Blinded Interviews Research Articles

Brief Cognitive Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated after discharge from inpatient level of care. Empirically supported inpatient suicide prevention treatments are needed. To determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether substance use disorder moderates treatment effects. This randomized clinical trial compared treatment as usual (n = 106) to treatment as usual plus brief cognitive behavioral therapy for inpatients (n = 94) at a private psychiatric hospital in Connecticut. Follow-up assessments were completed monthly for 6 months postdischarge. Participants were enrolled from January 2020 through February 2023. Inpatients admitted following a suicidal crisis (past-week suicide attempt or ideation with plan on admission and attempt within previous 2 years) were included. Medical records of consecutive admissions (n = 4137) were screened, 213 were study eligible and randomized, and 200 were analyzed. A total of 114 participants (57.0%) completed 6-month follow-up assessments. Data from medical records were also obtained through 6-month follow-up. Up to 4 individual sessions of brief cognitive behavioral therapy for suicide prevention designed for inpatients. Suicide attempts and readmissions were assessed via blind interviews and medical record review. Suicidal ideation was assessed via self-report. The mean (SD) age among 200 analyzed participants was 32.8 (12.6) years; 117 participants were female and 83 were male. Brief cognitive behavioral therapy-inpatient reduced the occurrence of suicide attempt over 6 months postdischarge by 60% (odds ratio, 0.40; 95% CI, 0.20-0.80; number needed to treat, 7) in the entire patient group, and the rate of psychiatric readmissions by 71% (rate ratio, 0.29; 95% CI, 0.09-0.90) in those without a substance use disorder. The effect of treatment condition on suicidal ideation was less clear, although post hoc analyses indicated less severe suicidal ideation following brief cognitive behavioral therapy-inpatient vs treatment as usual at 1 and 2 months postdischarge. Brief cognitive behavioral therapy-inpatient reduced 6-month postdischarge suicide reattempts and rate of readmissions when added to treatment as usual. Substance use disorder moderated the treatment's effect on readmission rates. Treatment effects on suicidal ideation were less clear. Implementation research is needed to facilitate dissemination. Additional research is also needed to optimize outcomes for individuals with substance use disorders. ClinicalTrials.gov Identifier: NCT04168645.

Adjuvant Psychotherapies to Prevent Relapse in Bipolar Disorder

Several psychotherapy protocols have been evaluated as adjuncts to pharmacotherapy for patients with bipolar disorder (BD). Little is known about their comparative effectiveness. To compare the effectiveness of 2 types of group psychotherapy, skill-oriented, material-based cognitive behavioral therapy (SEKT) and supportive, patient-centered, emotion-focused therapy (FEST), to prevent relapse in patients with euthymic BD. This was a large, observer-blind, randomized clinical trial conducted over 18 months (posttreatment after 6 months; follow-up at 12 and 18 months). In addition to psychiatric care as usual (including mood-stabilizing medication), each participant at 9 clinical outpatient units in Germany received 24 hours of group psychotherapy over 4, full-day sessions spread over 5 months. Patients with euthymic BD type 1 (BD 1) or BD type 2 (BD 2) between the ages of 18 and 50 years were randomly assigned to 1 of 2 forms of psychotherapy, SEKT or FEST. Independent clinicians blinded to patient grouping performed assessments using structured interviews (Structured Clinical Interview for DSM Disorders and Longitudinal Interval Follow-Up Evaluation) and self-rating and clinician rating for inclusion criteria and outcome. Kaplan-Meier survival curves were calculated for time to relapse. Cox proportional hazards statistics and propensity score matching were calculated for the multivariate analysis. Study data were analyzed from March 2020 to September 2022. SEKT intervention is a structured cognitive behavioral therapy integrating elements of interpersonal social rhythm therapy, and of mindfulness-based cognitive therapy. FEST psychotherapy has its roots in emotion-focused, supportive, and nondirective therapy. Recurrence of a new affective episode assessed by blinded interviewer with the LIFE interview. In addition, self-rating and clinician rating of depressive and mania symptoms as well as level of social functioning were assessed. Of 348 screened referrals, 305 patients (median [IQR] age, 34 [18-50] years; 162 male [53%]) with euthymic BD 1 or BD 2 were included in the study. A total of 207 patients (68%) had BD 1, 98 (32%) had BD 2, and 278 (91%) received psychiatric care. Both therapies were equally effective in preventing recurrence of a new episode. Outcome (higher rate of new episodes) was not predicted by kind of treatment (SEKT: 69 [49%] relapse; FEST: 63 [46%] relapse) but was predicted by BD 2, comorbidity, attending all sessions, and the interaction of type of treatment by BD 1 or 2. Patients with BD 2 had the highest rate of relapse (60 [61%] relapse), in particular, when treated by SEKT (39 [70%] relapse). Results of this randomized clinical trial revealed that a structured, skill-oriented, material-based cognitive behavioral therapy (SEKT) and a supportive, patient-centered, emotion-focused therapy (FEST) were equally effective in preventing relapse of affective episodes when delivered in a new, intensive group format. Additionally, there were baseline factors, in particular BD 2, that influenced outcomes. ClinicalTrials.gov Identifier: NCT02506322.

