Contradictory Advice Research Articles

Patients with Delusional Infestation are being given conflicting advice by pharmacy colleagues.

The role of pharmacists in psychodermatology includes counseling patients on psychotropic medications, ensuring adherence, and providing guidance that complements the advice of dermatology health care professionals. This pilot study is the first to highlight discrepancies in counselling effectiveness between clinicians and pharmacists. Patients were provided with suboptimal, conflicting or contradictory advice and training specialized pharmacists with prescribing privileges and providing specific information on psychotropic medications are essential.

Global Expectations for Bystander Intervention in Domestic Violence: A Scoping Review of Governmental Policies and Community Resources in Eight Countries

Abstract Purpose Over recent years, expectations for bystanders to intervene to interrupt or prevent domestic violence have increased. However, the extent of these expectations and the ways in which bystanders are supported to uphold these expectations remain ambiguous. Drawing on a scoping review methodology, this study aims to map the bystander expectations and advice contained in government policies and community resources across eight countries. Methods We conducted a grey-literature search to identify the three most recent and relevant policy documents from each country, as well as the three most easily-accessible online community resources. We charted key information from each policy and resource, including type of violence and level of prevention; responsibility to intervene and effectiveness of bystander intervention; recognition of danger; and recommended bystander actions. Results The results indicate that the government policies and community resources included in the review held high expectations for bystanders to intervene in domestic violence. However, the information provided on how to safely and effectively intervene was inconsistent in its recognition of the risk posed to bystanders, and often offered contradictory advice. Conclusions An examination of our findings within the context of existing evidence suggests that there are severe limitations to the messages and information presented by the policies and resources. As a matter of urgency, more empirical research is needed to inform the government policies and community resources that encourage bystanders to intervene in domestic violence.

Diet and multiple sclerosis – development and mixed methods feasibility testing of a comprehensive nutritional information resource (NUTRIMS)

Purpose Persons with multiple sclerosis (pwMS) are often confused by contradictory dietary advice. The purpose of this research was to explore the information needs and design a comprehensive, evidence-based nutritional information resource on diet and MS (NUTRIMS). Methods A mixed-methods design with three sequential phases was adopted: (1) Needs assessment and development: Two focus groups with pwMS to explore experiences, information needs and preferred support around diet. Development of a draft NUTRIMS, (2) Feasibility Step 1: Feedback on the draft NUTRIMS from stakeholders and (3) Feasibility Step 2: Online survey among pwMS to explore content quality and acceptability. Results Two focus groups with a total of 12 pwMS showed that MS-specific evidence on food groups/ingredients, nutrients and special diets were of most interest. The draft NUTRIMS was refined through feedback from 13 stakeholders. The pre-final NUTRIMS consisted of 81 pages including scientific references on each topic, 16 illustrations and a glossary of terms. 85 pwMS participated in the online survey and reported an intensive use and high satisfaction with the information resource, which was perceived as comprehensible, highly credible and useful for making decisions on dietary change. Conclusions A collaborative research approach led to a well-accepted nutrition information resource.

In Spiderman we trust: The influence of familiar media characters on the decision-making of primary school children

Children are increasingly active consumers in the media world and are thus confronted with a wide range of information. Making good decisions in such an environment is a major challenge. Weighting valid information in decision-making is an important skill that children must learn and apply. Yet, how do children weight information and which weights do they use? We developed a measuring instrument for children's weighting of advices by cue validity – the so-called Space Treasure Hunt. It is an easy to understand, child-friendly decision game. By anchoring it in the reality of children's media lives, we are able to assess the influence of familiarity and affect on children's decision making. During a treasure hunt in game situated in outer space, children are confronted with various characters who provide contradictory advice regarding where to find treasures. One of the advice-givers was an expert (valid cue), whereas the other advice-giver varied in terms of its media familiarity and affect. In our study (N = 372), we found that media familiar characters had a strong influence on children's decision-making. Media idols showed an assimilation effect, meaning that children followed the expert's advice the least often when it contradicted their media idol. Conversely, media familiar but less liked characters showed a contrast effect, meaning that children followed the expert's advice most often when it contradicted the media familiar, less liked character. Moreover, we found differences between children in terms of a three-way split: One third of the children, respectively, systematically followed the expert's advice, the media idol, or made their decisions unsystematically. We discuss how our results indicate the use of different weights in children's decision making.

