Unrealistic Expectations Research Articles

Real-world experience of OnabotulinumtoxinA treatment in female patients with chronic migraine: a qualitative study using in-depth interviews

Background Chronic migraine (CM) causes great disability and affects an individual’s quality of life. OnabotulinumtoxinA (OBT-A, Botox®) was the first prophylactic treatment specifically indicated for CM. The aim of this study was to describe the experiences of women with CM treated with OBT-A. Materials and Methods The study design is a qualitative descriptive study. A purposeful sampling of 30 women (mean age, 42.7; standard deviation, 10.6) who had received at least two administrations of OBT-A for CM (PREEMPT protocol) was performed. Data collection included in-depth interviews and researchers’ field notes. A thematic analysis was carried out according to qualitative research guidelines. Results Five themes were identified: (a) A long way to go before Botox®, (b) First time hearing about the treatment and its expectations, (c) The administration of Botox®, (d) Treatment effects, and (e) Follow-up. Patients described a long history of treatment failures prior to the start of OBT-A treatment. Information about this migraine treatment came from the neurologist; following the information, patients had high expectations, including unrealistic expectations regarding the onset and duration of effect. They acknowledged fear of the injections and some discomfort due to the procedure. With treatment, participants reported better migraine control and an improvement in their quality of life. Follow-up had some barriers, such as delayed appointments for subsequent doses, but also strengths, such as effectiveness and few side effects. Conclusions Qualitative research offers insight into how patients with CM experience treatment with OBT-A. Our results highlight some relevant aspects that should be considered when providing OBT-A treatment.

The nature of expectations of bariatric surgery in patients during the pre- and post-operative period: A unicentric, qualitative study of patient perspectives.

Many patients (20%-30%) experience suboptimal weight loss (WL) after bariatric surgery (BS), and unrealistic preoperative WL expectations may be a contributing factor. This study aimed to describe the nature of patients' general expectations of BS during the pre-surgical period, and how patients determined whether their expectations and WL goals (WLGs) were realistic. The extent to which patients' expectations and WLGs were met and/or changed during the post-surgical period was also assessed. Semi-structured interviews were conducted with 15 preoperative patients recruited approximately 6-months before surgery. Focus groups were also conducted with 14 post-operative patients recruited approximately 6-months after surgery. Interviews and focus groups were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. Preoperative patients reported expectations that BS would positively impact physical and psychological health, social relationships, as well as quality of care. Preoperative patients perceived that they and their health care professionals had unrealistically high expectations of WL. Post-operative patients reported being generally satisfied with the outcomes of surgery, even though many did not reach their expected WL. Finally, most post-operative patients reported changing their expectations from pre- to post-surgery. This study provides data that may help inform the development of preoperative interventions focusing on helping patients set realistic expectations for WL and related outcomes, which could better prepare patients for the challenges they will face after surgery.

The role of self-compassion in mediating the effect of perfectionism on personal growth initiative in dental hygienists.

This study explored perfectionism, self-compassion and personal growth initiative in clinical dental hygienists. Cross-sectional survey research was conducted with a non-probability sample of clinical dental hygienists (n = 877). The survey had 55 items and consisted of three validated instruments: Frost's Multidimensional Perfectionism Scale-Brief (including evaluative concerns and perfectionistic striving subscales), Neff's Self-Compassion Scale and Robitschek's Personal Growth Initiative Scale. Descriptive, correlation, t-test, ANOVA and logistic regression analyses were used to evaluate the relationships among variables. Mediation analysis was conducted to determine the presence of a mediated moderation effect of self-compassion on perfectionism and personal growth initiative. The completion rate for the survey was 89% (n = 788). Evaluative concerns (M = 11.83) and perfectionistic strivings (M = 15.44) among dental hygienists were high, levels of self-compassion (SC) were moderate (M = 2.87) and levels of personal growth initiative (PGI) were low (M = 38.07) compared to others not in the dental field. The mediation analysis found that SC mediates the relationship between perfectionistic evaluative concerns and PGI. It was also determined that SC mediates the relationship between perfectionistic strivings and PGI. Dental hygienists have high levels of perfectionism and may lack necessary levels of self-compassion to counteract those perfectionistic tendencies resulting in a decrease in taking the initiative to engage in opportunities for growth. This suggests the importance of dental hygienists developing a more adaptive perfectionism to balance self-criticism along with not having unrealistic expectations for perfection while engaging in self-compassion that includes self-kindness and mindfulness to support their continued growth.

New technology in prostate cancer and financial toxicity.