Case-control study to identify management practices associated with morbidity or mortality due to bovine anaplasmosis in Mississippi cow-calf herds

Bovine anaplasmosis (BA) is a costly disease affecting the U.S. beef cattle industry. Chlortetracycline (CTC) in feed or mineral supplements is often used to control clinical signs of BA. The objective of this study was to determine if manage­ment practices, such as feeding CTC, are associated with ill­ness or death from BA in Mississippi cow-calf herds. Case and control herds were solicited from veterinary practices across Mississippi. Cases were herds with clinical BA diagnosed by a veterinarian within the previous calendar year. Controls were herds under the care of the same practice with no clini­cal BA diagnosed in the previous year. Blinded interviewers conducted telephone surveys of case and control herd owners. Management and biosecurity factors were tested for associa­tion with herd status using a logistic regression generalized linear mixed model with veterinary practice as a random vari­able. Twenty-two case and 25 control herds from 6 veterinary practices across Mississippi were interviewed, representing 22 counties. The average herd size was 132 for case herds, and 136 for control herds. Twenty case herds and 13 control herds fed CTC medicated mineral or feed. Providing CTC was associated with case herd status (OR = 9.2, 95% C.I. = 1.7-50.7). The association observed between case herds and feeding CTC might be because: 1) herds that had experienced previous BA morbidity and mor­tality subsequently began feeding CTC, or 2) some individual cattle consume enough CTC to achieve clearance of the per­sistent carrier state, thereby increasing risk of reinfection and clinical BA.

Clinical reappraisal of the composite international diagnostic interview version 3.3 in Qatar's National Mental Health Study.

Lifetime DSM-5 diagnoses generated by the lay-administered Composite International Diagnostic Interview for DSM-5 (CIDI) in the World Mental Health Qatar (WMHQ) study were compared to diagnoses based on blinded clinician-administered reappraisal interviews. Telephone follow-up interviews used the non-patient edition of the Structured Clinician Interview for DSM-5 (SCID) oversampling respondents who screened positive for five diagnoses in the CIDI: major depressive episode, mania/hypomania, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Concordance was also examined for a diagnoses of post-traumatic stress disorder based on a short-form versus full version of the PTSD Checklist for DSM-5 (PCL-5). Initial CIDI prevalence estimates differed significantly from the SCID for most diagnoses ( =6.6-31.4, p=0.010<0.001), but recalibration reduced most of these differences and led to consistent increases in individual-level concordance (AU-ROC) from 0.53-0.76 to 0.67-0.81. Recalibration of the short-form PCL-5 removed an initially significant difference in PTSD prevalence with the full PCL-5 (from =610.5, p<0.001 to =2.5, p=0.110) while also increasing AU-ROC from 0.76 to 0.81. Recalibration resulted in valid diagnoses of common mental disorders in the Qatar National Mental Health Survey, but with inflated prevalence estimates for some disorders that need to be considered when interpreting results.

