, and productive future.

Political Hearts of Darkness: The Dark Triad as Predictors of Political Orientations and Interest in Politics.

BACKGROUND: This study investigated the relationships between the Dark Triad of personality (sub-clinical psychopathy, Machiavellianism, and narcissism) and four political variables: socio-religious conservatism, support for greater economic equality, overall liberal-conservative orientation, and interest in politics. A theoretical approach that focused on the influence of the Dark Triad in large groups was provided to interpret those relationships. Methodological issues found in previous research that related to the use of abbreviated scales to measure the dark traits and the use of unidimensional indicators of political orientations were addressed. METHODS: A hierarchical regression analysis was conducted to determine whether any of the three dark traits could explain variance in the aforementioned political attributes over and above that accounted for by the Big Five, sex, age, and nationality, using the full personality scales and measures of political orientation that captured both social and economic liberalism-conservatism. RESULTS: Machiavellianism uniquely predicted lower levels of socio-religious conservatism, and both Machiavellianism and narcissism uniquely predicted lower levels of overall conservatism. CONCLUSIONS: There were important links between the Dark Triad and politics.

Making and maintaining relationships through the prism of the dark triad traits: A longitudinal social network study.

OBJECTIVE: We investigated how Dark Triad traits influence the development and maintenance of social relations. METHOD: Participants completed the Short Dark Triad questionnaire and a measure of social relations at three time points: at the beginning of their first year in high school, 3 months later, and at the end of their first year. We investigated whether the Dark Triad traits are stable over time using Multilevel Modeling (N = 265; 59.6% girls), and how Dark Triad traits predict incoming and outgoing agentic and communal relations using Temporal Exponential Random Graph Models (N = 192; 60.4% girls). RESULTS: Overall, the Dark Triad traits were stable over a one-year period. Narcissism did not predict an increase in communal and agentic relations in the short-term, but predicted slightly less incoming communal and more agentic relations in the long-term. In the short-term, Machiavellianism predicted a small increase while psychopathy predicted a small decrease in the incoming agentic and communal relations. In the long-term, however, neither Machiavellianism nor psychopathy was a significant predictor of any incoming relations. CONCLUSIONS: Our results shed new light on the dynamics of making and maintaining social relations through the prism of the Dark Triad traits.

Preoperative Opioid Use Is Associated With Persistent Use, Readmission and Postoperative Complications After Arthroscopic Knee Surgery.

PURPOSE: To evaluate factors associated with prolonged opioid use after arthroscopic knee surgery and to identify associations between preoperative usage and postoperative complications. METHODS: The MarketScan commercial database was searched to identify patients who underwent arthroscopic knee surgery from 2005 to 2014 (based on Current Procedure Terminology code). Preoperative comorbidities including Diagnostic and Statistical Manual of Mental Disorders mental health disorders, chronic pain, chronic regional pain syndrome, obesity, tobacco use, non-narcotic medications and diabetes were queried and documented. Patients who filled opioid prescriptions 1 to 3 months before surgery were identified. Patients who filled opioid prescriptions after surgery were identified. Adjusted odds ratios and 95% confidence intervals were calculated using multivariable logistic regression analysis to determine factors associated with prolonged postoperative opioid use. RESULTS: In total, 1,012,486 patients who underwent arthroscopic knee surgery were identified, and we determined which of these patients were on preoperative opioids. Preoperative opioid usage was associated with a statistically significant increased risk of usage out to 1 year. There was a statistically significant association between postoperative usage and preoperative variables (mental health diagnosis, smokers, chronic pain, chronic regional pain syndrome, and use of non-narcotic medications). There was a statistically significant association between preoperative opioid use and 90-day readmission and postoperative complications. CONCLUSION: In this study, we found that patients taking opioids 1 to 3 months before arthroscopic knee surgery have increased risk of postoperative use. Additionally, chronic opioid use, chronic pain, or use of non-narcotic medications has the highest risk of postoperative opioid use. Finally, preoperative use was associated with an increased risk of 90-day readmission. EVIDENCE: Prognostic Level IV Evidence.