Is ChatGPT an Effective Tool for Providing Dietary Advice?

The chatbot Chat Generative Pretrained Transformer (ChatGPT) is becoming increasingly popular among patients for searching health-related information. Prior studies have raised concerns regarding accuracy in offering nutritional advice. We investigated in November 2023 ChatGPT's potential as a tool for providing nutritional guidance in relation to different non-communicable diseases (NCDs). First, the dietary advice given by ChatGPT (version 3.5) for various NCDs was compared with guidelines; then, the chatbot's capacity to manage a complex case with several diseases was investigated. A panel of nutrition experts assessed ChatGPT's responses. Overall, ChatGPT offered clear advice, with appropriateness of responses ranging from 55.5% (sarcopenia) to 73.3% (NAFLD). Only two recommendations (one for obesity, one for non-alcoholic-fatty-liver disease) contradicted guidelines. A single suggestion for T2DM was found to be "unsupported", while many recommendations for various NCDs were deemed to be "not fully matched" to the guidelines despite not directly contradicting them. However, when the chatbot handled overlapping conditions, limitations emerged, resulting in some contradictory or inappropriate advice. In conclusion, although ChatGPT exhibited a reasonable accuracy in providing general dietary advice for NCDs, its efficacy decreased in complex situations necessitating customized strategies; therefore, the chatbot is currently unable to replace a healthcare professional's consultation.

Revisiting the analysis of matched‐pair and stratified experiments in the presence of attrition

AbstractIn this paper, we revisit some common recommendations regarding the analysis of matched‐pair and stratified experimental designs in the presence of attrition. Our main objective is to clarify a number of well‐known claims about the practice of dropping pairs with an attrited unit when analyzing matched‐pair designs. Contradictory advice appears in the literature about whether or not dropping pairs is beneficial or harmful, and stratifying into larger groups has been recommended as a resolution to the issue. To address these claims, we derive the estimands obtained from the difference‐in‐means estimator in a matched‐pair design both when the observations from pairs with an attrited unit are retained and when they are dropped. We find limited evidence to support the claims that dropping pairs helps recover the average treatment effect, but we find that it may potentially help in recovering a convex‐weighted average of conditional average treatment effects. We report similar findings for stratified designs when studying the estimands obtained from a regression of outcomes on treatment with and without strata fixed effects.

The need for a personalized, core digital resource to facilitate health self-management

High quality healthcare is becoming increasingly unaffordable and inaccessible. To reverse this trend, people need to self-manage as much of their health as possible. They need to take appropriate preventive actions and use health services in a timely and efficient manner. Yet health self-management is challenging in an increasingly complex environment that involves competing demands and sometimes contradictory advice as well as increasingly fragmented delivery of health services. Digital tools have added a new dimension to healthcare and hold the potential to help bridge these challenges. Unfortunately, much of the potential benefit of digital resources is not being realized, partly because of difficulties people face in identifying appropriate and effective resources in a haystack of mainly unevaluated and often poorly conceived resources. Underuse and failure to maintain use of resources found to be effective also retards progress. Furthermore, people need more help to understand their needs and establish priorities around their health self-management. We argue that these needs can be met with a person-centered, digital self-management core resource that supports people to better understand their needs and priorities and has links to find the resources they need to manage their health, alone or by judicious use of health services.

Color and NICU Design.

