Case Vignettes Research Articles

ChatGPT for Teachers: Practical Examples for Utilizing Artificial Intelligence for Educational Purposes

Background: Artificial intelligence (AI), specifically ChatGPT, has the potential to revolutionize medical education by acting as an interactive virtual tutor and personalized learning assistant. It may help both teachers and students in various ways. Objective: The objective of this article is to provide practical examples of the utilization of ChatGPT for educational purposes in the context of teaching. Materials and Methods: The article presents various scenarios and applications where ChatGPT can be effectively employed by teachers. These examples are based on real-world experiences and observations, showcasing the potential of AI in enhancing educational practices. Results: The article demonstrates how ChatGPT can serve as a valuable tool for teachers in preparation of presentation slide, formulating essay-type, multiple choice, and viva questions, answering students’ queries, making customized content for students according to comprehension capability, evaluation of answers, creating case vignette, plan a lesson, or create contents for blended learning. Conclusion: The findings of this article emphasize the practical implications and benefits of utilizing ChatGPT for educational purposes. Teachers who are overburdened with academic loads can take help from the program. However, teachers must use it with caution as the content created by ChatGPT may have errors or have scientific inaccuracy. Future research should focus on exploring the long-term effects and pedagogical strategies for effective implementation of ChatGPT in educational settings.

Old dog, new tricks? Exploring the potential functionalities of ChatGPT in supporting educational methods in social psychiatry.

Artificial Intelligence is ever-expanding and large-language models are increasingly shaping teaching and learning experiences. ChatGPT is a prominent recent example of this technology and has generated much debate around the benefits and disadvantages of chatbots in educational domains. This study seeks to demonstrate the possible use-cases of ChatGPT in supporting educational methods specific to social psychiatry. Through interactions with ChatGPT 3.5, we asked this technology to list six ways in which it could aid social psychiatry teaching. Subsequently, we requested that ChatGPT perform one of the tasks it identified in its responses. ChatGPT highlighted several roles it could fulfil in educational settings, including as an information provider, a tool for debates and discussions, a facilitator of self-directed learning and a content-creator for course materials. For the latter scenario, based on another prompt, ChatGPT generated a hypothetical case vignette for a topic relevant to social psychiatry. Based on our experiences, ChatGPT can be an effective teaching tool, offering opportunities for active and case-based learning for students and instructors in social psychiatry. However, in their current form, chatbots have several limitations that must be considered, including misinformation and inherent biases, although these may only be temporary in nature as these technologies continue to advance. Accordingly, we argue that large-language models can support social psychiatry education with appropriate caution and encourage educators to become attuned to their potential through further detailed research in this area.

Between Leisure and Pressure—Veterinarians’ Attitudes towards the Care of Competition Horses in Germany, Austria and Switzerland

Equine veterinarians face a range of challenges when attending competition horses. Athletic goals may significantly impact veterinary decision making, and the veterinarian’s work can be complicated by reputational considerations and rival opinions during an assessment of whether a horse is “fit to compete”. Using an online questionnaire, we found that the majority of German, Austrian and Swiss equine veterinarians (N = 172) surveyed agreed that the owners of competition horses are more likely than owners of leisure horses to approach them with clear treatment ideas, and that the former have higher expectations of the medical services provided. The data also show that the veterinarian’s reputation plays a more important role in the competition sphere. Using a case vignette, we established that, on the grounds of equine welfare, the majority of respondents indicated that they would decide against starting a dressage horse with low-grade lameness in a competition. Those respondents who indicated that they would approve a start of the dressage horse indicated that a horse with a low-grade lameness was fit enough “to compete”. We conclude that clearer definitions of phrases, such as “fit to compete”, may be helpful in guiding veterinarians as they discharge their professional responsibilities during competitions and reduce the reputational stress they experience in this working context.

