Unrealistic Expectations Research Articles

Dermatology in Contemporary Times: Building Awareness of Social Media's Association With Adolescent Skin Disease and Mental Health.

The contribution of psychological disorders to the burden of skin disease has been poorly explored in adolescent patients. The review aims to provide insights into the psychological, social, occupational, and social medias' association with acne, atopic dermatitis (AD), and aesthetics in adolescent patients. The project used a modified Delphi process comprising face-to-face discussions followed up online. The systematic literature search results informed the 14 draft statements. During an expert panel meeting, the draft statements underwent the panel's evaluation at a workshop, followed by a plenary discussion adopting five statements using evidence from the literature coupled with the panel's opinions and experiences. Results: Studies reported an association between poor sleep, social impairment, and mental health disorders, including body dysmorphic disorder (BDD) with acne or AD in adolescents with acne or AD. Education for patients and parents may improve self-management skills and self-responsibility, promoting better outcomes for acne and AD. The use of certain types of social media can contribute to unrealistic expectations regarding the outcomes of cosmetic procedures. Social media use may also be associated with, and potentially contribute to unrealistic appearance expectations and certain mental health conditions. However, social media use may have benefits, such as connection, diversity, social support, increased self-esteem, safe identity experimentation, and an increased opportunity for self-disclosure. Conclusions: The association with negative life events, BDD, suicidal ideation, depression, and anxiety are thought to be high for adolescent patients with acne or AD. Using social media for information has both positive and negative aspects. Awareness of the risks and benefits of receiving health information about dermatological disease among adolescents needs to be improved through the education of patients and clinicians. Action-oriented items need to be developed to help dermatologists address these issues in clinical practice.Rieder EA, Andriessen A, Cutler V, et al. Dermatology in contemporary times: building awareness of social media's association with adolescent skin disease and mental health. J Drugs Dermatol. 2023;22(8):817-825. doi:10.36849/JDD.7596.

Emotional reflexivity in the time of COVID-19: working-class emotional practices

We share findings from a qualitative study on emotions in Scottish working-class households during lockdown. The results challenge existing research focused on emotional capital, which often suggests that working-class people struggle to provide emotional resources to those close to them. Using the concept of emotional reflexivity we show how these household members cared for each other’s feelings, challenging deficit views of working-class emotionality. This research offers a novel understanding of working-class participants collaboratively making space for each other to feel, many favouring acts of care rather than talking. The COVID-19 lockdown, however, tended to reinforce gendered practices of emotion work, although some participants drew on emotional support beyond the household to try to mitigate this burden. The emotionally reflexive practices seen in these households suggest that sustaining more equality in emotional wellbeing relies on navigating material circumstances, is not always about verbal sharing, is often an interactional achievement, but also means resisting unrealistic expectations of intimate relationships within households as the fountainhead of all emotional succour.

Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality.

Conversations about personal values and goals of care (GOC) at the end of life are essential in caring for patients with advanced cancer. However, GOC conversations may be influenced by patient and oncologist factors during transitions of care. We electronically administered surveys to medical oncologists of inpatients who died from May 1, 2020, to May 31, 2021. Primary outcomes included oncologists' knowledge of inpatient death, anticipation of patient death, and recollection of GOC discussions. Secondary outcomes, including GOC documentation and advance directives (ADs), were collected retrospectively from electronic health records. Outcomes were analyzed for association with patient, oncologist, and patient-oncologist relationship factors. For 75 patients who died, 104/158 (66%) surveys were completed by 40 inpatient and 64 outpatient oncologists. Eighty-one oncologists (77.9%) were aware of patients' deaths, 68 (65.4%) anticipated patients' deaths within 6 months, and 67 (64.4%) recalled having GOC discussions before or during the terminal hospitalization. Outpatient oncologists were more likely to report knowledge of patient death (P < .001), as were those with longer therapeutic relationships (P < .001). Inpatient oncologists were more likely to correctly anticipate patient death (P = .014). Secondary outcomes revealed 21.3% of patients had documented GOC discussions before admission and 33.3% had ADs; patients with a longer duration of cancer diagnosis were more likely to have ADs (P = .003). Oncologist-reported barriers to GOC included unrealistic expectations from patients or family (25%) and decreased patient participation because of clinical conditions (15%). Most oncologists recalled having GOC discussions for patients with inpatient mortality, yet documentation of serious illness conversations remained suboptimal. Further studies are needed to examine barriers to GOC conversations and documentation during transitions of care and across health care settings.