The management of prostate cancer has significantly evolved over the last few decades with the emergence of new diagnostic and treatment technologies, which are typically more expensive than the previous alternatives. However, decision-making regarding which diagnostics and treatment to pursue is often influenced by perceived benefits, adverse effects, and physician recommendations, without considering the financial liability borne by patients. New technologies may exacerbate financial toxicity by replacing less costly alternatives, promoting unrealistic expectations, and expanding treatment to those who would have previously gone untreated. More judicious use of technologies with an understanding of the contexts in which they are most beneficial may help prevent avoidable financial toxicity to patients.

Clinical Year Veterinary Students' Expectations of New Graduate Independence Exceed Their Self-Perceived Competence and Expectations of Community Practitioners.

Veterinary medicine is unique in that graduating veterinarians can be licensed to practice independently at the time of graduation. A veterinary curriculum needs to not only prepare graduate veterinarians to meet the expectations of their professional community but also ensure those veterinarians have an accurate perception of expected job requirements. This paper evaluates and compares veterinary students' perceived expectations of graduate-level independence with their self-perceived competence over their clinical (fourth) year. Additionally, we compare these findings to practitioner expectations of graduate-level independence. A survey assessing nine technical and three non-technical categories was distributed to clinical year students at the beginning and end of their clinical year at the University of Wisconsin-Madison School of Veterinary Medicine (UW-SVM). These results were compared to previously obtained survey data from community practitioner members of the Wisconsin Veterinary Medical Association (WVMA). Results indicate an improvement in student self-perceived competence in technical tasks over the clinical year, with the final measures of self-perceived competence aligning with community practitioner expectations of graduate-level independence. However, our results demonstrate a significant difference between student expectations of graduate-level independence, their self-perceived competence, and the community practitioner expectations of graduate independence. These results indicate that veterinary students have unrealistic expectations of their expected independence at graduation and that their self-perceived competence cannot meet these perceived expectations of independence. This misalignment and perceived self-deficit could perpetuate stress and burnout. Further investigation into the cause of this misalignment may help inform educational interventions that encourage students to set realistic expectations.

625 The Public’s Perspective on the Amount of Time Surgeons Spend Operating

Abstract Aim As waiting lists for elective surgery grow, there seems to be a disconnect between the public’s expectations on the amount of time surgeons spend operating compared with reality. On average, a surgeon in the NHS spends one day a week performing elective surgery. We aimed to investigate the public’s perception on the amount of time surgeons spend performing elective surgery and what they would desire. Method Members of the public in the UK were approached randomly either on-line or in-person to complete an anonymised 6-question survey. The questionnaire included demographic details, surgical history, occupational experience in the healthcare sector, the number of days a week they believe and wish for surgeons to be performing elective surgery. Results 252 members of the public responded to the survey nationally (150 females, 102 males). 38.5% have experience working in the healthcare sector and 58.5% have had surgery in the past. 83.7% believe surgeons spend at least 3 days a week performing elective surgery [3-4 days (43.2%), 5-7 days (40.5%)]. 45.7% of respondents want their surgeon to operate between 5-7 days per week. Conclusions The public appears to overestimate the amount of time that surgeons spend performing elective surgery and have unrealistic expectations of how much they want their surgeons to operate.

Using the Socioecological Model to Explore Barriers to Health Care Provision in Underserved Communities in the Philippines: Qualitative Study.

The Philippines' primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities' access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. Examining individual-, interpersonal-, institutional-, community-, and policy-level determinants that affect BHCs can inform community-based health promotion interventions for the country's underserved communities. Given the multidimensional barriers identified, a comprehensive program must be developed and implemented in collaboration with health care providers, community leaders, local and regional health care department representatives, and policy makers.

Expectations, Crisis, and Vulnerability: Impact on Student Behaviour

The exodus of new generation passes outs completing schooling and seeking to pursue degree programs is at an all-time high in colleges across the State of Kerala. As a matter of fact, many of them are short of the basic standards required to cope with the levels demanded of higher education. Barring premier institutes and professional courses, students in UG programs in Arts and Science colleges reveal a declining trend in overall academic standards. Adding to the difficulty, subjects are taught in the local language at the UG and PG levels. This incapacitates students from utilizing the vast repository of knowledge open before them. Resultantly pass percentages are on the decline. Even those who pass are not worth the expectations of a graduate. Classroom experience conveys an apparently dismal picture of student indifference and lack of interest in studies. The main reason for this is that students join the institution with an entirely different set of expectations contrary to what is required. They expect unlimited freedom, leisure, and enjoyment. These are the basic urges in stark contrast with the ground realities of real requirements. If effective learning has to take place, the prime requirement to be met is that students should be interested to learn, willing to learn, and motivated to learn. Their unrealistic expectations are giving way to an array of problems. This is further compounded by a set of contributing factors rooted in crisis such as emotional and personal distress, and low energy levels. A set of predisposing factors adds to the vulnerability. On top of this is the supplementing factors that backtrack them. This paper is an attempt to explore the factors that are responsible for the behavior of students which drives them to pursuits other than studies in the place of their primary objective. The findings are the result of a Case Study conducted in an educational institution in Malappuram district of Kerala.

