Background Preoperative anxiety (prevalent in 60-80% in adult patients) describes an unpleasant state of tension resulting from a patient's doubts or fears before surgery, and may play an important...Show moreBackground Preoperative anxiety (prevalent in 60-80% in adult patients) describes an unpleasant state of tension resulting from a patient's doubts or fears before surgery, and may play an important role in one’s anesthetic preference, as anesthesia seemed to be the main cause of preoperative anxiety (62%) rather than the surgery (15%). Preoperative anxiety was associated with increased complications during the preoperative and postoperative period, thus implies the importance of reducing this anxiety while examining anesthetic choice. Aim To examine the role of preoperative anxiety (in the form of fear of needles, fear of pain and fear of losing control) in a patient’s preference in anesthetic choice between general (GA) or spinal anesthesia (SA), after the patient is adequately educated on the risks and benefits of both techniques. Hypotheses included that if the patient has a higher fear of needles, a higher fear of pain, an external health locus of control (HLC) or a high degree of trust in physicians, the patient will prefer GA over SA. Method This prospective exploratory study examined fear of needles, fear of pain and fear of losing control using several questionnaires: Injection Phobia Scale-Short Form (IPS-SF), Fear of Pain Questionnaire-9 (FPQ-9), Multidimensional Health Locus of Control Scale (MHLC) and Amsterdam Preoperative Anxiety and Information Scale (APAIS). Patients of preoperative anesthesiology outpatient clinic (N = 484) of Albert Sweitzer participated and twelve binary logistic regression analyses were executed. Results 68.8% of participants preferred GA over SA. IPS-SF (OR 0.91 (95% CI 0.85-0.96, p<0.001), FPQ-9 (OR 0.94 (95% CI 0.91-0.98), p=0.006), and physician scale of MHLC (OR 0.94 (95% CI 0.90-0.98), p=0.007) reported to be statistically significant associated with anesthesia. Discussion Fear of needles, fear of pain and trust in physicians played a significant role in a patient’s anesthetic preference. Suggestions for future research include reassessment of the used information videos, specify study inclusion to those who could choose their anesthetic and inclusion of detailed information of a patient’s previous anesthetic experience. This study also highlighted the importance of health care professionals and their efforts to reassure the patient in minimizing preoperative anxiety on an educational level and implementing interventions specifically aimed at fear of needles and fear of pain.Show less
Introduction: Parkinson’s Disease (PD) is a neurodegenerative, progressive motor disorder. Receiving this diagnosis can be impactful for patients. PD patients have reported dissatisfaction with the...Show moreIntroduction: Parkinson’s Disease (PD) is a neurodegenerative, progressive motor disorder. Receiving this diagnosis can be impactful for patients. PD patients have reported dissatisfaction with the diagnostic process, which may partly result from a perceived lack of active involvement during medical decision-making. Neurologists are expected to inform and involve patients based on the ethical imperative of patient autonomy. Yet, insight into how medical decisions are actually made is scarce, particularly which types of medical decisions, the extent of patient involvement, and how this affects their satisfaction. This study aimed to get more insight into medical decision-making by observing PD diagnostic consultations in current clinical practice. Hypotheses: Firstly, it was expected that medical decisions were related to topics such as follow-up appointments and PD medication (H1). Secondly, it was expected that the level of patient involvement was low during PD diagnostic consultations (H2). Thirdly, it was hypothesized that patient involvement and overall satisfaction were positively associated (H3). Fourthly, it was hypothesized that female, younger, and more highly educated patients were more substantially involved compared to male, older, and more lowly educated patients (H4, H5 & H6). Methods: This prospective longitudinal study used both quantitative (i.e., questionnaires, structured observational coding) and qualitative (i.e., explorative observational coding) data. PD patients (N=12) visiting neurology outpatient departments in the Netherlands were included upon referral. Diagnostic consultations were video-recorded and patients filled in questionnaires. Types of medical decisions were identified using an adapted existing coding scheme. The observed level of involvement was scored using the OPTION-12 for the most frequently and crucial occurring medical decision. Patients’ overall satisfaction with their consultations was measured six weeks after their last consultation. Statistical analyses included non-parametric tests and multiple regressions. Results: Topics of medical decisions most frequently concerned: follow-up appointments, PD medication and diagnostic testing. Patient involvement was low (M = 9.8; 0-100), indicating that neurologists exhibited few attempts to involve patients during medical decisions about PD medication. Patient involvement was not predictive for patients’ overall satisfaction (p = .23), nor did patients’ demographic characteristics predict the level of patient involvement (p = .29). Conclusion: Medical decisions during PD diagnostic consultations mainly pertained to follow-up appointments, diagnostic testing, and PD medication. PD patients are rarely involved in decisions about PD medication. These results should be interpreted with caution due to a small sample. We recommend repeating this study with a larger sample and investigating what neurologists think is necessary and feasible in terms of patient involvement for the various identified types of medical decisions.Show less