Foundations of the Positive Affect Tolerance Protocol: The Central Role of Interpersonal Positive Affect in Attachment and Self-Regulation

Research has highlighted the negative effects of early neglect and abuse on the development of emotional self-regulation and attachment. Attention has focused more on negative affect states related to past adverse and traumatic experiences than on the deactivating effects of the absence of early shared positive affect states from parent-infant play, warmth, and affection. Treatment strategies for survivors of early neglect and abuse have focused on methods to metabolize memories of traumatic events. Skills development models have emphasized the benefits of distress tolerance, acceptance, and mindfulness training for patients with persistent negative affect states. Research on the benefits of therapeutic interventions intended to increase positive affect indicates they promote prosocial behaviors and creativity, broaden the scope of attention, reduce emotional symptoms and behavioral problems, and improve physical health. Within the field of eye movement desensitization and reprocessing (EMDR) therapy, procedures to increase positive affect have generally focused on resource development and installation procedures intended to increase access to positive affect-related memories and images. A neglected clinical issue is the inability of survivors of early neglect to tolerate and integrate actual positive interpersonal experience into positive emotional states, interpersonal scripts, or self-concepts. These deficiencies, characteristic of those with dismissing insecure attachment, help produce and maintain profound psychological, medical, and social problems that limit the ability of patients with these histories from progressing in psychotherapy. This article explores research supporting the potential benefits of an EMDR-related procedure, the positive affect tolerance (PAT) and integration protocol, along with possible mechanisms by which the PAT protocol in general, and its bilateral stimulation procedures, might produce clinical benefits for survivors of early neglect. Case vignettes illustrate the potential challenges of implementing and the potential impact of the PAT protocol. Research designs and assessment tools are described that could clarify the potential benefits of the PAT protocol compared to other treatments designed to increase positive affect.

Do malpractice claim clinical case vignettes enhance diagnostic accuracy and acceptance in clinical reasoning education during GP training?

BackgroundUsing malpractice claims cases as vignettes is a promising approach for improving clinical reasoning education (CRE), as malpractice claims can provide a variety of content- and context-rich examples. However, the effect on learning of adding information about a malpractice claim, which may evoke a deeper emotional response, is not yet clear. This study examined whether knowing that a diagnostic error resulted in a malpractice claim affects diagnostic accuracy and self-reported confidence in the diagnosis of future cases. Moreover, suitability of using erroneous cases with and without a malpractice claim for CRE, as judged by participants, was evaluated.MethodsIn the first session of this two-phased, within-subjects experiment, 81 first-year residents of general practice (GP) were exposed to both erroneous cases with (M) and erroneous cases without (NM) malpractice claim information, derived from a malpractice claims database. Participants rated suitability of the cases for CRE on a five-point Likert scale. In the second session, one week later, participants solved four different cases with the same diagnoses. Diagnostic accuracy was measured with three questions, scored on a 0–1 scale: (1) What is your next step? (2) What is your differential diagnosis? (3) What is your most probable diagnosis and what is your level of certainty on this? Both subjective suitability and diagnostic accuracy scores were compared between the versions (M and NM) using repeated measures ANOVA.ResultsThere were no differences in diagnostic accuracy parameters (M vs. NM next step: 0.79 vs. 0.77, p = 0.505; differential diagnosis 0.68 vs. 0.75, p = 0.072; most probable diagnosis 0.52 vs. 0.57, p = 0.216) and self-reported confidence (53.7% vs. 55.8% p = 0.390) of diagnoses previously seen with or without malpractice claim information. Subjective suitability- and complexity scores for the two versions were similar (suitability: 3.68 vs. 3.84, p = 0.568; complexity 3.71 vs. 3.88, p = 0.218) and significantly increased for higher education levels for both versions.ConclusionThe similar diagnostic accuracy rates between cases studied with or without malpractice claim information suggests both versions are equally effective for CRE in GP training. Residents judged both case versions to be similarly suitable for CRE; both were considered more suitable for advanced than for novice learners.