Understanding Dynamics Dating Infidelity: Behaviors, Motivations, and Implications for Relationship Well-being

This research delves into the intricate dynamics of dating infidelity within the context of modern romantic relationships. By examining behaviors, motivations, consequences, challenges, and treatment interventions related to dating infidelity, this study offers a comprehensive exploration of this complex phenomenon. The findings reveal a spectrum of behaviors, ranging from emotional connections facilitated by technology to seeking sexual novelty and exploring relationships outside of primary partnerships. Motivational factors, including emotional fulfillment, sexual exploration, and dissatisfaction within the current relationship, emerge as key drivers of dating infidelity. The implications of infidelity extend beyond individuals, impacting relationship well-being and household welfare. Challenges such as communication breakdowns and unrealistic expectations hinder effective relationship dynamics. Treatment interventions, such as couples therapy, communication training, and strategies for rebuilding trust, provide a roadmap for addressing infidelity and promoting healing. This research enriches relationship science by offering insights into the evolving landscape of modern romantic connections and underscores the importance of open dialogue and communication to foster healthier and more resilient relationships.

Predictors of young people's anti-vaccine attitudes in the context of the COVID-19 pandemic.

The objective of this research was to explore how attitudes to science and scientists may be related to anti-vax positions and whether the psychological trait known as Need for Closure may influence the relationship between any or all of these attitudes. A questionnaire was administered to a sample of 1128 young people aged 18-25 living in Italy during the COVID-19 health crisis. Based on the results of exploratory and confirmatory factor analyses, which allowed the extraction of a three-factor solution (scepticism about science, unrealistic expectations about science and anti-vax postures), we tested our hypotheses by means of a structural equation model. We found that anti-vax positions are strongly correlated with sceptical views of science, while unrealistic expectations about science affect attitudes to vaccination only indirectly. Either way, Need for Closure emerged as a key variable in our model, as it significantly moderates the effect of both factors on anti-vax positions.

DS06 Does the content of patient information leaflets reflect real-life practice? A comparison of four patient information leaflets in Mohs micrographic surgery

Abstract In our experience, patients referred for Mohs micrographic surgery (MMS) often have unrealistic expectations, anticipating defects that are small in size and depth, and incorrectly describe the procedure as removal of skin cancer by ‘taking away thin slices’ or ‘skimming the skin layer by layer’. This observation prompted us to critically appraise four widely accessed online patient information leaflets (PILs) on MMS produced by the British Association of Dermatologists, the American Academy of Dermatology, Dermnetnz.org and the European Society of Micrographic Surgery. Our aim was to evaluate the wording used and propose evidence-based changes to help manage patients’ expectations. We focused on two core themes: (i) excision of tumour by MMS, including the number of stages, and (ii) cosmetic benefit of MMS over standard excision (SE). All of these PILs state the need for ‘stages’ to achieve margin clearance, with an initial margin of excision as low as 1 mm per stage mentioned in one PIL. The leaflets suggest cosmetic benefit and tissue preservation of MMS over SE, and one leaflet ranked this higher than other advantages offered by MMS. We feel that these points are overstated and better addressed with evidence-based facts. Studies have shown that 60% of cases of MMS are cleared in one stage; &amp;gt; 90% of tumours are cleared within two stages, and the number of patients needing three or more stages is only 6% (Macfarlane L, Waters A, Evans A et al. Seven years’ experience of Mohs micrographic surgery in a UK centre, and development of a UK minimum dataset and audit standards. Clin Exp Derm 2013; 38:262–9). In our experience, a surgical margin of 1 mm is not feasible in MMS. There is no direct evidence that MMS improves cosmesis compared with SE (Brown AC, Brindley L, Hunt WTN et al. A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma. Clin Exp Dermatol 2022; 47:1794–804). Cosmetic and functional outcomes are usually only relevant in high-risk sites (e.g. the central face H zone) and in certain high-risk tumours where wide local excision would be the alternative treatment. In conclusion, we propose that PILs in MMS should avoid using misleading language like ‘thin’ and ‘small’ when describing the procedure. Patient information leaflets should clarify that the vast majority of tumours are cleared after two stages rather than requiring multiple stages. Tissue sparing should not be highlighted as the main advantage of MMS, and patients should not be pledged small wounds and better cosmetic outcomes.

