Appraisal Bias Research Articles

A Commentary on Miron et al. (2024): Power Maintenance via Illusory Justice Begets Biased Appraisals as Systemic Practice

Miron et al. (2024) provide a compelling framework for understanding how dominant group members have the power to strategically manipulate evidentiary standards to sustain systemic inequities, particularly in gendered workplace contexts. Our commentary extends their argument by illustrating how these standards not only inhibit justice, but actively create cascading injustices. Herein, we argue that excessive resource demands imposed by high evidentiary thresholds disproportionately burden disadvantaged groups, effectively reducing their available resources and thus threatening their ability to meet performance standards, ultimately reinforcing and exacerbating organizational inequities. This compounded impact ensures that inequality remains self-perpetuating and largely unchallenged. We likewise identify covert discrimination and structural biases as contemporary manifestations of inequality, highlighting how systems ostensibly designed to address injustice often serve to sustain and even amplify it. We propose actionable strategies to combat these inequities. Specifically, we advocate for a multifaceted approach that fosters genuine male allyship, disallows reductive arguments about gender inequalities, reevaluates the distribution of efforts to combat gender inequality, and considers employment-related strategies (e.g., revisiting norms for performance evaluations, recruitment, hiring) to level the playing field at a systemic level. In doing so, we propose specific pathways to begin dismantling systemic barriers and creating organizational cultures that promote justice, reinforcing the nascent call for systemic change while offering new insights into actionable solutions.

Who will Judge the Judges? An Appraisal of Bias in the Delivery of Justice

Who will Judge the Judges? An Appraisal of Bias in the Delivery of Justice

Exposure to Drinking Water Trihalomethanes and Risk of Cancer: A Systematic Review of the Epidemiologic Evidence and Dose-Response Meta-Analysis.

Chlorination is a widespread method for drinking water disinfection that has the drawback of introducing potentially carcinogenic chemical by-products to drinking water. We systematically evaluated the epidemiologic evidence of exposure to trihalomethane (THM) disinfection by-products and risk of cancer. We conducted a systematic review and meta-analysis of epidemiologic studies that assessed the association of exposure to residential concentrations of THMs with risk of cancer in adults. A protocol was preregistered in PROSPERO (CRD42023435491). PubMed, Embase, Web of Science, and Cochrane were searched for publications up to April 2024. Study selection and risk of bias appraisal using the National Toxicology Program Office of Health Assessment and Translation (NTP OHAT) tool was done in duplicate. Summary risk estimates were assessed using random effects meta-analysis and one-stage dose-response meta-analysis. The literature search resulted in 2,022 records, of which 29 publications assessing 14 different cancers were eligible for inclusion. Summary relative risks (RRs) were estimated for bladder cancer and colorectal cancer based on 5,860 and 9,262 cases and 84,371 and 90,272 participants, respectively. The summary RR of bladder cancer for the highest exposed compared with the lowest was 1.33 (95% CI: 1.04, 1.71), and in the dose-response analysis, RRs were statistically significant above THM concentrations of . For colorectal cancer, the summary RR was 1.15 (95% CI: 1.07, 1.24). According to the World Cancer Research Fund criteria, we found limited-suggestive evidence that THM in drinking water increases the risk of bladder and colorectal cancer at levels below current regulatory limits in the US and EU, indicating that these fail to protect against cancer in the general population. https://doi.org/10.1289/EHP14505.

Surgical management of complicated diverticulitis: systematic review and individual patient data network meta-analysis : An EAES/ESCP collaborative project.

We performed a systematic review and network meta-analysis (NMA) of individualized patient data (IPD) to inform the development of evidence-informed clinical practice recommendations. We searched MEDLINE, Embase, and Cochrane Central in October 2023 to identify RCTs comparing Hartmann's resection (HR), primary resection and anastomosis (PRA), or laparoscopic peritoneal lavage (LPL) among patients with class Ib-IV Hinchey diverticulitis. Outcomes of interest were prioritized by an international, multidisciplinary panel including two patient partners. Article screening, data extraction for IPD, and risk of bias appraisal were performed by two reviewers. We used a random-effects NMA to synthesize direct and indirect evidence. Heterogeneity was evaluated using the I2 statistic. The panel appraised the certainty of the evidence using GRADE and CINeMA. Fourteen reports of seven RCTs were derived from 4,659 articles. IPD data were available for 595/678 patients (88.8%) across trials. Patients had a mean age ± SD of 64.61 ± 13.64years and a mean BMI ± SD of 26.12 ± 5.20kg/m2, representing Hinchey classes I (1.2%), II (1.0%) III (76.3%), and IV (12.1%), respectively. Using minimal important difference thresholds, in-hospital/30-day mortality was higher among patients receiving LPL versus HR [42 more per 1000, 95% CI (41 fewer to 331 more), moderate effect; low certainty] as well as PRA [45 more per 1000 patients, 95% CI (33 fewer to 340 more) moderate effect; low certainty] without heterogeneity (I2 = 0%). Among 417 patients from four trials, there was a lower stoma rate among patients receiving PRA versus LPL [539 fewer per 1000, 95% CI (647 fewer to 306 fewer), large effect; low certainty]. PRA likely confers a lower stoma rate at 1year compared to HR, while there may be no difference in 30-day/in-hospital mortality. LPL likely confers a higher in-hospital/30-day mortality rate compared to HR and PRA.