A Bayesian predictive processing account of Othello syndrome in Parkinson’s disease

ABSTRACT Introduction: Although delusions in Parkinson’s disease (PD) are rare, when they occur they frequently take the form of “Othello syndrome”: the irrational belief that a spouse or partner is being unfaithful. Hitherto dismissed as either a by-product of dopamine therapy or cognitive impairment, there are still no convincing theoretical accounts to explain why only some patients fall prey to this delusion, or why it persists despite clear disconfirmatory evidence. Methods: We discuss the limitations of existing explanations of this delusion, namely hyperdopaminergia-induced anomalous perceptual experiences and cognitive impairment, before describing how Bayesian predictive processing accounts can provide a more comprehensive explanation by foregrounding the importance of prior experience and its impact upon computation of probability. We illustrate this new conceptualisation with three case vignettes. Results: We suggest that in those with prior experience of romantic betrayal, hyperdominergic-induced aberrant prediction errors enable anomalous perceptual experiences to accrue greater prominence, which is then maintained through Bayes-optimal inferencing to confirm cognitive distortions, eliciting and shaping this dangerous delusion. Conclusions: We propose the first comprehensive mechanistic account of Othello syndrome in PD and discuss implications for clinical interventions.

Cardiovascular Toxicity of Immune Checkpoint Inhibitors: A Guide for Clinicians.

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment and care of patients with cancer owing to unique features, including the occurrence of the so-called immune-related adverse events (irAEs). A multidisciplinary team, possibly including a cardio-oncology specialist, is warranted to achieve a favorable patient outcome. Cardiovascular toxicity, especially myocarditis, emerged as a life-threatening irAE in the real-word setting, and the European Society of Cardiology has recently published the first guideline on cardio-oncology to increase awareness and promote a standardized approach to tackle this complex multimodal issue, including diagnostic challenges, assessment, treatment, and surveillance of patients with cancer receiving ICIs. In this article, through a question & answer format made up of case vignettes, we offer a clinically oriented overview on the latest advancements of ICI-related cardiovascular toxicity, focusing on myocarditis and associated irAEs (myositis and myasthenia gravis within the so-called overlap syndrome), with the purpose of assisting clinicians and healthcare professionals in daily clinical practice.

Single-rater reliability of a three-dimensional instrument for decision-making in tertiary triage and ICU- prioritization—a case vignette simulation study

Disconcerting reports from different EU countries during the first wave of the COVID-19 pandemic demonstrated the demand for supporting decision instruments and recommendations in case tertiary triage is needed. COVID-19 patients mainly present sequentially, not parallelly, and therefore ex-post triage scenarios were expected to be more likely than ex-ante ones. Decision-makers in these scenarios may be highly susceptible to second victim and moral injury effects, so that reliable and ethically justifiable algorithms would have been needed in case of overwhelming critical cases.To gather basic information about a potential tertiary triage instrument, we designed a three-dimensional instrument developed by an expert group using the Delphi technique. The instrument focused on three parameters: 1) estimated chance of survival, 2) estimated prognosis of regaining autonomy after treatment, and 3) estimated length of stay in the ICU. To validate and test the instrument, we conducted an anonymous online survey in 5 German hospitals addressing physicians that would have been in charge of decision-making in the case of a mass infection incident. Of about 80 physicians addressed, 47 responded. They were presented with 16 fictional ICU case vignettes (including 3 doublets) which they had to score using the three parameters of the instrument.We detected a good construct validity (Cronbach’s Alpha 0.735) and intra-reliability (p < 0.001, Cohens Kappa 0.497 to 0.574), but a low inter-reliability (p < 0.001, Cohen’s Kappa 0.252 to 0.327) for the three parameters. The best inter-reliability was detected for the estimated length of stay in the ICU. Further analysis revealed concerns in assessing the prognosis of the potentially remaining autonomy, especially in patients with only physical impairment.In accordance with German recommendations, we concluded that single-rater triage (which might happen in stressful and highly resource-limited situations) should be avoided to ensure patient and health care provider safety. Future work should concentrate on reliable and valid group decision instruments and algorithms and question whether the chance of survival as a single triage parameter should be complemented with other parameters, such as the estimated length of stay in the ICU.

