Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

Stereotype threat: Antecedents and consequences for working women

Three studies investigated antecedents and consequences of stereotype threat for female employees. The results of Studies 1 and 2 suggest that social comparisons with men are associated with feelings of stereotype threat whereas social comparisons with women are not. Stereotype threat, in turn, was associated with conflict surrounding women's identity as female employees and with decreased perceived likelihood of achieving career goals. Study 3 extended these findings by demonstrating that feelings of stereotype threat are also negatively related to workplace attitudes and turnover intentions. Furthermore, the effect of stereotype threat on these job attitudes and intentions was itself mediated by identity conflict and perceived likelihood of achieving career goals. Implications and limitations of these findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

The evolution and psychology of self-deception

In this article we argue that self-deception evolved to facilitate interpersonal deception by allowing people to avoid the cues to conscious deception that might reveal deceptive intent. Self-deception has two additional advantages: It eliminates the costly cognitive load that is typically associated with deceiving, and it can minimize retribution if the deception is discovered. Beyond its role in specific acts of deception, self-deceptive self-enhancement also allows people to display more confidence than is warranted, which has a host of social advantages. The question then arises of how the self can be both deceiver and deceived. We propose that this is achieved through dissociations of mental processes, including conscious versus unconscious memories, conscious versus unconscious attitudes, and automatic versus controlled processes. Given the variety of methods for deceiving others, it should come as no surprise that self-deception manifests itself in a number of different psychological processes, and we discuss various types of self-deception. We then discuss the interpersonal versus intrapersonal nature of self-deception before considering the levels of consciousness at which the self can be deceived. Finally, we contrast our evolutionary approach to self-deception with current theories and debates in psychology and consider some of the costs associated with self-deception.     

Behandlungs- und Kunstfehler in der Psychoanalyse

Failures and transgressions in psychoanalyses are nowadays more often published and also ascribed to mistakes made by the therapists. In German professional literature, however, no difference is made between treatment errors due to the special method and serious malpractice. The authors show in case studies transgressions in the psychoanalytic setting und discuss their causes and consequences.     

Social Capital and Individual Happiness in Europe

This paper explores the relationship between social capital and happiness both in Europe as a whole, as well as in its four main geographical macro-regions—North, South, East and West—separately. We test the hypothesis of whether social capital, in its three-fold definition established by Coleman (Am J Sociol 94:S95–S120 1988)—trust, social interaction, and norms and sanctions—influences individual happiness across European countries and regions. The concept of social capital is further enriched by incorporating Putnam (Making democracy work—civic traditions in modern Italy. Princeton University Press, Princeton, 1993) and Olson (The rise and decline of nations—economic growth, stagflation, and social rigidities. Yale University Press, New Haven and London, 1982) type variables on associational activity. Using ordinal logistic regression analysis on data for 48,583 individuals from 25 European countries, we reach three main findings. First, social capital matters for happiness across the three dimensions considered. Second, the main drivers of the effects of social capital on happiness appear to be informal social interaction and general social, as well as institutional trust. And third, there are significant differences in how social capital interacts with happiness across different areas of Europe, with the connection being at is weakest in the Nordic countries.     

The Beneficial Role of Spiritual Counseling in Heart Failure Patients

To ascertain the beneficial role of spiritual counseling in patients with chronic heart failure. This is a pilot study evaluating the effects of adjunct spiritual counseling on quality of life (QoL) outcomes in patients with heart failure. Patients were assigned to “religious” or “non-religious” counseling services based strictly on their personal preferences and subsequently administered standardized QoL questionnaires. A member of the chaplaincy or in-house volunteer organization visited the patient either daily or once every 2 days throughout the duration of their hospitalization. All patients completed questionnaires at baseline, at 2 weeks, and at 3 months. Each of the questionnaires was totaled, with higher scores representing positive response, except for one survey measure where lower scores represent improvement (QIDS-SR16). Twenty-three patients (n = 23, age 57 ± 11, 11 (48 %) male, 12 (52 %) female, mean duration of hospital stay 20 ± 15 days) completed the study. Total mean scores were assessed on admission, at 2 weeks and at 3 months. For all patients in the study, the mean QIDS-SR16 scores were 8.5 (n = 23, SD = 3.3) versus 6.3 (n = 18, SD = 3.5) versus 7.3 (n = 7, SD = 2.6). Mean FACIT-Sp-Ex (version 4) scores were 71.1 (n = 23, SD = 15.1) versus 74.7 (n = 18, SD = 20.9) versus 81.4 (n = 7, SD = 8.8). The mean MSAS scores were 2.0 (n = 21, SD = 0.6) versus 1.8 (n = 15, SD = 0.7) versus 2.5 (n = 4, SD = 0.7). Mean QoL Enjoyment and Satisfaction scores were 47.2 % (n = 23, SD = 15.0 %) versus 53.6 % (n = 18, SD = 16.4 %) versus 72.42 % (n = 7, SD = 22 %). The addition of spiritual counseling to standard medical management for patients with chronic heart failure patients appears to have a positive impact on QoL.     