The Brexit Omnishambles and the law of large solutions

ABSTRACT The UK’s decision to leave the European Union (EU) in 2016 unquestionably represents a critical juncture in British politics. Yet the intervening years in which the terms of Britain’s withdrawal have been painstakingly negotiated by the UK political elite appear less of a watershed, even if there have been significant alterations in particular fields of public policy. Path dependencies have reasserted themselves derailing the process of ‘getting Brexit done’, while the constraints and unintended consequences confronting policy-makers in the polity and politics have become increasingly apparent, not least on the issue of how far in practice to pursue regulatory divergence from the EU. The framing of Brexit as a ‘critical juncture’ has fuelled unrealistic expectations while contributing towards growing disillusionment among citizens. Amidst the ensuing chaos, Brexit appears more than ever to be an omnishambles of epic proportions.

The GDPR’s Rules on Data Breaches: Analysing Their Rationales and Effects

The General Data Protection Regulation (GDPR) requires an organisation that suffers a data breach to notify the competent Data Protection Authority. The organisation must also inform the relevant individuals, when a data breach threatens their rights and freedoms. This paper focuses on the following question: given the goals of the GDPR’s data breach notification obligation, what are its strengths and weaknesses? We identify six goals of, or rationales for, the GDPR`s data breach notification obligation, and we assess the obligation in the light of those goals. We refer to insights from information security and economics, and present them in a reader-friendly way for lawyers. Our main conclusion is that the GDPR’s data breach rules are likely to contribute to the goals. For instance, the data breach notification obligation can nudge organisations towards better security; such an obligation enables regulators to perform their duties; and such an obligation improves transparency and accountability. However, the paper also warns that we should not have unrealistic expectations of the possibilities for people to protect their interests after a data breach notice. Likewise, we should not have high expectations of people switching to other service providers after receiving a data breach notification. Lastly, the paper calls for Data Protection Authorities to publish more information about reported data breaches. Such information can help to analyse security threats.

The paradox of endless options and unrealistic expectations: understanding the impact on youth mental health

ABSTRACT There is substantial evidence pointing towards a rise in mental health problems among young people worldwide. A recent survey showed that, compared to older age groups, Faroese young people aged 18–24 struggled the most with symptoms of psychological stress, depression, and loneliness. They also worried more about their economic and housing conditions compared to their older counterparts. The reasons for the higher degree of young people´s mental health challenges, however, remain unclear. The aim of this study was therefore to gain insight into the contributors to young people´s mental health. Six semi-structured focus group interviews were conducted with 28 people aged 18–34. Through the thematic analysis, three main themes were identified: 1. Too many options, 2. High expectations and 3. Limiting small-scale living. We interpret these themes as being intricately connected to the recent societal changes, and we address the importance of understanding young people´s mental health considering this context.

Corroborating otolith age using oxygen isotopes and comparing outcomes to scale age: Consequences for estimation of growth and reference points in northern pike (Esox lucius)

AbstractAccurate age estimates are crucial for assessing the life‐histories of fish and providing management advice, but validation studies are rare for many species. We corroborated age estimates with annual cycles of oxygen isotopes (δ18O) in otoliths of 86 northern pike (Esox lucius) from the southern Baltic Sea, compared results with visual age estimates from scales and otoliths, and assessed bias introduced by different age‐estimation structures on von Bertalanffy growth models and age‐structured population models. Age estimates from otoliths were accurate, while age estimates from scales significantly underestimated the age of pike older than 6 years compared to the corroborated reference age. Asymptotic length () was larger, and the growth coefficient was lower for scale ages than for corroborated age and otolith age estimates. Consequentially, scale‐informed population models overestimated maximum sustainable yield (), biomass at (), relative frequency of trophy fish (), and optimal minimum length limit but underestimated fishing mortality at (). Using scale‐based ages to inform management regulations for pike may therefore result in conservative management and lost yield. The overestimated asymptotic length may instill unrealistic expectations of trophy potential in recreational anglers targeting large pike, while the overestimation in MSY would cause unrealistic expectations of yield potential in commercial fishers.

Roles and Responsibilities in the Transition to Working Independently: A Qualitative Study of Recently Graduated Radiographers' Perspectives in Australia.