Diagnostic momentum in physical therapy clinical reasoning.

Diagnostic momentum refers to ruling in a particular diagnosis without adequate evidence. As the field of physical therapy continues to transition more towards autonomous practitioners with direct access, there is a need to identify the effect of a physician diagnosis on a therapist's examination and treatment. The purpose of this study was to identify if diagnostic momentum exists in physical therapy and whether this phenomenon could affect the ability of the therapist to identify clinical red flags. An online survey with randomized case scenarios was completed by 75 licensed practicing physical therapists. Participants received one of two scenarios: a case vignette where the patient was referred to physical therapy for left shoulder pain and presented with 'red flags' indicative of myocardial infarction, or a similar vignette with additional results from an exercise stress test that ruled out myocardial infarction. The subjects were asked if they would 'treat' or 'refer' to another healthcare provider and the reason behind their decision. Independent t-tests and χ2 analyses were conducted to understand the differences between the groups. A thematic analysis was used to explore the therapists' responses regarding the reasoning for their decision. There was no significant difference in clinical decision making based on age, gender, years of experience, advanced certification, primary caseload or primary practice setting. Among those who received the case without the stress test, 31.4% of participants indicated that they would refer, compared to 12.5% of the participants that had the additional stress test result included within their case. The presence of the negative stress test was indicated as the main reason for choosing to treat without referral by 65.7% of the subjects that received the additional stress test result. This study suggests that practicing physical therapists may be influenced by diagnostic decisions made by other clinicians, causing them to overlook signs and symptoms of possible myocardial infarction.

Cardiac MRI as a possible alternative to echocardiography for therapeutic response monitoring in ATTR cardiomyopathy: a multiparametric evaluation in patisiran treated patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac amyloidosis (CA) is characterized by the extracellular deposition of amyloid fibrils in the heart, mostly light chain (AL) and transthyretin (ATTR) amyloidosis. Recent data have improved both the recognition and treatment of ATTR CA. The therapeutic advances in ATTR CA led to improvement in survival and quality of life, but less detailed evidence is available for the myocardial changes during treatment. Purpose The aim of this pilot study is to evaluate cardiac response under treatment with the genetic "silencer" patisiran in patients with mixed phenotype ATTR with an indication for neuropathy, using multimodal imaging techniques. Methods We prospectively evaluated consecutive patients with mixed phenotype v-ATTR amyloidosis who had received patisiran for aggravated polyneuropathy since 2021. All patients had a complete clinical, paraclinical and comprehensive echocardiography evaluation including myocardial deformation assessment, prior to receiving patisiran and at most recent follow-up. Five of our patient had complementary cardiac magnetic resonance (CMR) at baseline and 1 year follow-up. Results We included 13 patients (mean age 48.1±5.4 yo, 4 men) monitored for the therapeutic response based on the current ESC expert consensus on the monitoring of ATTR CA. They have all been diagnosed with variant ATTR with the same mutation - Glu54Gln - with severe mixed phenotype: both cardiac involvement and autonomous and peripheral polyneuropathy. Time since first diagnosis was 3.4 ±0.8 years, and they had all received Tafamidis 20 mg before being switched to patisiran. At 1 year of treatment, there was no significant change in NYHA functional class, but 6 MWT could not be performed due to impairment related to polyneuropathy. There was no significant change in NT-proBNP during treatment (median at baseline 543 pg/ml vs follow-up 255 pg/ml, p = 0.75). Echocardiography showed no significant change in LV maximal wall thickness (MWT), LV mass index (LVMi), LVEF, stroke volume and myocardial deformation (LV GLS) (Table). Based on these echocardiographic and biological parameters we considered our patients stationary. Meanwhile, CMR confirmed no significant difference between baseline and follow-up in LVMi, MWT and LVEF. Moreover, there was no difference in the visually assessed LGE distribution, native T1, T2 and ECV values (Table, Case vignette). Based on the tissue characterization all patients were considered stable regarding ATTR-CA evolution. We found strong correlations between echo and MRI for LVEF (r=0.71), LVEDV (r=0.67) and MWT (r=0.66). Conclusions Even if used after more than 3 years from first diagnosis in our cohort, structural and functional cardiac parameters remain stable under patisiran therapy. Our study highlights the utility of introducing CMR as an alternative to echocardiography in ATTR-CA disease monitoring protocols, based on its high accuracy, strong correlations and complexity of derived parameters.

