Citations

Aims and objectives To describe patients’ experiences from symptom onset to initial treatment for atrial fibrillation. Background The estimated number of individuals with atrial fibrillation globally in 2010 was 33·5 million. World‐wide, each year, new cases of atrial fibrillation approach 5 million, and prevalence will increase 2·5‐fold by 2050. As a result, clinicians worldwide will treat a growing number of patients with atrial fibrillation. Early intervention to promote atrial fibrillation self‐management is critical to reduce associated complications of stroke and heart failure. Greater understanding of patients’ experiences from symptom onset to initial treatment for atrial fibrillation is needed to guide development of interventions to promote early effective self‐management. Design A descriptive qualitative design was used. Methods Twenty females and 21 males at an academic medical centre were interviewed using open‐ended questions to explore their experiences from symptom onset to initial treatment for atrial fibrillation. Data were analysed using qualitative content analysis. Results Participants’ mean age was 64·3 (SD = 10·1) years. Four themes were identified: (1) misinterpreting symptoms; (2) discovering the meaning of atrial fibrillation; (3) facing fears, uncertainty, and moving to acceptance; and (4) receiving validation and reassurance. Participants lacked knowledge of atrial fibrillation and took cues from providers’ responses to appraise symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment and took time to explain atrial fibrillation. Patients appreciated receiving clear information about atrial fibrillation, were engaged in learning, and motivated to participate in their care. Conclusions Providers played a critical role in helping patients to develop an accurate understanding of atrial fibrillation, to cope with the new diagnosis, and motivated them to engage in effective self‐management. Relevance to clinical practice Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self‐management.

AbstractPerformance of patients with quadrant lesions on the inherently ambiguous Cognitive Bias Task (CBT) suggests sexual dimorphism in the fundamental aspects of functional cortical geometry, by emphasizing different cerebral axes. In right-handed males, extreme context-dependent and context-independent response selection biases are reciprocally linked to left vs. right frontal systems. In right-handed females, these complementary biases appear to be reciprocally linked to posterior vs. frontal cortices. Frontal lobe functions are more lateralized in males than females due to sexual dimorphism of the left frontal systems. Both in males and females, patterns of CBT scores in non-right-handers with quadrant lesions are opposite to those found in right-handers. This suggests the existence of two functionally and neurally distinct cognitive selection mechanisms. Both mechanisms involve the frontal lobes, but their exact neuroanatomy depends on sex and handedness.

Abstract Executive function mediated by prefrontally driven distributed networks is frequently impaired by traumatic brain injury (TBI) as a result of diffuse axonal injury and focal lesions. In addition to executive cognitive functions such as planning and working memory, the effects of TBI impact social cognition and motivation processes. To encourage application of cognitive neuroscience methods to studying recovery from TBI, associated reorganization of function, and development of interventions, this article reviews the pathophysiology of TBI, critiques currently employed methods of assessing executive function, and evaluates promising interventions that reflect advances in cognitive neuroscience. Brain imaging to identify neural mechanisms mediating executive dysfunction and response to interventions following TBI is also discussed.