The appropriate use of color in healthcare settings has been a topic of interest for designers and researchers, and the need for evidence-based standards evident. The purpose of this article is to summarize recent research on color as applicable to neonatal intensive care units and to propose standards for color in these settings. Research on this topic is limited due to difficulties associated with constructing research protocols, challenges in setting parameters for the independent variable (color), and the need to simultaneously address infants, families, and caregivers. For our literature review, the following research question was developed: Does the use of color in the design of the neonatal intensive care units (NICUs) impact health outcomes in newborn infants, families, and/or staff? Using Arksey and O'Malley's framework for conducting a structured literature review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, and (4) collated and summarized the results. Only four papers were found regarding NICUs, so the search was expanded to include related healthcare and authors reporting on best practice. Overall, the primary research focused on behavioral or physiological outcomes including the role of wayfinding and art, the impact of lighting on color, and tools for evaluating the impact of color. Best practice recommendations sometimes reflected the primary research but occasionally provided contradictory advice. Based on the reviewed literature, five topics are addressed: palette malleability; the use of the primary colors, blue, red, and yellow; and the relationship between light and color.

Physical functioning post-COVID-19 and the recovery process: a mixed methods study

Purpose To describe physical functioning after severe COVID-19-infection. Materials and method An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation. Results At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms. Conclusion Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice.

“Disastrous to Take a Single Note”: Memory and Materiality in a Century of U.S. Journalism Textbooks

ABSTRACT In this paper, I examine the highly contested professional discourse around journalistic notetaking through 125 years of U.S. reporting textbooks, exploring how professional practices have been presented, rationalized, and justified in succeeding eras of modern journalism. Analyzing through a cultural lens and material theories of “objects of journalism,” the study offers insight into developing perceptions of journalists’ ethical obligations to accuracy, presumed audience expectations for journalistic content, and the capacities of human memory. Analysis suggests that rather than resolving questions of whether and how journalists should take notes, reporting textbooks offered ambivalent, unrealistic, and contradictory advice through much of the twentieth century.

The Relationship between Physical Activity and Long COVID: A Cross-Sectional Study.

The relationship between Long Covid (LC) symptoms and physical activity (PA) levels are unclear. In this cross-sectional study, we examined this association, and the advice that individuals with LC received on PA. Adults with LC were recruited via social media. The New Zealand physical activity questionnaire short form (NZPAQ-SF) was adapted to capture current and pre-COVID-19 PA levels and activities of daily living (ADLs). Participants reported how PA affected their symptoms, and what PA recommendations they had received from healthcare professionals and other resources; 477 participants completed the survey. Mean age (SD) was 45.69 (10.02) years, 89.1% female, 92.7% white, and median LC duration was 383.5 days (IQR: 168.25,427). Participants were less active than pre-COVID-19 (26.88 ± 74.85 vs. 361.68 ± 396.29 min per week, p < 0.001) and required more assistance with ADLs in a 7-day period compared to pre-COVID-19 (2.23 ± 2.83 vs. 0.11 ± 0.74 days requiring assistance, p < 0.001). No differences were found between the number of days of assistance required with ADLs, or the amount of PA, and the different durations of LC illness (p > 0.05). Participants reported the effect of PA on LC symptoms as: worsened (74.84%), improved (0.84%), mixed effect (20.96%), or no effect (28.72%). Participants received contradictory advice on whether to be physically active in LC. LC is associated with a reduction in PA and a loss of independence, with most participants reporting PA worsened LC symptoms. PA level reduction is independent of duration of LC. Research is needed to understand how to safely return to PA without worsening LC symptoms.

Human-Animal Interactions with Bos taurus Cattle and Their Impacts on On-Farm Safety: A Systematic Review.