Research on the neural processing of reward and punishment thus far has indicated the complex and constant role it plays in decision making and behaviour. Current findings suggest that an action...Show moreResearch on the neural processing of reward and punishment thus far has indicated the complex and constant role it plays in decision making and behaviour. Current findings suggest that an action can be incentivised by the desire to avoid punishment as well to gain reward. A means of gauging how effective a financial incentive is to motivate behaviour is via the neural response it elicits using EEG data. This study uses the Monetary Incentive Delay task (MIDt) to examine financial incentive-driven behavior. Due to loss aversion, we expected a greater neural response (feedback related negatively; FRN), in punishing conditions where money is lost compared to reward or control where it is not. We investigate how reward and punishment sensitivity of the participant could moderate this relationship between FRN and the type of incentive, assuming that higher punishment sensitivity will predict an increased FRN amplitude generated in the punishment compared to reward conditions. This thesis is a preliminary analysis, involving university students with no substance abuse or problematic gambling histories (N = 21) that complete the MIDt while EEG was being recorded. The short Sensitivity to Punishment and Sensitivity to Reward Questionnaire was administered pre-experiment and all money earned during the MIDt was awarded to the participants upon completion. Data was analyzed using repeated measures ANOVA, with contrasts as follows: control vs gain; control vs loss; gain vs loss. A moderation analysis was run of punishment/reward sensitivity (SP/SR) on gain versus loss with FRN amplitude as outcome using PROCESS in SPSS. Data is still being obtained at this point in time to achieve necessary power for this study. This is potentially why our preliminary results were non-significant for our hypotheses. However, the trends shown in the FRN absolute values indicate a greater neural response in punishment conditions where money is lost compared to either the reward or neutral counterparts. Additional analysis is required to fully ascertain how punishment and reward sensitivity impact the neural correlates of financial incentives and how this finding can be applied when using such incentives practically.Show less
Recent research proposes that psychological factors might influence individuals’ pain experiences via descending endogenous pain modulation. This can be studied using the experimental paradigm of...Show moreRecent research proposes that psychological factors might influence individuals’ pain experiences via descending endogenous pain modulation. This can be studied using the experimental paradigm of conditioned pain modulation (CPM). Two types of psychological variables suggested to influence individuals’ pain experience are self-efficacy beliefs and dispositional optimism. It is further proposed that self-efficacy might predict dispositional optimism. The present study aims to investigate whether self-efficacy and dispositional optimism affect individuals’ CPM response. The primary research question asks whether the influence of self-efficacy on CPM is mediated by dispositional optimism. This is investigated by three hypotheses: First, self-efficacy affects CPM; second, dispositional optimism affects CPM; third, dispositional optimism mediates the effect of self-efficacy on CPM. The provisional research question asks whether verbal suggestions are effective in changing self-efficacy beliefs and is tested with a hypothesis stating that verbally manipulation self-efficacy is successful. Participants (N = 17) are university students or adults, randomly grouped into a high versus low self-efficacy condition in which they are accordingly manipulated. The Life Orientation Test-Revised (LOT-R) is administered to measure dispositional optimism. The CPM paradigm is executed using an algometer and the cold-pressor test as stimuli. The primary hypotheses are analysed using linear regression and the PROCESS macro procedure. The results were not statistically significant at p ≤ .05 and, followingly, neither of the hypotheses could be confirmed. However, secondary findings might potentially point towards an effect of self-efficacy on CPM (β = .17) and dispositional optimism on CPM (β = .15). The provisional hypothesis, tested using a one-way ANOVA, revealed non-significant results at p ≤ .05. Thus, the manipulation of self-efficacy was not successful. The present research represents one of the first studies investigating the role of self-efficacy and dispositional optimism in CPM. The current findings suggest that future research into this field is highly needed. This would help to uncover the impact of self-efficacy and dispositional optimism on CPM or to show that a different approach including other psychological variables is more suitable. Investigating the field of CPM further could help to improve pain treatments and prevent the development of persistent pain conditions.Show less