Medical imaging features along the entire healthcare continuum and is known for its fast-paced technological evolution which enables it to keep up with the demands of the healthcare system to provide safe, quality services. The overall efficacy and efficiency of the system depends on practitioners' clinical competence, achieved through professional education and continuous professional development. Recent studies have revealed concerns regarding newly graduated healthcare professionals' preparedness and readiness to handle actual practice. We conducted qualitative face-to-face and telephonic interviews with a convenient and purposive sample of 23 participants consisting of recently graduated radiographers (n=14), radiography students (n=5) and supervising radiographers (n=4) in Australia. Verbatim transcriptions were analyzed inductively to identify themes pertaining to perspectives and experiences of the work readiness of novice radiographers. The findings of our study suggest that the workplace immersion and transitioning of recently graduated radiographers into their professional roles requires a process of experiential learning and honing of knowledge and skills if they are to function efficiently and independently in a team-oriented workplace. Radiographic services are spread across various levels of care and are an integral part of the organizational structure of a healthcare system. Maladaptive transitions to the workplace may be the result of low self-confidence, a lack of support, uncertainty in inter-collegial interactions, or unrealistic performance expectations. The overarching themes of communication and interaction emerged clearly as recently graduated radiographers navigated the four roles of coordinator, collaborator, mediator, and advocate. The application of radiographic skills is embedded in a workplace culture of communication and safety. Transitioning to independent practice takes place in a complex, multifaceted environment and is accompanied by internal and external expectations. Because each workplace has a unique context, system and culture, no novice radiographic professional can ever be fully prepared through pre-service training and workplace induction.

Reconsidering the Relationship Between War and Strategy

The doctrinal definitions of strategy regarding ‘ends, ways, and means’ imply an unrealistic linear process, which lulls military officers into unrealistic expectations before conflict and subverts their strategic roles once fighting begins. When it comes to actions taken during a conflict, there should be no separation between political, economic or military strategies, as death and destruction drive reciprocity between war and strategy. Shane Praiswater argues that despite the best efforts of pre-war military strategists, there is an unrecognised danger in attempting strategy before a conflict. Therefore, while generals briefing a literal war plan and objectives amid an emerging crisis will ask important questions regarding national interests, feasibility, risks and so on, they should not use the term strategy. Military leaders present plans, tactics and objectives derived from political guidance, but true strategy can only begin once the war starts. This essay is written from a US perspective but is applicable to any democratic system with a civilian-dominated chain of command. ◼

Enhancing local governance through community‐based conservation: lessons learned from a Utah local working group

AbstractBecause home ranges for many sensitive wildlife species often transcend jurisdictions, species conservation requires collaborative efforts to engage multiple stakeholders. The West Box Elder County Coordinated Resource Management (CRM) in northwestern Utah initially organized as a greater sage‐grouse (Centrocercus urophasianus) local working group (LWG), evolved through a CRM process, to enhance local governance across jurisdictional boundaries by engaging a wider range of public and private partners in species conservation and community development. By completing landscape scale management and development projects, the CRM has benefitted wildlife and local ranchers and contributed to enhancing the social and economic well‐being of rural residents in the county. In 2019, to identify the operational mechanisms of governance that enabled the CRM to achieve long‐term sustainability while meeting community and species conservation needs, we interviewed 17 key stakeholders (8 private, 6 state, and 3 federal) who had been involved in both the LWG and CRM since their inception. Each interview addressed the CRM's origin, support and synergy, administration, communications, outcomes, and improvements. Qualitative analysis of responses revealed that 1) participation by representatives of federal and state government agencies was paramount for funding and program structure, 2) landowner involvement was necessary for long‐term stability and persistence, 3) intergroup communication has improved, and 4) trust of local landowners between state and federal agencies has been enhanced. However, respondents were concerned that the CRM governance process should be re‐evaluated periodically to mitigate stakeholder burnout and group cohesion deterioration. The re‐evaluation could help temper unrealistic expectations relative to sustaining momentum the CRM has achieved over the last decade and establish new goals to better address current conservation issues. Our results may be applicable by other rural communities who desire enhanced local governance to identify and address emerging community development needs and species conservation.

Qualitative Research in Return to Sport: a Current Review of the Literature.