Development and Validation of the Parental Expectations Scale (PES) in Parents From Romania

Abstract: Social cognitive models of parenting consider the role of unrealistic parental expectations (UE) regarding children’s abilities and behaviors as antecedents to the occurrence of child abuse. However, existing self-report measures of UE yield inconsistent results, often failing to differentiate aggressive and non-aggressive parents, raising questions about their validity and utility in understanding maladaptive parenting. To address these concerns, we developed and tested a new measure of parental UE in two samples of parents. The first sample ( N = 179) was used to test the initial structure of the scale, while the second sample ( N = 249) was used to replicate the structure and examine the concurrent validity, criterion validity, and internal consistency of the new measure. The final scale demonstrated adequate internal consistency, criterion, and concurrent validity. More unrealistic expectations predicted unique variance in parental negative behavior after controlling for other related variables. The current study provides preliminary evidence for the reliability and validity of the Parental Expectations Scale (PES), discussing its utility in the clinical assessment of parents at risk for child abuse and in tailoring parenting interventions.

Persuasive Appeals in Genetic Biobank Recruitment Campaigns: Social and Ethical Implications.

The social and ethical implications of large-scale biobank donor recruitment campaigns have remained understudied. We use two recent campaigns of the population-based genetic biobank in Estonia as an example to demonstrate how campaign spokespersons try to persuade potential donors by appealing to (1) gaining self-knowledge, (2) gaining control over one's health, (3) fear of illness, (4) contributing to healthcare, (5) contributing to science, and (6) contributing to one's country. While these campaigns succeeded in recruiting 15 percent of the country's adult population as donors, we explain how the use of some of these appeals may (a) create unrealistic expectations regarding the benefits donors could receive and (b) conceal the risks regarding health data. The study lays a necessary groundwork for future empirical research on the ethics of biobank recruitment campaigns.

Qualitative evaluation of the health insurance program in Nepal: Expectations beyond limitations

AbstractThe government of Nepal introduced a national health insurance program in 2016 to comply with the constitution and international commitments to ensure universal health coverage by 2030. This qualitative study explores public perceptions and satisfaction concerning the new health insurance program. The study is guided by an interpretive worldview using both in‐depth interviews (IDIs) and focus group discussions (FGDs). Altogether, 34 (28 IDIs and 6 FGDs) events were conducted covering both self‐ and government‐sponsored health insurance enrollees in the new health insurance program. The study found that insurees had larger expectations as well as both favorable and negative perceptions of the program. Positive perceptions included that the program helped to lower the gap between the wealthy and the poor, increase coverage with fewer financial contributions, and make it easier to receive health services financially. Negative perceptions included long waiting times for registration, consultations, laboratory test results, and pharmacy visits, as well as the lack of drugs, inadequate coverage (a low ceiling), low‐quality services, and strict procedures, which combined to make insurees dissatisfied. We noticed that insurees had expectations that went beyond the program's guidelines, such as the expectation that services would be provided without queues and long waits, that additional services and coverage would be provided, and that preference would be shown for patients who lived far from hospitals. Adequate information, education, and communication‐ and process‐related interventions that address these issues may help minimize the insurees' unrealistic expectations and areas of dissatisfaction.

The impact of parental complaints on teachers working within Scottish schools during Covid-19

Abstract This exploratory research examines the impact of everyday parental complaints on teachers working in Scottish Schools during the Covid-19 pandemic. Through interviews with 18 teaching professionals, our findings demonstrate that parental complaints both before and during Covid-19 are a feature of school life, even if they were not conceptualised in that way by teaching professionals. We found that teaching professionals have become accustomed to the everyday informal complaints parents voice about schools to the point only serious situations or repeat complaints were considered to be raising a ‘complaint’. Formal complaints procedures were seen as being a barrier to maintaining good relationships with parents. Complaints during Covid were rationalised as coming from anxious parents due to the pandemic, or a small group of parents with unrealistic expectations, or outdated understandings of education. Despite the fact our research was about complaints experienced by teachers during the pandemic, our respondents frequently referenced complaints prior to this, emphasising the impact complaints can have long after they have been made, which resonates with other research on the long-term practical and emotional impact of complaints.