Patients with type 2 diabetes mellitus need to pay attention to healthy food because this could help to control blood glucose levels. With more insight into approach tendencies towards healthy and...Show morePatients with type 2 diabetes mellitus need to pay attention to healthy food because this could help to control blood glucose levels. With more insight into approach tendencies towards healthy and unhealthy food, it could be determined who is more or less sensitive to healthy or unhealthy food stimuli. Primarily, approach tendencies towards healthy and unhealthy food in patients with type 2 diabetes and healthy controls will be researched. It is hypothesized that the patient group has a higher approach bias towards unhealthy food compared to the healthy control group. Secondary, the effect of intranasal insulin on approach tendencies will be researched. It is hypothesized that insulin will affect approach tendencies towards food more in the patient group than in the healthy control group. Approach tendencies were measured with the mobile version of the Approach-Avoidance Task (AAT). During the acquisition day, half of the participants received an insulin spray and half of the participants received a placebo spray. During the evocation day, all participants received the placebo spray. Differences between days indicate the effect of intranasal insulin. In total, 26 participants were included (20 type 2 diabetes patients and 6 healthy volunteers). There was a significant interaction effect between group and food F(1,21) = 8.199, p = 0.009, which means that the groups differed in their responses towards healthy and unhealthy food stimuli. The patient group had a nonsignificant higher approach bias towards unhealthy food and the healthy control group had a higher approach bias towards healthy food. There was no interaction effect between food, group, and day, which means that there was not found an effect of intranasal insulin. Further studies with bigger group sizes and a more heterogeneous group, through a better age and gender distribution, in a study specifically focused on the differences in approach tendencies towards healthy and unhealthy food between (intranasal) insulin and placebo are required. More insight could lead to better treatment with diet and psychological interventions where patients learn how to cope with a balance between healthy and unhealthy food distractions.Show less
Adherence to lifestyle changes like a healthy diet in type 2 diabetes patients is low and can result in a low Quality of Life. Previous research has shown that intranasal insulin, as a new form of...Show moreAdherence to lifestyle changes like a healthy diet in type 2 diabetes patients is low and can result in a low Quality of Life. Previous research has shown that intranasal insulin, as a new form of treatment, can have a side-effect of potentially decreasing hunger in food consumption in healthy men, but not in healthy women. The effect of intranasal insulin, and possible gender-specific responses, has not been investigated in diabetes type 2 patients yet. This is important as it might result in a decreased disease burden, risk of complications through increased treatment adherence to lifestyle changes. Research questions were: 1) Is the effect of intranasal insulin on food consumption different for women and men? and 2) Is the possible gender-effect of intranasal insulin on food consumption also found in diabetes type 2 patients and healthy subjects? It was hypothesized that men would eat less than women as a response to intranasal insulin in both the healthy participants as well as the type 2 diabetes patients. The study had a double-blind, randomized, placebo-controlled design. The 26 participants came to the lab on two consecutive days. On day one, half of them were given the intranasal insulin spray and half were given a placebo spray. On day two, all were administered the placebo spray. Afterwards, participants were presented with bowls of healthy snacks on both days. A 2x2x2 repeated-measures ANOVA was conducted to analyse possible gender effects. 1) there was no main effect of gender (p= .302), nor significant difference in food consumption (p= .213). The interaction was non-significant (p= .552). 2) there was no main effect of gender (p = .645), no main effect of group (p = .982), and no significant difference in food consumption (p = .400). The interaction was non-significant (p = .693). No gender-effects in food consumption as a response to intranasal insulin could be found. Putting the study on hold due to the COVID-19 pandemic, resulted in unknown group membership and a small sample size. Future research may add a questionnaire measuring self-efficacy and intention to investigate behavioural tendencies on (un)healthy food consumption as they could moderate the effect of intranasal insulin.Show less
Prior research has demonstrated a strong positive relationship between self-efficacy beliefs and pain tolerance. However, the pathways through which self-efficacy beliefs may be manipulated and...Show morePrior research has demonstrated a strong positive relationship between self-efficacy beliefs and pain tolerance. However, the pathways through which self-efficacy beliefs may be manipulated and affect pain tolerance are not clear. The current study aims to examine the effect that self-efficacy beliefs have on pain tolerance ratings, as assessed by a cold-pressor test (CPT). Secondly, whether self-efficacy can be altered through verbal suggestions is examined. Healthy participants (N = 17) were randomly assigned into a low self-efficacy group (Low-SE group) and a high self-efficacy (High-SE group) and participated in a CPT, after self-efficacy manipulation. Differences on pain tolerance and the manipulation check question, across the groups were examined with Analysis of Variance (ANOVA). Baseline measurements of self-efficacy were administered and analysed with ANOVA. Although participants in the High-SE group showed higher pain tolerance ratings (M = 43.23, SD = 19.09) compared to those in the Low-SE group (M = 41.58, SD = 23.36), the difference between the groups was not significant, p = .883. Participants in the High-SE group (M = 5.24, SD = 1.89) had a lower score on the manipulation check question, compared to those in the Low-SE group (M = 5.62, SD = 1.71). However, the difference was not statistically significant, p = .666. No statistically significant baseline differences have been found between the groups. Further research is needed, to determine the mechanisms through which perceived control and affective responses on pain experience may intermediate the relationship between self-efficacy and pain tolerance, while contributing to self-efficacy manipulation.Show less