The delayed impact of informed versus blind interviewing on eyewitness memory

AbstractBackgroundPrevious research has highlighted the potentially detrimental effects of pre‐interview preparation on witness memory within an interview context (Rivard et al., 2016). The present study examined the effect of an interviewer's pre‐interview knowledge on eyewitness memory beyond the initial interview.MethodStudent witnesses were interviewed one week after viewing a mock crime event by a student interviewer who was either correctly informed, incorrectly informed, or uninformed (blind) to case details and who was either told to avoid suggestions or was not given cautionary instructions.ResultsAnalyses of the witnesses' recall quantity and quality one week after the interview revealed that witnesses of blind interviewers recalled more details than witnesses of incorrectly informed interviewers. Witnesses of blind interviewers were also more accurate than witnesses of incorrectly informed interviewers, but only when interviewers were warned not to ask suggestive questions.ImplicationsFindings suggest that interviewer training and pre‐interview knowledge may play an important role in witness recall.

Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol

BackgroundEach year in the US, approximately 1.5–2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. MethodsThe single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. ConclusionsThe overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations.Trial Registration:Clinicaltrials.govNCT05632770

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Successful Integration of Blinded Interviews for Resident Selection: Applicant and Faculty Perspective

To evaluate interviewer and interviewee perceptions of semiblinded interviews performed during 2021-2022 and 2022-2023 urology matches at our institution. Traditional interviews, where interviewers have access to the entire application, are open to significant bias. Blinded interviews are common in industry but under explored in resident selection. Interviewers had access to a limited portion of the application (personal statement and letters of recommendation). Applicants were ranked by faculty based solely on their interview and these documents. Following the interview, a survey was given to applicants and faculty regarding their experience. A total of 67 applicants and 10 faculty responded to the questionnaire. Among applicants, 51% felt that blinding of interviewers offered a better assessment of fit into our program (39% neutral), while 37% felt they had improved eye contact with the interviewer (51% neutral) and that interviewers had improved (66%) or similar (19%) knowledge of their application in relation to nonblinded interviews. All but one faculty member felt able to accurately assess a candidate with the information provided, and 80% felt that the blinded interview allowed them to focus more on the applicant during the interview (20% neutral). Semiblinded interviews allow for accurate assessment of applicants and decrease bias in the interview process. Overall applicants and faculty were highly receptive to blinded interviews. Reducing the amount of information available to the interviewer allowed them to spend more time on the materials provided, leading to both improved eye contact and improved engagement between participants.

Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study.

frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy seven item questionnaire (PRISMA-7) and InterRAI-ED at predicting adverse outcomes at 30days and 6months amongst older adults presenting to the Emergency Department (ED). a prospective cohort study of adults ≥65years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30days and 6months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables. a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes. older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention.

Effect of Holistic Review, Interview Blinding, and Structured Questions in Resident Selection: Can we Predict Who Will Do Well in a Residency Interview?

ObjectiveTo examine the Urology residency application process, particularly the interview. Historically, the residency interview has been vulnerable to bias and not determined to be a predictor of future residency performance. Our goal is to determine the relationship between pre-interview metrics and post-interview ranking using best practices for Urology resident selection including holistic review, blinded interviews, and structured behaviorally anchored questions. MethodsApplications were assessed on cognitive (Alpha Omega Alpha, class rank, junior year clinical clerkship grades) and non-cognitive attributes (letters of recommendation [LOR], personal statement [PS], demographics, research, personal characteristics) by reviewers blinded to USMLE scores and photograph. Interviewers were blinded to the application other than PS and LORs. Interviews consisted of a structured behaviorally anchored question (SBI) and an unstructured interview (UI). Odds ratios were determined comparing pre-interview and interview impressions. ResultsFifty-one applicants were included in the analysis. USMLE step 1 score (average 245) was associated with Alpha Omega Alpha, class rank, junior year clinical clerkship, and PS. The UI score was associated with the LOR (P = .04) whereas SBI scores were not (P = .5). Faculty rank was associated with SBI, UI, and overall interview (OI) scores (P < .001). Faculty rank was also associated with LOR. Resident impression of interviewees were associated with faculty interview scores (P = .001) and faculty rank (P < .001). ConclusionTraditional interviews may be biased toward application materials and may be balanced with behavioral questions. While Step 1 score does not offer additional information over other PI metrics, blinded interviews may offer discriminant validity over a PI rubric.

Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders

Anxiety disorders are common, highly distressing, and impairing conditions. Effective treatments exist, but many patients do not access or respond to them. Mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR) are popular and can decrease anxiety, but it is unknown how they compare to standard first-line treatments. To determine whether MBSR is noninferior to escitalopram, a commonly used first-line psychopharmacological treatment for anxiety disorders. This randomized clinical trial (Treatments for Anxiety: Meditation and Escitalopram [TAME]) included a noninferiority design with a prespecified noninferiority margin. Patients were recruited between June 2018 and February 2020. The outcome assessments were performed by blinded clinical interviewer at baseline, week 8 end point, and follow-up visits at 12 and 24 weeks. Of 430 individuals assessed for inclusion, 276 adults with a diagnosed anxiety disorder from 3 urban academic medical centers in the US were recruited for the trial, and 208 completed the trial. Participants were 1:1 randomized to 8 weeks of the weekly MBSR course or the antidepressant escitalopram, flexibly dosed from 10 to 20 mg. The primary outcome measure was anxiety levels as assessed with the Clinical Global Impression of Severity scale (CGI-S), with a predetermined noninferiority margin of -0.495 points. The primary noninferiority sample consisted of 208 patients (102 in MBSR and 106 in escitalopram), with a mean (SD) age of 33 (13) years; 156 participants (75%) were female; 32 participants (15%) were African American, 41 (20%) were Asian, 18 (9%) were Hispanic/Latino, 122 (59%) were White, and 13 (6%) were of another race or ethnicity (including Native American or Alaska Native, more than one race, or other, consolidated owing to low numbers). Baseline mean (SD) CGI-S score was 4.44 (0.79) for the MBSR group and 4.51 (0.78) for the escitalopram group in the per-protocol sample and 4.49 (0.77) vs 4.54 (0.83), respectively, in the randomized sample. At end point, the mean (SD) CGI-S score was reduced by 1.35 (1.06) for MBSR and 1.43 (1.17) for escitalopram. The difference between groups was -0.07 (0.16; 95% CI, -0.38 to 0.23; P = .65), where the lower bound of the interval fell within the predefined noninferiority margin of -0.495, indicating noninferiority of MBSR compared with escitalopram. Secondary intent-to-treat analyses using imputed data also showed the noninferiority of MBSR compared with escitalopram based on the improvement in CGI-S score. Of patients who started treatment, 10 (8%) dropped out of the escitalopram group and none from the MBSR group due to adverse events. At least 1 study-related adverse event occurred for 110 participants randomized to escitalopram (78.6%) and 21 participants randomized to MBSR (15.4%). The results from this randomized clinical trial comparing a standardized evidence-based mindfulness-based intervention with pharmacotherapy for the treatment of anxiety disorders found that MBSR was noninferior to escitalopram. ClinicalTrials.gov Identifier: NCT03522844.

303 SCREENING INSTRUMENTS TO PREDICT ADVERSE OUTCOMES FOR UNDIFFERENTIATED OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: RESULTS OF SOAED PROSPECTIVE COHORT STUDY