White Coats at a Crossroads: Hygiene, Infection Risk, and Patient Trust in Healthcare Attire—An Umbrella Review with Quantitative Synthesis and Stress, Weaknesses, Opportunities, and Threats Analysis

White coats, traditionally symbols of physicians’ hygiene and professionalism, are now scrutinized for potential infection risks during patient interactions. This review investigates whether wearing white coats is linked to microbial contamination, infection transmission, and patient expectations. An umbrella review of peer-reviewed studies and guidelines was conducted, with searches in PubMed/Medline and Scopus using terms related to medical attire, infection control, patient perceptions, and discrimination. Ten records were included, and a bibliometric analysis was performed with VOS Viewer. Bias appraisal was conducted using the JBI Bias Assessment Toolset, and a SWOT analysis was developed to support evidence-based decision-making. Findings indicate that white coats may harbor pathogens such as Staphylococcus aureus, Gram-positive cocci, Gram-negative rods, and MRSA. To mitigate contamination risks, it is recommended that physicians roll up coat sleeves during examinations and that the coats receive daily laundering in healthcare settings. However, evidence supporting a coatless policy is yet to be published. Patients tend to expect physicians to wear identifiable attire, like white coats or scrubs for surgeons. Recent research in this field shifts the focus from infection control to the impact of attire on patient trust and physician–patient relationships.

The blind HR: Why do people leave managers not companies? A case of inconsistency in performance appraisal and performance outcome

Learning outcomes The learning outcomes are as follows: to benchmark and compare the theoretical models of the performance management and appraisal processes. (Questions 1 and 2) Remembering-in Bloom’s Taxonomy; to understand the importance of practicing fair performance appraisal process. (Question 4) Understanding-in Bloom’s Taxonomy; to analyze the implementation and effectiveness of 180-degree performance appraisal method and rating system prevalent in the IT Sector. (Question 1) Applying and Analyzing-in Bloom’s Taxonomy; to assess the impact of perceptual biases on human behavior and performance (Questions 2 and 3) Evaluating-in Bloom’s Taxonomy. Case overview/synopsis The case study entitled “Is HR Blind? Why do People Leave Managers Not Companies? A Case of Unfair Performance Appraisal and Biases” is a classic example of a flawed and biased performance appraisal process and perceptual biasness, which resulted in the loss of a valuable and talented resource in a leading Indian IT MNC. The present case had been based upon the real-life experience of an employee (i.e. Rahul Verma), who worked with the company from year 2010 to 2021. It was among the top ten IT MNCs employing about 0.1 million people. The objective of the case was to highlight real time issues existing with HR practices, mainly in IT sector organizations. For example, in the present case, do the HR seek proper justification from the manager before taking a harsh decision like forcibly asking an employee to sign a termination contract without looking at the contributions of his qualitative performance or even performance rating (refer to the transcript) for that matter? Was the job of the HR to only ensure how to fit in employees in the faulty bell curve system? Whether the performance appraisal system being followed at the company is adequately capable of identifying and recognizing the talent. Do the different functions really work cohesively and organically toward achieving the intended goals and objectives of the organization? Was this a failure of the manager in recognizing talent or something went wrong at the employee’s part? Was this a failure of the entire HR system or performance management process at the organization that was unable to filter out the capable and skilled resources out of the crowd? Was this a problem of organizational culture that put on stake its most critical resource – the human capital – by allowing the appraisers to evaluate them just because of the hierarchical structure, and not because they are not being competent enough to perform this most critical job objectively? Who ensures the appraiser is free from any kind of prejudice or bias and is capable of fairly assessing the talent resource? So, the present case was a deliberate attempt to throw out these burning questions to the practitioners and students to ponder upon. Does HR really follow the blind process merely acting on the feedback received from the different units of the organization? With the help of strong theoretical foundation and practical applications, the following objectives and questions have been framed to deliberate and propose the workable solutions for the benefits of the relevant stakeholders. Complexity academic level HR practitioners, HR managers, supervisors, senior management and HR students, IT heads, project managers. Supplementary material Teaching notes are available for educators only. Subject code CSS 6: Human Resource Management.