An overview of the use of artificial intelligence (AI) tools in higher education

The integration of Artificial Intelligence (AI) tools in higher education has the potential to revolutionize teaching and learning. However, there is a lack of pedagogical integration when using these tools, which hinders their full potential. This paper provides an overview of the research on AI applications in higher education and highlights the challenges of using AI in the classroom. The study will also look at the ethical issues that occur when using artificial intelligence in higher education, as well as the benefits of this technology and how it impacts student- teacher interaction in online learning environments. The impact of AI on student-teacher interaction in online learning environments is also observed. AI systems have the potential to affect the way student-teacher interaction occurs, but there can be barriers to the effective use of AI systems due to students’ unrealistic expectations and misunderstandings about AI. More research and exploration are needed to fully understand the potential and consequences of AI in educational settings. In conclusion, it is crucial to carefully weigh the benefits and challenges of incorporating AI tools into the education system. It is important to note that AI should be used as a tool to enhance education and support teachers, rather than replacing human educators. Further research, teacher training, and fostering AI literacy are necessary to fully harness the potential of AI in education and create meaningful learning experiences for students.

Oncology patients through the eyes of their physicians.

e18757 Background: There is a continuous need for optimizing and rationalizing cancer care according to national and international guidelines. The aim of the survey is exploring the thoughts and expectations of oncologists worldwide regarding their patients' management and prognosis and the factors affecting these expectations. This survey shed light on the oncologists' side of the relationship with their patients, which is often ignored. Methods: This is an observational cross-sectional study via an online pre-tested self-administered survey, targeting subspecialties of Oncologists across the world. Results: Among 929 Oncologists who completed the survey, 50.7% worked at University hospitals. They came from 17, 27, 23 and 14 countries in Africa, Asia and Australia, Europe, and the Americas respectively. Our results showed that, 58.7% thought stage of the disease is the most important factor affecting the prognosis. Additionally, 34.4%, 21.4% and 14.2% agreed that the 2nd most important factor was Performance status, stage of the disease, and disease pathology and immunohistochemistry respectively. Also 63% agreed that targeted therapy improves their expectations of the outcomes in eligible patients. While, 56% agreed that Immunotherapy improves their expectations. Only 42.3% indicated that they always inform patients of the detailed management plan and only 20.7% agreed that they always inform advanced cases about their incurable disease. Moreover, 52% usually expect the patients to fully understand the detailed management plan, but only 7% always expect that. The main factor affecting this is the patients’ education level as indicated by 76% of the respondents. The 2nd leading cause is that patients usually have some degree of denial as indicated by 35%, followed by patients’ unrealistic expectations as indicated by 30% of oncologists. Results also showed that 63.5% always inform their patients about all adverse events of their therapy directly, and 59% agreed that patients usually accept them, but only 6.5% indicated that patients always accept them. The fear of death or possible disabilities are the main factors causing some patients to reject these adverse events as indicated by 52%, while 31% thought fear of the looming social or financial difficulties is the main cause. The majority agreed that patients are either always (33%) or usually (46.9%) open to their case being discussed in Multidisciplinary clinics. Contrarily, only 5.3% indicated patients are always open to being referred to Psychiatrists. The majority agreed that patients are open to being referred to nutritionists or non-oncology physicians. However, only 19% and 7% agreed that patients are always open to being referred to Palliative care and Hospice respectively. Conclusions: The survey shows that oncologists worldwide have consistent evidence-based prognosis. Contrary to that, it shows widely varying perceptions regarding the patients’ reactions, due to variable factors.