Simple SummaryCattle are large animals that can cause serious injuries to humans. Humans may encounter cattle through working on farms, living on a farm, or traversing fields with cattle. A systematic review was carried out to assess the factors which may lead to a dangerous interaction with cattle. A literature search was carried out to find papers that included the criteria ‘Bovine’, ‘Handling’, ‘Behaviour’ and ‘Safety’, or terms therein. The search returned 17 papers, and after collation, six themes were identified: actions of humans; human demographics, attitude, and experience; facilities and the environment; the animal involved; under-reporting and poor records; and mitigation of dangerous interactions. Exploration of these themes shows that more accurate recording of interactions before an injury is required. Furthermore, targeted, tailored education for anyone who may come into contact with cattle could reduce cattle-induced injuries.Cattle production necessitates potentially dangerous human–animal interactions. Cattle are physically strong, large animals that can inflict injuries on humans accidentally or through aggressive behaviour. This study provides a systematic review of literature relating to farm management practices (including humans involved, facilities, and the individual animal) associated with cattle temperament and human’s on-farm safety. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to frame the review. Population, Exposure, and Outcomes (PEO) components of the research question are defined as “Bovine” (population), “Handling” (exposure), and outcomes of “Behaviour”, and “Safety”. The review included 17 papers and identified six main themes: actions of humans; human demographics, attitude, and experience; facilities and the environment; the animal involved; under-reporting and poor records; and mitigation of dangerous interactions. Cattle-related incidents were found to be underreported, with contradictory advice to prevent injury. The introduction of standardised reporting and recording of incidents to clearly identify the behaviours and facilities which increase injuries could inform policy to reduce injuries. Global differences in management systems and animal types mean that it would be impractical to impose global methods of best practice to reduce the chance of injury. Thus, any recommendations should be regionally specific, easily accessible, and practicable.

Madariaga, probabilism and the polysynodial regime of the Spanish monarchy

ABSTRACT This paper examines the use of the theological doctrine of probabilism by the Valencian political writer Juan de Madariaga in his Del senado y su príncipe of 1617. Madariaga’s work is but one example of the phenomenal diffusion of probabilism in political and legal writings in seventeenth century Spain. Such popularity must be understood in the institutional context of the Habsburg monarchy, effectively managed by an expanding number of powerful councils (consejos), constituting what Spanish historians call a ‘polysynodial regime’. Probabilists argued that council members could, within limits, defer to the majority opinion within the council without shirking their conscientious duties. As explained by Madariaga, by morally allowing such deferrals, probabilism strengthened the cohesiveness of the councils and preserved their authority in the eyes of the king and the people. It is suggested that by relying on probabilism in order to foster unanimity within the council, Madariaga was in fact attempting to remove occasions for one of the favoured criticisms against the polysynodial regime: that the multiplicity of contradictory advice confused the monarch and prevented the sort of expedite action necessary for solving the urgent problems of the monarchy.

This study aimed to explore women’s experiences of infant feeding in Ireland

Abstract Background While breastfeeding may be among the most effective ways to ensure child health and survival, breastfeeding rates in Ireland are consistently low. This study aimed to explore women's experiences of infant feeding in Ireland. Methods Thematic analysis of feeding-related free-text comments from the National Maternity Experience Survey 2020 was undertaken. The survey collected data on the experiences of women who were 16 years or older and gave birth in one of Ireland's 19 maternity hospitals or units or had a home birth. Results 3,204 women participated in the survey (50% response rate). In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle fed only. 824 comments related to feeding were received. A number of themes were identified, including support and encouragement from healthcare professionals, information and education regarding feeding, and pressure and respect for personal preferences. Women highlighted that while breastfeeding was encouraged in antenatal care, this was not always the case in the postnatal ward, where formula was readily available, with an apparent lack of resources for breastfeeding women. Some women described feeling pressured to use a feeding method that was not their first preference, with some feeling pushed to breastfeed when this may not have been their wish, while women who wished to breastfeed felt pressured to supplement with formula. Staffing shortages on postnatal wards, a lack of lactation consultants and contradictory advice from healthcare professionals exacerbated difficulties with both feeding methods. Conclusions Some women experience a lack of practical support with infant feeding, regardless of feeding method, and clear and concise information on feeding practices is needed. The addition of lactation consultants, home supports and further education and training could benefit mothers on their breastfeeding journey. Key messages Barriers to breastfeeding included a lack of support from healthcare professionals and conflicting information. It is important to support women regardless of their chosen feeding method.