Abstract Background Frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention in the acute or community setting. We assessed the validity of the ISAR (Identification of Seniors at Risk), Rockwood Clinical Frailty Scale (CFS), PRISMA-7 and InterRAI-ED at predicting adverse outcomes at 30 days and six months among older adults presenting to the ED. Methods A prospective cohort study of consecutive older adults (≥65 years) who presented to the ED at a University Hospital was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were performed by an experienced ED research nurse. Blinded follow-up telephone interviews were completed at 30 days and six months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity and specificity of the screening tools were calculated using 2×2 tables. Results 419 patients were recruited with 49% female and a mean age of 76.9 years (SD 7.15). The prevalence of frailty varied across the screening tools (ISAR, 47% vs InterRAI-ED, 63%). At 30-days, mortality rate was 5.4%, ED re-attendance 16.9%, hospital readmission 13.6%, functional decline 47.1% and nursing home admission 7.3%. Older adults who screened positive for frailty demonstrated an increased risk of all adverse outcomes at 30 days and 6 months, regardless of frailty screening tool administered. All tools had a relatively high sensitivity but low specificity. The ISAR was the only tool which was statistically significant at predicting all outcomes at 30 days. Conclusion The ISAR, CFS, PRISMA-7 and InterRAI-ED demonstrated modest validity at predicting adverse outcomes at 30 days and 6 months. We would recommend the implementation of one of these frailty screening tools in Irish EDs to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention in the hospital or community setting.

Best Practices for Reducing Bias in the Interview Process.

Purpose of ReviewObjective measures of residency applicants do not correlate to success within residency. While industry and business utilize standardized interviews with blinding and structured questions, residency programs have yet to uniformly incorporate these techniques. This review focuses on an in-depth evaluation of these practices and how they impact interview formatting and resident selection.Recent FindingsStructured interviews use standardized questions that are behaviorally or situationally anchored. This requires careful creation of a scoring rubric and interviewer training, ultimately leading to improved interrater agreements and biases as compared to traditional interviews. Blinded interviews eliminate even further biases, such as halo, horn, and affinity bias. This has also been seen in using multiple interviewers, such as in the multiple mini-interview format, which also contributes to increased diversity in programs. These structured formats can be adopted to the virtual interviews as well.SummaryThere is growing literature that using structured interviews reduces bias, increases diversity, and recruits successful residents. Further research to measure the extent of incorporating this method into residency interviews will be needed in the future.

Neural Markers of Methylphenidate Response in Children With Attention Deficit Hyperactivity Disorder.

BackgroundDespite widespread use of stimulants to treat ADHD, individual responses vary considerably and few predictors of response have been identified. The identification of reliable and clinically feasible biomarkers would facilitate a precision medicine approach to pharmacological treatment of ADHD. We test the hypothesis that two electroencephalography (EEG) based neural signatures of ADHD, resting aperiodic slope exponent and novelty P3 amplitude, are markers of methylphenidate response in children. We hypothesize that positive response to methylphenidate treatment will be associated with greater abnormality of both neural markers.MethodsTwenty-nine 7-11 year-old children with ADHD and a history of methylphenidate treatment, and 30 controls completed resting EEG and visual oddball event related potential (ERP) paradigms. ADHD participants were characterized as methylphenidate responders (n = 16) or non-responders (n = 13) using the clinical global improvement (CGI-I) scale during blinded retrospective interview. All participants abstained from prescribed medications for at least 48 hours prior to the EEG.ResultsAs expected, methylphenidate responders (CGI-I rating < 3) demonstrated attenuated P3 amplitude relative to controls. Unexpectedly, methylphenidate non-responders showed atypically flat aperiodic spectral slope relative to controls, while responders did not differ on this measure.ConclusionADHD symptoms associated with atypical patterns of intrinsic neural activity may be less responsive to methylphenidate. In contrast, ADHD symptoms associated with abnormal frontal-striatal neural network excitation may be correctable with methylphenidate. Altogether, EEG is a feasible and promising candidate methodology for identifying biomarkers of stimulant response.

Impact of blinding interviewers to written applications on ranking of Gynecologic Oncology fellowship applicants from groups underrepresented in medicine

Biases in application review may limit access of applicants who are underrepresented in medicine (URM) to graduate medical training opportunities. We aimed to evaluate the association between blinding interviewers to written applications and final ranking of all applicants and URM applicants for Gynecologic Oncology fellowship. During 2020 virtual Gynecologic Oncology fellowship interviews, we blinded one group of interviewers to written applications, including self-reported URM status. Interviewers visually interacted with the applicants but did not review their application.Interviewers submitted independent rank lists. We compared pooled rankings of blinded and non-blinded interviewers for all applicants and for URM applicants using appropriate bivariate statistics.We received 94 applications for two positions through the National Resident Matching Program, of which 18 (19%) self-identified as URM.We invited 40 applicants to interview and interviewed 30 applicants over six sessions. Ten interviewees (33%) self-identified as URM.Of 12 or 13 faculty interviewers during each interview session, 3 or 4 were blinded to the written application. There was no statistically significant difference in rank order when comparing blinded to non-blinded interviewers overall. However, blinded interviewers ranked URM applicants higher than non-blinded interviewers (p = 0.04). Blinding of written application metrics may allow for higher ranking of URM individuals.

