Will people follow their intuition even when they explicitly recognize that it is irrational to do so? Dual-process models of judgment and decision making are often based on the assumption that the ...correction of errors necessarily follows the detection of errors. But this assumption does not always hold. People can explicitly recognize that their intuitive judgment is wrong but nevertheless maintain it, a phenomenon known as acquiescence. Although anecdotes and experimental studies suggest that acquiescence occurs, the empirical case for acquiescence has not been definitively established. In four studies—using the ratio-bias paradigm, a lottery exchange game, blackjack, and a football coaching decision—we tested acquiescence using recently established criteria. We provide clear empirical support for acquiescence: People can have a faulty intuitive belief about the world (Criterion 1), acknowledge the belief is irrational (Criterion 2), but follow their intuition nonetheless (Criterion 3)—even at a cost.
The use of performance enhancing drugs (PEDs) elicits widespread normative opposition, yet little research has investigated what underlies these judgments. We examine this question comprehensively, ...across 13 studies. We first test the hypothesis that opposition to PED use cannot be fully accounted for by considerations of fairness. We then test the influence of 10 other potential drivers of opposition in an exploratory manner. We find that health risks for the user and rules and laws prohibiting use of anabolic steroids reliably affect normative judgments. Next, we test whether these patterns generalize to a different PED-cognitive-enhancement drugs. Finally, we sketch a framework for understanding these results, borrowing from Social Domain Theory (e.g., Turiel, 1983). We argue that PED use exemplifies a class of violations with properties of moral, conventional, and prudential offenses. This research sheds light on a widespread, but understudied, normative judgment, and illustrates the utility of exploratory methods.
Coaches in the National Basketball Association (NBA) typically bench players who are perceived to be in danger of fouling out. I examine the efficacy of this strategy. At a baseline level, it seems ...dubious to guarantee that a player misses playing time for fear that he might miss time later in the game. However, there are broadly two categories of reasons that coaching conventional wisdom might be optimal. First, it is possible that players who are in foul trouble tend to play poorly, and thereby hinder their team’s performance. And second, the end of the game might be meaningfully different from the rest of the game, such that having the team’s best players available for the final minutes is more valuable. Section 1 demonstrates that benching players in foul trouble does not merely shift the minutes that players would typically rest, but instead decreases their overall playing time. Section 2 reveals that having a player on the court in foul trouble actually improves team performance. And Section 3 provides evidence showing that the play at the end of games does not justify the decrease in playing time that accompanies benching foul-troubled players. Taken together, this analysis demonstrates that in general, coaches should not bench their players because of foul trouble.
In this randomized trial, the use of video laryngoscopy in critically ill patients undergoing intubation in the ED or ICU resulted in a higher incidence of successful intubation on the first attempt ...than direct laryngoscopy.
Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and ...effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development.
•Large variation in pain treatment response exists even for effective treatments.•Precision pain medicine individualizes treatment based on patient characteristics.•We know to some degree “what works ...for whom,” but more research is needed.•This review provides recommendations for advancing precision pain medicine.
Large variability in the individual response to even the most-efficacious pain treatments is observed clinically, which has led to calls for a more personalized, tailored approach to treating patients with pain (ie, “precision pain medicine”). Precision pain medicine, currently an aspirational goal, would consist of empirically based algorithms that determine the optimal treatments, or treatment combinations, for specific patients (ie, targeting the right treatment, in the right dose, to the right patient, at the right time). Answering this question of “what works for whom” will certainly improve the clinical care of patients with pain. It may also support the success of novel drug development in pain, making it easier to identify novel treatments that work for certain patients and more accurately identify the magnitude of the treatment effect for those subgroups. Significant preliminary work has been done in this area, and analgesic trials are beginning to utilize precision pain medicine approaches such as stratified allocation on the basis of prespecified patient phenotypes using assessment methodologies such as quantitative sensory testing. Current major challenges within the field include: 1) identifying optimal measurement approaches to assessing patient characteristics that are most robustly and consistently predictive of inter-patient variation in specific analgesic treatment outcomes, 2) designing clinical trials that can identify treatment-by-phenotype interactions, and 3) selecting the most promising therapeutics to be tested in this way. This review surveys the current state of precision pain medicine, with a focus on drug treatments (which have been most-studied in a precision pain medicine context). It further presents a set of evidence-based recommendations for accelerating the application of precision pain methods in chronic pain research.
Given the considerable variability in treatment outcomes for chronic pain, progress in precision pain treatment is critical for the field. An array of phenotypes and mechanisms contribute to chronic pain; this review summarizes current knowledge regarding which treatments are most effective for patients with specific biopsychosocial characteristics.
Objective
To measure the efficacy of mecasermin (recombinant human insulin‐like growth factor 1, rhIGF‐1), for treating symptoms of Rett syndrome (RTT) in a pediatric population using a double‐blind ...crossover study design.
Methods
Thirty girls with classic RTT in postregression stage were randomly assigned to placebo or rhIGF‐1 in treatment period 1 and crossed over to the opposite assignment for period 2 (both 20 weeks), separated by a 28‐week washout period. The primary endpoints were as follows: Anxiety Depression and Mood Scale (ADAMS) Social Avoidance subscale, Rett Syndrome Behaviour Questionnaire (RSBQ) Fear/Anxiety subscale, Parent Target Symptom Visual Analog Scale (PTSVAS) top three concerns, Clinical Global Impression (CGI), Parent Global Impression (PGI), and the Kerr severity scale. Cardiorespiratory‐ and electroencephalography (EEG)‐based biomarkers were also analyzed.
Results
There were no significant differences between randomization groups. The majority of AEs were mild to moderate, although 12 episodes of serious AEs occurred. The Kerr severity scale, ADAMS Depressed Mood subscale, Visual Analog Scale Hyperventilation, and delta average power change scores significantly increased, implying worsening of symptoms. Electroencephalography (EEG) parameters also deteriorated. A secondary analysis of subjects who were not involved in a placebo recall confirmed most of these findings. However, it also revealed improvements on a measure of stereotypic behavior and another of social communication.
Interpretation
As in the phase 1 trial, rhIGF‐1 was safe; however, the drug did not reveal significant improvement, and some parameters worsened.
Among critically ill patients undergoing orotracheal intubation in the emergency department (ED) or intensive care unit (ICU), failure to visualise the vocal cords and intubate the trachea on the ...first attempt is associated with an increased risk of complications. Two types of laryngoscopes are commonly available: direct laryngoscopes and video laryngoscopes. For critically ill adults undergoing emergency tracheal intubation, it remains uncertain whether the use of a video laryngoscope increases the incidence of successful intubation on the first attempt compared with the use of a direct laryngoscope.
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(DEVICE) trial is a prospective, multicentre, non-blinded, randomised trial being conducted in 7 EDs and 10 ICUs in the USA. The trial plans to enrol up to 2000 critically ill adults undergoing orotracheal intubation with a laryngoscope. Eligible patients are randomised 1:1 to the use of a video laryngoscope or a direct laryngoscope for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcome is the incidence of severe complications between induction and 2 min after intubation, defined as the occurrence of one or more of the following: severe hypoxaemia (lowest oxygen saturation <80%); severe hypotension (systolic blood pressure <65 mm Hg or new or increased vasopressor administration); cardiac arrest or death. Enrolment began on 19 March 2022 and is expected to be completed in 2023.
The trial protocol was approved with waiver of informed consent by the single institutional review board at Vanderbilt University Medical Center and the Human Research Protection Office of the Department of Defense. The results will be presented at scientific conferences and submitted for publication in a peer-reviewed journal.
ClinicalTrials.gov Registry (NCT05239195).
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