Is there a link between neurodiversity and stalking? a systematic review

Purpose The increasing conviction rates of stalking in the UK have prompted efforts to identify factors that may influence individuals to engage in such behaviour. Over two million people in England and Wales experience stalking every year, with estimated reoffending rates for stalking being between 25 and 55% (ONS, 2022; McEwan et al., 2017). Research has identified risk factors that may contribute towards stalking behaviours, which has included obsessive relational pursuit and online impulsivity (Post et al., 2014a; Rocheleau, 2019). This has resulted in researchers postulating a link between facets of neurodiversity and stalking behaviour (Freckelton, 2013). The purpose of this study was to examine the evidence base for any link between neurodiversity and stalking. Design/methodology/approach The Systematic Review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers were screened for quality appraisal and risk of bias. The initial search yielded 3,880 articles. A total of 10 papers were deemed as meeting the inclusion criteria. Findings There is insufficient research quality regarding neurodiversity and stalking perpetration due to poor diagnostic reliability of neurodiversity and a lack of reliable tools being used in the research which do not meet the definitions of stalking. As such, the existing research about neurodiversity and stalking perpetration is inconclusive and predominantly unreliable. Tentative evidence indicated that people with neurodiversity were at greater risk of being victims of stalking and that for the minority of people with neurodiversity who engage in stalking the factors that contribute towards this mirror those of neurotypical individuals. Practical implications Overall, the factors contributing to stalking highlighted by the included studies, such as difficulties with communication, empathy, insight into social functioning, interpersonal competence and ways of forming relationships with others, seem to map onto the deficits of neurotypical stalking perpetrators (Canter and Youngs, 2012; Lewis et al., 2001; Mullen et al., 2006). However, tools that contextualise neurodiversity in the context of risk assessments for stalking may be helpful (Al-Attar, 2019, 2021). Originality/value Recommendations for further research are made to gain a robust understanding of any potential relationship between neurodiversity and stalking and in particular a risk of stalking victimisation.

Trial-Adjusted Versus Generic Simulated Comparator Trial (SCT) Settings for Selection Bias Appraisal Using the I2 Test.

The aim was to test two null hypotheses: that I2testing with trial-adjusted simulated comparator trial (SCT) settings does not change the odds of identifying selection bias in clinical trials compared to I2 testing with generic SCT settings, and that I2 testing with trial-adjusted SCT settings does not change the odds of identifying selection bias in smaller trials (with sample size (n) = 100-199 per treatment group) compared to larger trials (n> 200 per group). Baseline data from 67 randomized controlled trials previously tested for selection bias using the I2 test with generic SCT settings were extracted. The generic settings were: SCT sample size NSCT = 200 (100 for each of Groups A and B), minimum-maximum range of random values (RSCT) = 67 (minimum = 18, maximum = 85), number of generated SCTs used in all meta-analyses (SCTN) = 2. The trials were re-tested with trial-adjusted SCT settings. Additionally, the SCT sample sizes were further increased stepwise to NSCT = 400, 800, and 1200, and the resulting I2 point estimates were recorded. Positive test results (I2 > 0%) were assigned a score of 1, while negative test results (I2 = 0%) were assigned a score of 0. From the resulting 0 and 1 scores of both types of SCT settings, odds ratios (ORs) with 95% confidence intervals (CIs) and p-values were computed. The alpha level was set at 5%. The original I2 testing with generic SCT settings yielded four positive and 63 negative results. In contrast, testing with trial-adjusted SCT settings of the same trials revealed 13 positive and 54 negative results (OR: 3.79; 95% CI: 1.17 - 12.32; p = 0.03). When the SCT sample size was increased with trial-adjusted SCT settings, the number of positive results rose from 13 to 16 (OR: 1.30; 95% CI: 0.57 - 2.98; p = 0.53). Consequently, only the first null hypothesis was rejected. I2testing with trial-adjusted SCT settings increased the odds of identifying selection bias in clinical trials and did not significantly alter the odds in smaller trials with fewerthan 200 patients per intervention group.