Role of Statins on Cognition and Section Memory: A Case-control Study

Introduction: Statins are a class of lipid lowering medication which can effectively lower cardiovascular mortality and morbidity by the beneficial effects in atherosclerotic cardiovascular disease. Recently, there are increasing concerns over the relationship between statins and cognitive deficits. On the contrary, some studies have indicated an improvement in memory functions with the use of statins. However, the impact of statins on cognition is still unclear. Aim: To analyse the effect of statins on cognition and memory using Mini-Mental Scale Examination (MMSE). Materials and Methods: The case control study was conducted in Department of Cardiology at PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India (tertiary care teaching hospital), from June 2019 to December 2019. Out of total 127 participants, case group included 63 adult patients of both gender, on statin therapy for at least 12 weeks duration and control group included 64 age and gender matched adults who were not on statin therapy. After obtaining a written informed consent, MMSE questionnaire was administered by a trained blinded interviewer to both groups. Pearson’s correlation was done to evaluate any significant correlation between duration of statin therapy with MMSE and individual domain scores. Data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0, and p-value &lt;0.05 was considered significant. Results: The mean age of the cases was 61.1±7.90 years, and that of the control group was 60.6±7.68 years. Using the cut-off score of 23 to diagnose dementia, 21 (33.3%) cases and 24 (37.5%) control participants had cognitive deficits, with no statistically significant difference. The mean score of patients on statin therapy for more than one year (26.45±3.03) was higher compared to those with less than or equal to one year duration of therapy (24.48±4.11), but did not reach statistical significance. But, statistically significant difference between mean scores of cases and controls was evident in cognitive domains like registration (p-value=0.01) and recall (p-value=0.04) in addition to a significant correlation (p-value=0.03) between the duration of statin therapy and orientation score. Conclusion: This study refutes the possibility of an association of statin therapy with cognitive decline in the study population. On the other hand, the results are illustrative of a potential cognitive benefit with the use of statins.

Validation of screening tools for common mental health disorders in the methadone maintenance population in Hanoi, Vietnam

BackgroundCommon mental health disorders (CMDs), including depression, anxiety and post-traumatic stress disorder (PTSD) may worsen both HIV and drug use outcomes, yet feasible tools to accurately identify CMDs have received limited study in this population. We aimed to validate the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder screen (GAD-7) and Primary Care PTSD screen for DSM-5 (PC-PTSD-5) in a methadone maintenance therapy (MMT) patient population in Hanoi, Vietnam.MethodsWe conducted a cross-sectional survey. The PHQ-9, GAD-7, and PC-PTSD-5 were administered to MMT patients. A blinded interviewer administered the Mini-International Neuropsychiatric Interview (MINI) as the reference gold standard. Total scores of each tool were compared with the MINI diagnoses using a receiver operating characteristic curves, and we identified the optimal respective cut-off scores using the Youden’s Index.ResultsWe enrolled 400 MMT patients. Approximately 99.3% were male (n = 397) and 21.8% (n = 87) were HIV positive. The prevalence of major depressive disorder, generalized anxiety disorder and PTSD, respectively, was 10.5, 4 and 2%. Optimal cut-off scores for the PHQ-9, GAD-7 and PC-PTSD were ≥ 5, ≥3, and ≥ 4 with a sensitivity/specificity of 95.2%/91.9, 93.8%/87.5, and 62.5%/95.2%.ConclusionsThe prevalence of CMDs in the MMT population was lower than expected. A lower cut-off score may be considered when screening for CMDs in this population. Further research should investigate the validity of somatic symptom-based screening tools among other drug-using or MMT populations.