Predicting donation behaviour with the Supernumerary Personality Inventory.

The present study aimed to broaden the investigation of personality traits and donation behaviour beyond the Five-Factor Model (FFM) framework. A sample of 506 participants completed the Supernumerary Personality Inventory (Paunonen, 2002), reported both their frequency of charitable giving and, given the option to donate potential lottery winnings to a charitable cause, the amount that they would donate. Religiosity was moderately positively correlated with charitable frequency, while integrity was weakly positively correlated with donation amount. Manipulativeness and egotism were weakly negatively correlated with donation amount. Overall, the results show limited evidence for the relevance of Supernumerary Personality Inventory personality traits in prosocial behaviour. Suggestions for future research are discussed.

Participant Perspectives on the Contributions of Physical, Psychological, and Sociological Fidelity to Learning in Interprofessional Mental Health Simulation.

INTRODUCTION: Simulation has been identified as a key training modality to enhance interprofessional care for patients with co-occurring physical and mental illnesses. Fidelity is an important instructional design consideration for interprofessional simulation; however, research examining the contribution of physical, psychological, and sociological fidelity in achieving learning outcomes remains limited. This qualitative study explored the relationship between fidelity and learning from the perspective of interprofessional simulation course participants. METHODS: Semistructured interviews were conducted with participants from the Interprofessional Simulations of Patient Experiences Across the Care Continuum - Child and Youth course. Consistent with grounded theory, data collection and analysis proceeded in an iterative fashion and emergent themes were identified by the research team through a process of constant comparative analysis. RESULTS: Data saturation was reached after 10 interviews. High psychological fidelity allowed participants to engage in the simulation scenarios in ways that were congruent with their professional roles, which supported individual practice change. Tasks that were too closely aligned with their clinical experiences sometimes, however, limited new learning opportunities. Selective manipulations of sociological fidelity seemed to support learning outcomes related to understanding and appreciating the roles and responsibilities of other health professionals. Physical fidelity was less essential. CONCLUSIONS: Psychological and sociological fidelity were perceived by participants as being most critical to learning in interprofessional mental health simulation. Improving our understanding of how simulation works in this context is important to effectively direct the efforts of learners, instructors, and designers toward maximizing the benefit of simulation-based learning in a cost-efficient manner.

Enthusiastic Acts of Evil: The Assessment of Sadistic Personality in Polish and Italian Populations.

Subclinical sadism has received substantial attention in recent research as a trait that predicts a variety of malevolent behaviors. The objective of this study was to assess the 'psychometric robustness and portability' of the Assessment of Sadistic Personality (ASP). We examined the convergent and discriminant validity, and invariance of translated versions of the ASP within community samples of Polish and Italian individuals. The study included 568 individuals (340 women and 228 men) residing in Italy (Mage = 23.57, SDage = 2.55) and 556 individuals (411 women, 144 men, 1 other) residing in Poland (Mage = 23.48, SDage = 4.60). For cultural invariance purposes, data from a Canadian sample comprising 638 students were used. To establish convergent and discriminant validity, participants completed measures of sadism, the Dark Triad, the Big Five, interpersonal reactivity, and maladaptive traits described in the DSM-5. Across both samples, convergent and discriminant validity were supported. Configural and partial metric invariance were satisfied, and following implementation of alignment optimization, latent mean differences were evaluated between countries. Results of the study supported the psychometric qualities of the ASP across different cultures and languages, and the utility of the ASP as a valid measure extending beyond university samples.

Interprofessional simulation training for community mental health teams: Findings from a mixed methods study.