A Systematic Review Exploring Empirical Pharmacogenomics Research Within Global Indigenous Populations.

This systematic review aims to highlight the scope of pharmacogenomics research within global Indigenous populations. This review also explores the barriers and facilitators of pharmacogenomics research within this population. A systematic review of literature was conducted to identify and present an understanding of current empirical evidence demonstrating the conduct of genomics or pharmacogenomics research within global Indigenous populations (PROSPERO registration: CRD42021257226). Using key search terms, relevant databases were searched for articles published between January 2010 and July 2022. Screening, data extraction, and analysis was conducted using well-defined inclusion criteria. Quality assessment and risk of bias appraisal was conducted using the mixed methods appraisal tool. Indigenous community engagement and participation in genomics research was assessed using the social-ecological framework. From the 427 articles identified, 77 articles met inclusion criteria and underwent full-text screening. Of these, 30 articles were included in the final review, with 16 being quantitative and 14 either qualitative or mixed methods studies. Most studies were conducted with native Indigenous populations from the United States of America (36%). Content analysis revealed that studies either explored genetic variations associated with disease in Indigenous populations (23%) or markers for drug metabolism (30%) or were designed to understand perspectives of genomics research within this population (47%). Perspectives included the exploration of the role of participants in research, benefits or outcomes achieved from participation in genomics research, and levels of Indigenous engagement and participation in genomics research. This review highlights a growing gap in Indigenous genomics research globally. It presents several important considerations from Indigenous participants, identifying how researchers can co-create culturally safe and inclusive design, implementation, analysis, and subsequent outcomes of genomics research involving Indigenous people. Indigenous governance, self-determination and leadership is essential, with researchers required to be responsive to such fundamental partnerships for research to progress.

Interplay among attention, appraisal, and memory bias in provisional posttraumatic stress disorder: Exploring the combined cognitive biases hypothesis.

Both theoretical and empirical studies suggest that negative cognitive biases significantly influence the onset and persistence of posttraumatic stress disorder (PTSD) symptoms. However, the interplay among these cognitive biases and their conjoint contribution to the long-term trajectory of posttraumatic stress symptoms remains underexplored. This study delves into the interplay among attention, appraisal, and memory biases within a provisional PTSD population and evaluates the predictive effects of two integrative models (weakest link, additive approach) on posttraumatic stress symptoms reported 2 months later. Sixty Chinese participants (Mage = 20.17, SDage = 2.11) with provisional PTSD undertook the scrambled sentences test (appraisal bias) with their eye movements recorded (attention bias) and then the free recall task (memory bias). Posttraumatic stress symptom was assessed at baseline and 2-month follow-up. Selective attention bias toward negative words was positively associated with the negative appraisal of scrambled sentences, which subsequently showed a strong association with negative memory bias. Regarding the progression of posttraumatic stress symptoms, the additive approach was found to be a more reliable predictor of self-reported posttraumatic stress symptoms at 2 months than the weak link approach. This study provides initial evidence supporting the combined cognitive biases hypothesis in provisional PTSD. It also underscores potential avenues to enhance cognitive bias modification techniques. Replication of these findings in broader clinical samples is essential. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attribute misreporting and appraisal bias

Abstract We assemble a property-level panel of appraiser-reported attributes associated with 4.6 million loan applications from 2013 to 2017 to test whether attributes were consistently reported. Appraisers have an incentive to misreport property attributes to justify higher appraised values to ensure that associated mortgage loans are approved. We focus on property transactions with multiple sets of attributes reported by the same appraiser within four quarters and find evidence consistent with an intent to inflate valuations through attribute misreporting. We find that strategic misreporting of attributes is prevalent across markets, and that highly leveraged borrowers whose appraisals had inconsistently reported attributes were 9.8 percent more likely to become seriously delinquent in their loan payments.

A Systematic Review of Structured Exercises and Music Therapy on the Functional Status of Stroke Survivors