Perceived Overqualification Among Therapists: An Experimental Study

The goal of the current study was to experimentally manipulate perceived overqualification (POQ) among a sample of therapists and assess this manipulation’s effect on task meaningfulness, positive affect, and negative affect. To conduct the experiment, we had participants read a clinical case vignette and then randomly assigned them to answer questions using their specialized clinical skills (control group) or using simple recall and transcription (perceived overqualification group). The POQ group reported significantly greater perceived overqualification and significantly less task meaningfulness than the control group. Perceived overqualification also mediated the relation between the experimental condition and task meaningfulness. The groups did not differ on positive or negative affect. Results support previous research and theory suggesting that perceived overqualification can have deleterious effects on job attitudes, which has implications for organizational and individual interventions.

Awareness of social care needs in people with epilepsy and intellectual disability

BackgroundNearly a quarter of people with intellectual disability (ID) have epilepsy with large numbers experiencing drug-resistant epilepsy, and premature mortality. To mitigate epilepsy risks the environment and social care needs, particularly in professional care settings, need to be met. PurposeTo compare professional care groups as regards their subjective confidence and perceived responsibility when managing the need of people with ID and epilepsy. MethodA multi-agency expert panel developed a questionnaire with embedded case vignettes with quantitative and qualitative elements to understand training and confidence in the health and social determinants of people with ID and epilepsy. The cross-sectional survey was disseminated amongst health and social care professionals working with people with ID in the UK using an exponential non-discriminative snow-balling methodology. Group comparisons were undertaken using suitable statistical tests including Fisher’s exact, Kruskal-Wallis, and Mann-Whitney. Bonferroni correction was applied to significant (p < 0.05) results. Content analysis was conducted and relevant categories and themes were identified. ResultsSocial and health professionals (n = 54) rated their confidence to manage the needs of people with ID and epilepsy equally. Health professionals showed better awareness (p < 0.001) of the findings/recommendations of the latest evidence on premature deaths and identifying and managing epilepsy-related risks, including the relevance of nocturnal monitoring. The content analysis highlighted the need for clearer roles, improved care pathways, better epilepsy-specific knowledge, increased resources, and better multi-disciplinary work. ConclusionsA gap exists between health and social care professionals in awareness of epilepsy needs for people with ID, requiring essential training and national pathways.

Counselling for Chronic Insomnia in Swiss Pharmacies: A Survey Study Based on Case Vignettes

(1) Introduction: Chronic insomnia (CI) reduces quality of life and may trigger depression and cardiovascular diseases. The European Sleep Research Society recommends cognitive behavioural therapy (CBT-I) as the first-line treatment. Because a recent study in Switzerland demonstrated that this recommendation was inconsistently followed by primary care physicians, we hypothesised that pharmacists also deviate from these guidelines. The aim of this study is to describe current treatment practices for CI recommended by pharmacists in Switzerland, compare them to guidelines and examine their attitudes towards CBT-I. (2) Methods: A structured survey was sent to all the members of the Swiss Pharmacists Association, containing three clinical vignettes describing typical CI pharmacy clients. Treatments had to be prioritised. The prevalence of CI, and the pharmacists’ knowledge and interest in CBT-I were assessed. (3) Results: Of 1523 pharmacies, 123 pharmacists (8%) completed the survey. Despite large variations, valerian (96%), relaxation therapy (94%) and other phytotherapies (85%) were most recommended. Although most pharmacists did not know about CBT-I (72%) and only 10% had recommended it, most were very interested (64%) in education. Missing financial compensation hampers the recommendation of CBT-I. (4) Conclusions: Contrary to existing European guidelines, community pharmacists in Switzerland mostly recommended valerian, relaxation therapy and other phytotherapies for treating CI. This might be connected to the client’s expectation of pharmacy services, e.g., medication dispensing. While pharmacists recommend sleep hygiene regularly, most did not know of CBT-I as an overarching concept but were willing to learn. Future studies should test the effects of dedicated training about CI and changes in the financial compensation for counselling for CI in pharmacies.