Impact of Social Media in Student’s Psychology

Over the past decade, social media has become an integral part of students' lives, influencing their mood, attitude, and behaviour. With the vast array of social networking sites that include Facebook, Twitter, Instagram, Snapchat, and WhatsApp, students have become connected to the world in a way that was unimaginable few decades ago. While social media enables students to build connections across the globe, it also has potential negative implications on their psychology. This paper examines the impact of social media on students' psychology, including its benefits and drawbacks. the impact of social media on students' psychology is a double-edged sword. While social media provides opportunities for students to connect with a diverse array of people and gain access to information, it can also lead to cyberbullying, false information, unrealistic expectations, and reduced face-to-face interaction. It is thus essential to balance the positive and negative effects of social media, while promoting positivity and using it as a tool for personal growth and development. This requires deliberate effort from students, parents, educators, and policy-makers to ensure social media is used responsibly for the benefit of individuals and society.

Barriers and facilitators to skin hygiene care and emollient use in residential care homes: Instrument design and survey.

The older person care home population is increasing. As skin ages, it becomes vulnerable to dryness, itching, cracks and tears. These are experienced by most older people, they impair quality of life and can lead skin breakdown, increased dependency, hospital stays and greater financial and human costs. Dryness, itching, cracks and tears can be prevented, but despite best practice guidance, concordance is suboptimal. (i) develop and test a theory-based diagnostic instrument to accurately and prospectively assess barriers and facilitators and (ii) survey barriers and facilitators to care home staff in the delivery of skin hygiene care. Instrument development and survey. Barriers and facilitators identified from the literature and pilot study were categorised in a Delphi survey of experts (n = 8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n = 38), construct validity (n = 235) and test-retest reliability (n = 11). Barriers and facilitators were surveyed in Round 2 and reported in accordance with TRIPOD. A 29-item valid and reliable instrument (SHELL-CH) resulted (χ2/df = 1.539, RMSEA = 0.047, CFA = 0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, being busy and the unrealistic expectations of relatives. Knowledge of skin hygiene care was a facilitator. This study has international significance having identified barriers and facilitators to skin hygiene care including barriers previously unreported.

(220) Penile Enhancement Supplements: The Only Thing Getting Bigger is Demand &amp; False Hope

Abstract Introduction Penile dysmorphophobia is common, with up to 20% of men reporting dissatisfaction with their genital size. The global market for Sexual Enhancement Supplements is estimated at $300 Million in the year 2020 and is projected to reach $608 Million by 2027 in the US alone. Evidence for efficacy is minimal, and purported claims are hyperbolic. Objective We sought to assess penile elongation internet offerings, quantify cost, ingredients, and risk and investigate scientific literature of product ingredients when available. Methods Three online marketplaces (Amazon, Google market, and Walmart) were queried for dietary supplements available without a prescription to improve penile size. Product labels were reviewed to compile penile size-related claims and active ingredients. The one-course (60-day) cost of treatment and consumer star rating were assessed. MEDLINE, Web of Science, and Google Scholar were queried with labeled ingredients to assess the scientific evidence from published and lay sources. Results A total of 84 dietary supplements claimed either increased penile length, girth, enhanced sexual performance, or a combination thereof. Of these 84 products, 90 ingredients were listed. The Mean 60-day cost was $52 (range of $12–$222). The median score by consumers in the markets with a possibility of star rating was 3.5 (range 2.4-4.2) with obvious repetitive and self-promotional tactics. Unsurprisingly, no scientific evidence supporting change in penile size was found for any products in our search. Actual described physiologic activity from active ingredients included were described as antidepressant, lipid and glucose lowering/metabolizing, blood pressure effecting, anti-inflammatory, renally protective, cognitive function effecting, antioxidant, and several ingredients weakly enhancing erectile activity. Renal failure, warnings against long-term use, heart problems, neuropathy, blood pressure effects, fertility toxicity, bleeding, liver disease, and numerous interactions with diabetes, blood thinning, immunosuppressant, and PDE5 medications were found for the ingredients. Conclusions Dietary supplements claiming to enhance penile size contained ingredients with conflicting or no scientific evidence to support their claims. Several ingredients were dangerous. Clinician awareness of these sham “solutions” and their continued mass consumption highlight the magnitude of misinformation, unrealistic expectations, shame, and enhancement desperation regarding penile size in the male public psyche. Disclosure No

Skill India’s unmet promises: raising expectations for financial assistance in training for informal sector livelihoods