Background: Stroke, a leading cause of disability worldwide, often leaves survivors grappling with functional impairments that significantly impact their daily lives. Enhancing the functional status of stroke survivors is not only a personal achievement but also a critical public health concern. Aim: A systematic review of literature was conducted to identify the various forms of structured exercises and music therapy used in enhancing the functional status of stroke survivors, and the various outcome measures used in measuring the functional status of the stroke survivors. Design: A systematic review Data Sources: A systematic literature search was performed for publications using PubMed, Scopus, Google Scholar, Embase, CINAHL, ISI, and ScienceDirect Databases. Eligibility Criteria: The review included published studies which reported use of structured exercises and Music therapy in enhancing the functional status of stroke survivors aged 18 years and above, and published in English between June 2012 and June 2022. Data Extraction: The titles and abstracts of articles were screened and studies that did not meet the eligibility criteria were excluded. Full texts of eligible studies were further scrutinized. The results were interpreted and reported with respect to their level of evidence, design, sample size, duration, quality appraisal and risk of bias. Result: A total of 2,427 studies were identified through initial search of the databases. Additional 8 records were identified through other sources making it a total of 2,435 records. 2,350 duplicate studies were removed after screening. The remaining 85 full-text articles were screened for eligibility criteria and further reduced to 26. Of these 26 studies, 17 were Randomized Controlled Trials (RCTs), 7 quasi-experimental studies, 1 case series, and 1 case study. Hand function exercise (23.0%) was the most used form of structured exercise while music-supported therapy (29.1%) was the most used music therapy intervention. Motor function (41.6%) was the most investigated construct of functional status. The most used outcome measures were Box and Blocks Test (BBT) (10.4%) and 9 Hole Pegboard Test (9HPT) (10.4%) which were used for measuring motor function of the stroke survivors. Conclusion: Various forms of structured exercises and music therapy were found to improve the functional status of stroke survivors. Also, various outcome measures for measuring the functional status of the stroke survivors were reported as well. Clinicians and researchers should choose the appropriate outcome measures for the right constructs in the course of their practice and research programmes.

Critical appraisal and assessment of bias among studies evaluating risk prediction models for in-hospital and 30-day mortality after percutaneous coronary intervention: a systematic review

ObjectiveWe systematically assessed prediction models for the risk of in-hospital and 30-day mortality in post-percutaneous coronary intervention (PCI) patients.DesignSystematic review and narrative synthesis.Data sourcesSearched PubMed, Web of Science, Embase, Cochrane...

Do nothing, do minimum or do something? Why public project appraisals “always” recommend large projects

PurposeIn the project initiation phase, an appraisal is needed to clarify the strategic problem and alternative solutions. Full-scale construction projects and simple solutions (do-minimum alternatives) should be assessed. The do-nothing alternative is the baseline for the appraisal and an option in itself. The paper explores the role of do-nothing and do-minimum alternatives in public project appraisal, which may significantly impact the attractiveness of a construction project.Design/methodology/approachThe paper presents an empirical study from Norway, which requires external quality assurance (QA) of early project appraisals. The data include an extensive document review of 112 projects and interviews with 41 experts involved in the appraisal processes.FindingsOf 112 appraisals, 110 recommended a major construction project, including cases where the benefits and value were low or uncertain. The do-nothing alternative was generally included as a reference but not treated as a viable option. Do-minimum alternatives were often not explored. By contrast, the external QA reports recommended do-nothing or do-minimum in 28 cases. Interestingly, although political decision-makers rarely reject projects, they may put them on hold indefinitely, implying that the actual outcome in many cases is still do-nothing.Originality/valueThe paper addresses a topic that has been understudied in the literature. The findings contribute to the broader literature on project initiation processes, project appraisal and how to reduce the risk of bias and manipulation in appraisals.

Effect of family-centered care interventions on well-being of caregivers of children with cerebral palsy: a systematic review.

Caring for a child with long-term functional limitations can have a negative impact on the physical and psychological well-being of the caregiver. Family-centered care (FCC) interventions have the potential to empower caregivers and contribute to their well-being. This systematic review aimed to synthesize existing evidence on the effectiveness of FCC interventions in improving the well-being of caregivers of children with cerebral palsy (CP), and identify the key components of such interventions that are most commonly practiced and deemed effective. This review systematically searched seven databases for randomized controlled trials that evaluated the effectiveness of any FCC intervention on the well-being of caregivers of children with or at risk of CP. We used the Cochrane RoB 2.0 tool to assess risk of bias and Critical Appraisal Skills Programme (CASP) checklist for critical appraisal. Due to high heterogeneity of studies, narrative synthesis was used to summarize the data. The review consists of 11 studies which were categorized into five sections based on the components of FCC intervention provided in each individual study: 1. Information provision, and Enabling and partnership (n= 5); 2. Information provision, and Respectful and supportive care (n= 1); 3. Enabling and partnership (n= 2); 4. Enabling and partnership, and Respectful and supportive care (n= 2); 5. Information provision, Enabling and partnership and Respectful and supportive care (n= 1). Risk of bias was low in four studies, unclear in two studies, and high in five studies. FCC interventions were found to be effective in improving caregivers' satisfaction with attainment of child and caregiver goals. Evidence from multiple studies does not strongly support the effectiveness of FCC interventions on caregiver's mental health, parenting and personal outcomes. Limited evidence precludes a conclusion on the effectiveness of the components of FCC on well-being of caregivers of children with CP.