Effect of the STAMP (Sharing and Talking About My Preferences) Intervention on Completing Multiple Advance Care Planning Activities in Ambulatory Care : A Cluster Randomized Controlled Trial.

Interventions with the potential for broad reach in ambulatory settings are necessary to achieve a life course approach to advance care planning. To examine the effect of a computer-tailored, behavioral health model-based intervention on the engagement of adults in advance care planning recruited from ambulatory care settings. Cluster randomized controlled trial with participant-level analysis. (ClinicalTrials.gov: NCT03137459). 10 pairs of primary and selected specialty care practices matched on patient sociodemographic information. English-speaking adults aged 55 years or older; 454 adults at practices randomly assigned to usual care and 455 at practices randomly assigned to intervention. Brief telephone or web-based assessment generating a mailed, individually tailored feedback report with a stage-matched brochure at baseline, 2 months, and 4 months. The primary outcome was completion of the following 4 advance care planning activities at 6 months: identifying and communicating with a trusted person about views on quality versus quantity of life, assignment of a health care agent, completion of a living will, and ensuring that the documents are in the medical record-assessed by a blinded interviewer. Secondary outcomes were completion of individual advance care planning activities. Participants were 64% women and 76% White. The mean age was 68.3 years (SD, 8.3). The predicted probability of completing all advance care planning activities in usual care sites was 8.2% (95% CI, 4.9% to 11.4%) versus 14.1% (CI, 11.0% to 17.2%) in intervention sites (adjusted risk difference, 5.2 percentage points [CI, 1.6 to 8.8 percentage points]). Prespecified subgroup analysis found no statistically significant interactions between the intervention and age, education, or race. The study was done in a single region and excluded non-English speaking participants. No information was collected about nonparticipants. A brief, easily delivered, tailored print intervention increased participation in advance care planning in ambulatory care settings. National Institute of Nursing Research and National Institute of Aging.

Impact of blinding interviewers to written application on ranking of applicants from underrepresented minorities (URM) in the gynecologic oncology fellowship match

<h3>Objectives:</h3> Preconceptions from application review in preparation for a professional interview may bias the professional interview. Biases may limit the access of underrepresented minorities (URM) to advanced medical training opportunities, such as subspecialty training. We evaluated whether blinding interviewers to applicants' written application was associated with difference in proportion of URM applicants ranked highly for our gynecologic oncology fellowship match compared to interviewers having reviewed written applications prior to the interviews. <h3>Methods:</h3> During our 2020 video Gynecologic Oncology interviews, we blinded one group of our interviewers to the written applications of the interviewees. Interviewers were able to visually interact with the candidates, but were blinded to the written aspects of the application, such as test scores and letters of reference. There were no opportunities to interact with the applicants before or after the interview, and interviewers submitted independent rank lists. Interviewers also did not know that they were being assessed as to ranking of URM candidates. We compared the pooled rankings of URM applicants of our blinded and non-blinded interviewers using a Medians Test and Mann-Whitney U test. <h3>Results:</h3> For 2 positions through the National Residency Program Match Process, we received 94 applications of which 18/94 (19%) were self-identified URM. Based on review of written application and minimum application criteria for our fellowship, we invited 36 applicants to interview and interviewed 30 over 6 half-day video sessions. A total of 11 of the 30 interviewees (37%) self-identified as URM. Of the eight faculty interviewers during each interview session, 3 or 4 were blinded to the written application. There was no statistically significant difference in rank order when comparing blinded to non-blinded reviewers overall. However, blinded interviewers were more likely to rank URM applicants towards the top of the rank list (p=0.05 Median Test, 0.044 Mann-Whitney U test). <h3>Conclusions:</h3> Interviewers blinded to written applications ranked URM applicants higher than interviewers who reviewed written applications prior to video interviews. Additional research is necessary to understand the etiology of this observed difference.

Navigating Bias on Interview Day: Strategies for Charting an Inclusive and Equitable Course.

Navigating Bias on Interview Day: Strategies for Charting an Inclusive and Equitable Course.