Return to sport (RTS) is an important metric tied to patient satisfaction after receiving treatment for a sports-related injury. Recently, there has been an explosion of literature on RTS; yet a comprehensive review encompassing multiple injuries does not exist. Furthermore, RTS has historically been defined by quantitative measures that assess strength, function, and pain but little consideration has been given to psychologic factors nor has there been an open-ended forum for athletes to share with health care providers which factors they feel are most influential for RTS. This review also serves to heighten surgeons' awareness of underlying psychologic/psychosocial factors affecting RTS. Qualitative studies which employ open-ended questioning of athletes who have undergone surgical management of superior labral anterior-posterior (SLAP) tears, shoulder instability, ulnar collateral ligament (UCL) rupture, femoral acetabular impingement (FAI), and anterior cruciate ligament (ACL) tear demonstrate that fear of reinjury, lack of social support, and unrealistic expectations are all barriers to RTS. Qualitative studies give health care providers unique insight into the perspectives of their patients so that unmet postoperative needs can be addressed to facilitate RTS. Sports psychologists, coaches, athletic trainers, and physical therapists should create a positive environment to address these needs and provide optimal, holistic care to return athletes to the field safely. Though time consuming, further qualitative research is necessary to understand the unique factors affecting RTS in athletes.

Changing Hungarians' L1 education / Jövőt formáló anyanyelvi nevelés

The transmission and maintenance of Hungarian standard language ideology is extremely harmful socially because it perpetuates social inequity and reduces the nation's resources. The insistence on speaking Hungarian “correctly”, i.e., that all Hungarians speak their mother tongue “correctly”, is both unrealistic and socially extremely damaging. In addition to anecdotal evidence cited from belletristic authors Gyula Illyés (1930s), Szilárd Borbély (21st century) and others, the results of several sociolinguistic studies are cited to show how unrealistic such expectations are. These studies cover important sociolinguistic variables e.g., t-final verbs and the inessive case ending (bVn) as used by Hungarians in Hungary, in Transcarpathia (Ukraine) and in Transylvania (Rumania). The social harms that result are illustrated by several well-documented cases of linguicism. The author recommends that the evaluation of linguistic phenomena in terms of “correct – incorrect” should be abandoned and replaced by “appropriate – inappropriate” evaluations (where appropriate language use varies according to speech partners and speech situations). The subtractive language education prevalent in Hungarian schools should be replaced by additive education. Teacher training should be revamped similarly, but the most difficult task ahead is changing the culture of widespread belief in “correct Hungarian” and cultivating a more democratic language ideology which, rather than striving to eliminate language variation, respects linguistic varieties and their speakers.

US-Saudi Relations: Plus Ça Change, Plus C’Est La Même Chose

ABSTRACT Since the end of World War II, the United States and Saudi Arabia have built a strong partnership based on the twin pillars of stable global energy markets and defense and security of the Gulf region. Popular perceptions of the relationship visualize it as a near-treaty alliance. While it is correct that the two countries have cooperated on a broad range of shared interests, it is also true that bilateral ties have often frayed over differences of policy and objectives. For decades, the two sides were particularly at odds over issues related to the Israeli-Palestinian conflict. But differences extend, as well, to the energy sector and, most recently, management of the Iran challenge. Thus, to maintain a stable, sustainable US-Saudi relationship, both sides would benefit from a more realistic, mutual understanding of the strengths and limitations of the partnership in order to avoid unrealistic expectations.

Supporting optimal dietary behaviors in women with perinatal depression: A qualitative exploration of experiences, practices, and challenges.

Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions. Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach. Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding. Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

Child Maltreatment and Perceptions Related to Parenthood and Children’s Development Among Non-Parents

ABSTRACT Parents with a history of maltreatment are at risk for parenting challenges, although the inconsistent findings in the literature suggest that other variables are needed to better understand this relationship. It is critical to identify risk factors for parenting difficulties even prior to parenthood. Pre-parenthood beliefs and expectations remain stable, are tied to later parenting behaviors, and thus may reveal a potential point of prevention for later parenting difficulties. However, to date, childhood maltreatment has not been investigated in regard to parenting expectations and beliefs among non-parents. The aim of the current study was to determine whether forms of cumulative maltreatment was related to more negative expectations of parenthood (i.e. infant, partner, self, social) and children’s development among 477 non-parents (M = 26.49SD = 8.34; 70% female; 63.3% White). Levels of posttraumatic stress symptoms (PTSS) and exposure to other traumatic events were also examined. Cumulative maltreatment was not associated with perceptions of parenthood nor with negative and unrealistic expectations about child development. Yet, greater levels of PTSS were tied to more negative parenting expectations in several domains (B = −.07 - −.14), which suggests that trauma symptoms, rather than maltreatment experiences, may be more detrimental to parenting expectations. Interestingly, greater exposure to other traumatic events were associated with more positive parenting expectations (B = .11–.13). These findings may speak to the resilience of maltreatment survivors, and trauma survivors in general, who are not suffering from PTSS with regard to expectations about parenthood.