A systematic review of cardiac surgery clinical prediction models that include intra-operative variables.

Most cardiac surgery clinical prediction models (CPMs) are developed using pre-operative variables to predict post-operative outcomes. Some CPMs are developed with intra-operative variables, but none are widely used. The objective of this systematic review was to identify CPMs with intra-operative variables that predict short-term outcomes following adult cardiac surgery. Ovid MEDLINE and EMBASE databases were searched from inception to December 2022, for studies developing a CPM with at least one intra-operative variable. Data were extracted using a critical appraisal framework and bias assessment tool. Model performance was analysed using discrimination and calibration measures. A total of 24 models were identified. Frequent predicted outcomes were acute kidney injury (9/24 studies) and peri-operative mortality (6/24 studies). Frequent pre-operative variables were age (18/24 studies) and creatinine/eGFR (18/24 studies). Common intra-operative variables were cardiopulmonary bypass time (16/24 studies) and transfusion (13/24 studies). Model discrimination was acceptable for all internally validated models (AUC 0.69-0.91). Calibration was poor (15/24 studies) or unreported (8/24 studies). Most CPMs were at a high or indeterminate risk of bias (23/24 models). The added value of intra-operative variables was assessed in six studies with statistically significantly improved discrimination demonstrated in two. Weak reporting and methodological limitations may restrict wider applicability and adoption of existing CPMs that include intra-operative variables. There is some evidence that CPM discrimination is improved with the addition of intra-operative variables. Further work is required to understand the role of intra-operative CPMs in the management of cardiac surgery patients.

Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption

Objective Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or ‘defensive processing’, may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. Design Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) and demographics. Results AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson’s correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = −0.48). Conclusion People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.

The Impact of Occupational Therapy on the Self-Management of Rheumatoid Arthritis: A Mixed Methods Systematic Review.

To determine the impact of occupational therapy (OT) on the self-management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA). Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE- Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type. Of 39 eligible papers, 29 were quantitative (n=2,029), 4 qualitative (n=50), and 6 mixed methods (n=896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long-term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self-management for fatigue. Although patient education is promising for self-managing RA, no strong evidence was found to support OT programs for self-managing fatigue or patient experience and long-term effectiveness. More research is required on lived experience, and the long-term efficacy of self-management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date.

Supplemental Material for Interplay Among Attention, Appraisal, and Memory Bias in Provisional Posttraumatic Stress Disorder: Exploring the Combined Cognitive Biases Hypothesis

Supplemental Material for Interplay Among Attention, Appraisal, and Memory Bias in Provisional Posttraumatic Stress Disorder: Exploring the Combined Cognitive Biases Hypothesis

Perioperative mortality in low-, middle-, and high-income countries: Protocol for a multi-level meta-regression analysis.

Surgery is an indispensable component of a functional healthcare system. To date there is limited information regarding how many people die during the perioperative period globally. This study describes a protocol for a systematic review and multilevel meta-regression to evaluate time trends regarding the odds of perioperative mortality among adults undergoing a bellwether surgical procedure while accounting for higher order clustering at the national level. Published studies reporting the number of perioperative deaths from bellwether surgical procedures among adults will be identified from MEDLINE, Embase, Cochrane CENTRAL, LILACS and Global Index Medicus. The primary outcome will be the rate of perioperative mortality across time and the secondary outcome will be investigating cause of death over time as a proportion of overall perioperative mortality. Two reviewers will independently conduct full text screening and extract the data. Disagreements will first be resolved via consensus. If consensus cannot be reached a third reviewer will be included to arbitrate. Due to human resource limitations, a risk of bias appraisal will not be conducted. From the included studies a multilevel meta-regression will be constructed to synthesize the results. This model will conceptualize patients as nested in studies which are in turn nested within countries while taking into account potential confounding variables at all levels. The systematic review and multilevel meta-regression that will be conducted based on this protocol will provide synthesized global evidence regarding the trends of perioperative mortality. This eventual study may help policymakers and other key stakeholders with benchmarking surgical safety initiatives as well as identify key gaps in our current understanding of global perioperative mortality. Systematic review registration: PROSPERO registration number 429040.