Community mental health teams (CMHTs) in England face mounting service pressures due to an increased focus on out-of-hospital care. Interprofessional working is essential to providing good mental healthcare in community settings. Simulation training is underused in mental health, despite strong support for its improvement of clinical skills, confidence, teamwork, and interprofessional collaboration in other healthcare settings. This study aims to evaluate the impact of simulation training on community mental health professionals. An interprofessional simulation training course on assessment and team working skills for community mental health professionals was developed and delivered at a time of service reorganisation in South London services, including changes to job roles and responsibilities. In total, 57 course participants completed a survey that measured perceptions of knowledge and confidence, as well as a general view of the course. Eight participants took part in further semi-structured interviews 2-3 months after the course to provide perceptions about this experience's subsequent impact. There were statistically significant increases in knowledge and confidence scores with large effect sizes. Thematic analyses of open-text survey and interview data identified emergent themes of interprofessional understanding; attitudes in clinical practice; staff well-being; the value of reflection; opportunity for feedback; and fidelity to clinical practice. Simulation training can improve confidence and knowledge in core skills and team working for CMHTs. Participants reported benefits to key areas of community mental healthcare, such as interprofessional collaboration, reflective practice, and staff well-being. Findings represented individual and team learning, as well as subsequent changes to clinical practice, and were related back to the interactive and reflective nature of the simulation. Implications are highlighted concerning the use of interprofessional simulation training in mental health, particularly relating to staff well-being, attitudes, and interprofessional working.

Lessons Learned: Implementing UK-Developed Interprofessional Simulation Training Courses in a Canadian Setting.

OBJECTIVE: In response to the need for practitioners to improve their skills in integrating mental and physical healthcare, the Centre for Addiction and Mental Health (CAMH) (Canada) invited education specialists from Maudsley Simulation (UK) to pilot two of their existing interprofessional simulation courses on the mental-physical interface in Toronto. Participants' experiences as well as the courses' educational impact were evaluated. METHODS: Participants completed pre-and post-course questionnaires, a 2-week follow-up questionnaire, and individual interviews 6 months after course completion. RESULTS: Participants (n = 23) found the courses to be relevant and applicable to their practice. Over half of the participants interviewed (8/15) reported changing their practice as a result of the course. However, concerns regarding the sociological fidelity of these courses within the Canadian context were noted. CONCLUSION: The findings support the transferability of interprofessional simulation courses developed in other countries. It is important, however, to contextualize course material to fit local healthcare systems and to ensure sociological fidelity where professional roles may vary.

Viewing the Disney Movie Frozen through a Psychodynamic Lens.

The Disney movie Frozen is the fifth highest grossing movie of all time. In order to better understand this phenomenon and to hypothesize as to why the movie resonated so strongly with audiences, we have interpreted the movie using psychodynamic theory. We pay particular attention to the themes of puberty, adolescence and sibling relationships and discuss examples of ego defenses that are employed by the lead character in relation to these concepts.

Interprofessional Simulation Training to Promote Working With Families and Networks in Mental Health Services.

OBJECTIVE: Working with the families and networks of patients with mental illness has significant benefits. There are, however, numerous barriers to this way of working, meaning that it is not universally privileged in mental healthcare services. This study evaluated the impact of an interprofessional simulation (IPS) course on working with families and networks on participants' confidence, attitudes, and perceived future clinical practice. METHODS: A one-day IPS course pairing high-fidelity scenarios with reflective debriefs was developed. Simulated patients were engaged to portray patients and family members. Participants were mental health professionals from a variety of medical, nursing, and allied health professional backgrounds (n = 105). A mixed-methods approach to data collection was adopted, comprising pre- and post-course quantitative data on confidence and attitudes towards working with families and networks, and post-course qualitative data on participant experience and learning. Paired samples t tests and thematic analysis were conducted on the respective data sets. RESULTS: Participants' overall confidence and attitude scores showed statistically significant improvements with large and medium effect sizes, respectively. Thematic analyses identified several perceived improvements in areas related to the following: personal professional development, interprofessional and team working, and patient care and experience. Key pedagogical features of IPS were also highlighted. CONCLUSIONS: These findings support the use of IPS to improve clinicians' capabilities in undertaking systemic work while also supporting its ability to alter clinicians' ways of working in general. The importance of interprofessional and team working for this was also highlighted. Longitudinal evaluation of the training's impact on clinical practice is warranted.