ABSTRACT Recent research on vocational training in the global South suggests training may have the effect of unrealistically inflating trainee expectations of remunerative employment and upward social mobility. These studies, however, have focused almost exclusively on training for formal sector employment. The present paper, by contrast, explores how formal vocational training initiatives for informal sector livelihoods affect trainee expectations – and the flow-on effects these altered expectations have for their social and economic lives. It presents the findings of a study of agricultural training initiatives in north India. The study found that training – in conjunction with other local actors and institutions – had the effect of fostering unrealistic expectations amongst trainees, but instead of fostering expectations for paid employment, it fostered the expectation that the training certificate would lead to financial assistance from banks and/or government sources. When these expectations went unmet, they could have adverse consequences for trainees – including financial losses. The effects of distorted expectations differed as a function of gender and caste, with marginalised castes most adversely effected. This situation might be improved through better institutional linkages between the skill development sector, banks, and relevant government departments and through trainers imparting more realistic advice on prospects for financial assistance.

Keeping Dr. Google under control: how to prevent and manage cyberchondria.

Keeping Dr. Google under control: how to prevent and manage cyberchondria.

Online Audio-Visual Information on the Treatment of OSA with Mandibular Advancement Devices: Analysis of Quality, Reliability and Contents

The Internet is a preferred source of health information. This study evaluated the quality, reliability and content of online audio-visual information on the mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA). “Mandibular advancement device” was searched on four online platforms. A total of 63 videos (51% from healthcare professionals, 22% from commercial companies, 21% from laypeople, and 6% from hospitals/universities) were evaluated using metrics, the video information and quality index (VIQI), modified-DISCERN, and the Journal of American Medical Association (JAMA) benchmark criteria and contents. VIQI had significantly lower scores for videos uploaded by laypeople (mean 7.92, 95%CI 5.90–9.95) versus healthcare professionals (12.38, 95%CI 11.28–13.47) and commercial companies (11.21, 95%CI 9.61–12.81). The m-DISCERN scores were significantly lower for laypeople (1.15, 95%CI 0.93–1.40) versus healthcare professionals (2.13, 95%CI 1.73–2.52) and hospitals/universities (3.00, 95%CI 1.70–4.30), as well as for commercial companies (1.43, 95%CI 1.13-1.73) versus hospitals/universities. Contents were significantly less complete for laypeople (1.54, 95%CI 0.60–2.48) versus healthcare professionals (3.25, 95%CI 2.66–3.84). The results of the present study suggest that the quality and completeness of online audio-visual information with respect to the use of MAD for the treatment of OSA are generally poor, and the currently available videos, especially those uploaded by laypeople, may determine misinformation and/or unrealistic treatment expectations.

Handheld Near-Infrared Spectroscopy: State-of-the-Art Instrumentation and Applications in Material Identification, Food Authentication, and Environmental Investigations

This present review article considers the rapid development of miniaturized handheld near-infrared spectrometers over the last decade and provides an overview of current instrumental developments and exemplary applications in the fields of material and food control as well as environmentally relevant investigations. Care is taken, however, not to fall into the exaggerated and sometimes unrealistic narrative of some direct-to-consumer companies, which has raised unrealistic expectations with full-bodied promises but has harmed the very valuable technology of NIR spectroscopy, rather than promoting its further development. Special attention will also be paid to possible applications that will allow a clientele that is not necessarily scientifically trained to solve quality control and authentication problems with this technology in everyday life.

Leveraging Cost Accounting to Manage Earnings: Evidence from Toshiba’s Semiconductor Business

ABSTRACT This case pertains to the interplay of cost accounting, performance measurement, and financial reporting issues in Toshiba’s semiconductor business. It addresses how Toshiba manipulated its reported profits by inappropriately allocating its budgeted fixed overheads and not recognizing inventory losses in a timely manner in the financial statements. These manipulations overstated profits of the semiconductor business by ¥36.0 billion, almost a quarter of the total of Toshiba Corporation’s ¥151.8 billion profit overstatement. The investigation report indicated that the profit manipulations were a likely outcome of top management’s unrealistic expectations. For the semiconductor business of Toshiba, the timely recognition of inventory losses would have offset the profit misstatements resulting from the inappropriate allocation of budgeted fixed overheads. Alternatively, proper allocation of budgeted fixed overheads would have reduced or even avoided the need to recognize inventory losses. The case provides an integrative view of cost and financial accounting.