Tracking water for human activities: From the ivory tower to the ground

Water policy requires well established metrics for success. Precise metrics allow for quantifying progress and adjusting processes to produce the desired outcomes. We analyze the different schools of thought, nomenclatures and indicators developed for tracking water for human activities. After comparing a variety of terms related to water accounting used to serve the different purposes (environmental vs. ecological economics), we found that the different approaches to water tracking utilize identical terms to refer to distinctive concepts. The characterization of widely used terms such as 'water use' varies across different branches of literature. Different approaches to water measurement and its efficiency have an impact on water allocation. Our paper points out that the current definitions and methods for tracking water for human activities may offer contradictory advice over whether progress is being made towards desirable objectives, which may differ across stakeholders. This review aims at helping the transfer of academic results to empirical decision-making by discerning the differences among the variety of indicators available in the literature and their empirical implications. The ambiguity in the water terminology should be clarified before policy decisions can be useful in practice for guiding actions.

Exploration and Exploitation in Dynamic Environments: How much versus how broad

In dynamic environments it is critical to find the correct balance between exploration and exploitation. However, both the empirical and theoretical literature offer contradictory advice regarding on how firms should change their exploration in the face of environmental change. Although prior work has distinguished between different facets of exploration, such as exploration intensity and exploration breadth, we currently do not know how environmental turbulence affects these aspects. We use a formal model to show that as environmental dynamism increases, better performing firms reduce exploration intensity while simultaneously increasing exploration breadth. This insight has significant implications for empirical research and management practice.

Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Background: The health benefits of breastfeeding are well-established but for mothers with severe mental illness (SMI), the decision to breastfeed can be complex. Very few prior studies have investigated the infant feeding choices of women with SMI, or the factors associated with this. Our aims were to examine antenatal infant feeding intentions and infant feeding outcomes in a cohort of women admitted for acute psychiatric care in the first postpartum year. We also aimed to examine whether demographic and clinical characteristics associated with breastfeeding were similar to those found in previous studies in the general population, including age, employment, education, BMI, mode of delivery, smoking status, and social support.Methods: This study was a mixed-methods secondary analysis of a national cohort study, ESMI-MBU (Examining the effectiveness and cost-effectiveness of perinatal mental health services). Participants had been admitted to acute care with SMI in the first postpartum year. Infant feeding outcomes were retrospectively self-reported by women during a 1-month post-discharge interview. Free-text responses to questions relating to infant feeding and experience of psychiatric services were also explored using thematic analysis.Results: 144 (66.1%) of 218 women reported breastfeeding (mix feeding and exclusive breastfeeding). Eighty five percentage of the cohort had intended to breastfeed and of these, 76.5% did so. Factors associated with breastfeeding included infant feeding intentions, employment and non-Caucasian ethnicity. Although very few women were taking psychotropic medication contraindicated for breastfeeding, over a quarter (n = 57, 26.15%) reported being advised against breastfeeding because of their medication. Women were given this advice by psychiatry practitioners (40% n = 22), maternity practitioners (32.73% n = 18) and postnatal primary care (27.27% n = 15). Most women stopped breastfeeding earlier than they had planned to as a result (81.1% n = 43). Twenty five women provided free text responses, most felt unsupported with infant feeding due to inconsistent information about medication when breastfeeding and that breastfeeding intentions were de-prioritized for mental health care.Conclusion: Women with SMI intend to breastfeed and for the majority, this intention is fulfilled. Contradictory and insufficient advice relating to breastfeeding and psychotropic medication indicates that further training is required for professionals caring for women at risk of perinatal SMI about how to manage infant feeding in this population. Further research is required to develop a more in-depth understanding of the unique infant feeding support needs of women with perinatal SMI.

Clinical practice guidelines for cancer pain: problems and solutions.