Efficient Hessian computation using sparse matrix derivatives in RAM notation

This article proposes a new, more efficient method to compute the minus two log likelihood, its gradient, and the Hessian for structural equation models (SEMs) in reticular action model (RAM) notation. The method exploits the beneficial aspect of RAM notation that the matrix derivatives used in RAM are sparse. For an SEM with K variables, P parameters, and P′ entries in the symmetrical or asymmetrical matrix of the RAM notation filled with parameters, the asymptotical run time of the algorithm is O(P?′?K ²?+?P ² K ²?+?K ³). The naive implementation and numerical implementations are both O(P ² K ³), so that for typical applications of SEM, the proposed algorithm is asymptotically K times faster than the best previously known algorithm. A simulation comparison with a numerical algorithm shows that the asymptotical efficiency is transferred to an applied computational advantage that is crucial for the application of maximum likelihood estimation, even in small, but especially in moderate or large, SEMs.     

Reading about explanations enhances perceptions of inevitability and foreseeability: a cross-cultural study with Wikipedia articles

In hindsight, people often perceive events to be more inevitable and foreseeable than in foresight. According to Causal Model Theory (Nestler et al. in J Exp Psychol Learn Mem Cogn 34: 1043–1054, 2008), causal explanations are crucial for such hindsight distortions to occur. The present study provides further empirical support for this notion but extends previous findings in several ways. First, ecologically valid materials were used. Second, the effect of causal information on hindsight distortions was investigated in the realm of previously known events. Third, cross-cultural differences in reasoning (analytic vs. holistic) were taken into account. Specifically, German and Vietnamese participants in our study were presented with Wikipedia articles about the nuclear power plant in Fukushima Daiichi, Japan. They read either the version that existed before the nuclear disaster unfolded (Version 1) or the article that existed 8 weeks after the catastrophe commenced (Version 2). Only the latter contained elaborations on causal antecedents and therefore provided an explanation for the disaster. Reading that version led participants to perceive the nuclear disaster to be more likely inevitable and foreseeable when compared to reading Version 1. Cultural background did not exert a significant effect on these perceptions. Hence, hindsight distortions were obtained for ecologically valid materials even if the event was already known. Implications and directions for future research are discussed.     

Couples' evaluations of fatherhood in different stages of the family life cycle

Fathers' and mothers' views on mothers' satisfaction with paternal behaviour as well as the respective processes of origination were studied in 393 cohabiting couples from three different stages of the family life cycle. Data on paternal competence and the couples' relationship characteristics were included as predictors in multiple regression analyses, and the stages of the family life cycle were taken into account with multigroup regression analyses. Results showed that the mothers were more satisfied with paternal behaviour than the fathers thought the mothers were. Moreover, mothers were satisfied when the fathers were willing to spend time with the child, whereas fathers thought that their partners were satisfied when they were able to establish and maintain a relationship with the child. Couple relationship satisfaction had a consistent impact on fathers' views, whereas it was not relevant to mothers' views unless the oldest child had reached adolescence.     

The Living Fossil of Human Judgment

Although the biases and anomalies characterizing psychometric data should serve as conclusive evidence of systematic flaws in scientific methodology, these problems are usually ignored, which reduces empirical psychology to the closed system of its error theory. However, psychometric scores are ambiguous, and response-shifts and fluctuating validities point to fundamental differences in what the measuring-apparatus questionnaire records and how the measuring-apparatus person judges. Therefore, empirical methods fail when psychology requires evidence-based knowledge about cognitive processes and phenomena. Correcting these flaws requires a reassessment of basic scientific premises and careful consideration of Homo sapiens’ biosemiotic heuristics. Based on comprehensive biopsychosocial, data, the author reconstructs the evolutionary axioms of self-referenced cognitions and reveals what is usually obscured by the axioms of normal science. He substantiates the need for a paradigm shift toward basic bio–cultural principles and an evolutionary understanding of human thinking and behavior.