Clinical practice guidelines (CPGs) should allow practitioners to follow the best evidence-based management for patients. The increasing specialisation of medicine and pain medicine has increased the number of CPGs, but practitioners are still facing contradictory advice that can be difficult to implement and follow. A recent comprehensive metareview of 25 reviews have highlighted that the same issues of quality, barriers to implementation and difficulties in applicability are as prevalent as they were years ago when assessment tools (e.g. AGREE II) and recommendations for CPG development were introduced. There remains a lack of consistency of recommendations and quality of evidence for CPGs in cancer pain that impedes the ability to provide the 'best' management for patients. Even the most renowned and apparently high-quality CPGs in many specialities, including cancer pain, still are potentially deficient especially in terms of applicability, implementation, and transparency of conflicts of interest. Despite the increased scrutiny, in part related to the opioid crisis, the situation has not changed. The development of CPGs should engender collaboration with multiple stakeholder groups and focus on transparency and facilitating implementation.

Diet and Nutrition Advice After a Solid Tumor Diagnosis

Credible evidence-based diet and nutrition advice is essential for patients with cancer. This study aimed to explore what advice patients with cancer obtained before a formal dietetic visit. A multicenter, observational study was conducted in seven hospital-based oncology services. Consecutive patients were recruited at first dietetic assessment. In addition to routine dietetic assessment, participants completed a four-item questionnaire describing diet and nutrition advice obtained since diagnosis. Seventy-seven patients participated. More than 80% had multiple nutrition-impact symptoms. In total, 53 (69%) obtained advice from professional and nonprofessional sources before dietetic visit. Family and friends were the most common sources of advice. More than one third got advice from (nondietetic) healthcare professionals. Most advice related to "foods to include" (61%) and "foods to avoid" (54%) in the diet. Many of the "foods to avoid" were important sources of micro- and macronutrients. Advice about dietary supplements (31%) and specific diets (28%) was common, rarely evidence-based, and frequently contradictory. Participants found it difficult to discern what advice was trustworthy and reliable. Despite this, most followed the advice. The majority of patients received diet and nutrition advice before first dietetic visit. Most of this came from nonprofessional sources. Any advice from nondietetic healthcare professionals was inconsistent or vague. This was mainly related to the avoidance and/or inclusion of particular foods and was often contradictory. Nevertheless, patients usually followed such advice fully. To help manage their frequent nutrition-impact symptoms and resolve the contradictory advice they had received, many expressed the need for earlier professional dietetic consultation.

Management of inflammatory bowel disease associated colonic dysplasia: factors predictive of patient choice and satisfaction.

In cases of prognostic uncertainty and equipoise as to the best management (prophylactic colectomy vs. surveillance) for dysplasia in inflammatory bowel disease (IBD), individualized discussion with the patient is required. Further understanding of patients' preferences is needed. A nationwide cross-sectional survey was distributed to adult IBD patients who had never been diagnosed with dysplasia (dysplasia-naïve) and those who had (dysplasia-experienced). Risk perceptions and factors that influence management choices were explored. There were 123 respondents. A substantial proportion (29%) of the dysplasia-experienced respondents did not feel well informed about the associated cancer risk and/or its management by their clinical team. Contributing themes included contradictory advice and lack of personalized information regarding their cancer risk, alternative management options and impact on long-term quality of life. Decisional regret and health-related quality of life amongst those who chose either surveillance or surgery were comparable, but cancer-related worry scores were elevated in the surveillance group. The dysplasia-naïve respondents reported that they would only consider having a prophylactic colectomy if they had on average a 50% or even higher risk of developing cancer. On multivariable logistic regression analyses, predictors of colectomy or surveillance preference included ethnicity, personality traits such as health locus of control (whether health status is influenced by luck) and differences in perception of what a low risk of cancer is. This study identifies predictive factors that can influence decision-making and satisfaction with the counselling process when IBD dysplasia is diagnosed. Further qualitative exploration of cultural themes would be informative.