Biologics Initiation in Rheumatoid Arthritis by Race and Ethnicity: Results From a Randomized Survey Study.

To investigate whether the race and ethnicity of a patient with rheumatoid arthritis (RA) influences rheumatologists' likelihood of choosing to initiate biologic disease-modifying antirheumatic drug (bDMARD) treatment. We conducted a randomized survey experiment in which identical brief case vignettes of hypothetical patients with RA were sent to US rheumatologists (respondents). Three of the four cases included some level of treatment decision ambiguity whereas the fourth case strongly favored bDMARD initiation. Each respondent was shown the four case vignettes, with the race and ethnicity (Black, Hispanic, White) randomly assigned for each case. Each vignette offered multiple choices for next therapeutic step, which we summarized using frequencies and proportions by race and ethnicity version. Among 159 US rheumatologists, we found that for the three cases with some level of treatment decision ambiguity, there was little to no variability in the proportions of respondents who chose to start a biologic for the Black and Hispanic variants (cases 1, 2, and 3). For case 4, respondents generally agreed to start a biologic with some minimal variability across the variants (92.6% for the Black version, 98.1% for the Hispanic version, and 96.2% for the White version). There are conflicting data regarding bDMARD use and initiation in patients with RA based on the sex and race of the patient. This work adds to this conversation by examining how the next therapeutic step chosen by rheumatologists varied by the race and ethnicity of the hypothetical patient.

Approach to the Patient With Bone Fracture: Making the First Fracture the Last.

The global burden of osteoporosis and osteoporotic fractures will increase significantly as we enter a rapidly aging population. Osteoporotic fractures lead to increased morbidity, mortality, and risk of subsequent fractures if left untreated. However, studies have shown that the majority of patients who suffer an osteoporotic fracture are not investigated or treated for osteoporosis, leading to an inexcusable "osteoporosis care gap." Systematic and coordinated models of care in secondary fracture prevention known as fracture liaison services (FLS) have been established to streamline and improve the care of patients with osteoporotic fractures, and employ core principles of identification, investigation, and initiation of treatment. Our approach to the multifaceted care of secondary fracture prevention at a hospital-based FLS is illustrated through several case vignettes.

Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study.

Splanchnic vein thrombosis (SVT) is a major complication of moderate and severe acute pancreatitis. There is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and SVT. To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute pancreatitis. A total of 139 pancreatologists of the Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group were approached to complete an online survey and case vignette survey. The threshold to assume group agreement was set at 75%. The response rate was 67% (n = 93). Seventy-one pancreatologists (77%) regularly prescribed therapeutic anticoagulation in case of SVT, and 12 pancreatologists (13%) for narrowing of splanchnic vein lumen. The most common reason to treat SVT was to avoid complications (87%). Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation (90%). Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation (76%) and splenic vein thrombosis as the least preferred location (86%). The preferred initial agent was low molecular weight heparin (LMWH; 87%). In the case vignettes, therapeutic anticoagulation was prescribed for acute portal vein thrombosis, with or without suspected infected necrosis (82% and 90%), and thrombus progression (88%). Agreement was lacking regarding the selection and duration of long-term anticoagulation, the indication for thrombophilia testing and upper endoscopy, and about whether risk of bleeding is a major barrier for therapeutic anticoagulation. In this national survey, the pancreatologists seemed to agree on the use of therapeutic anticoagulation, using LMWH in the acute phase, for acute portal thrombosis and in the case of thrombus progression, irrespective of the presence of infected necrosis.

An Anti-Racism and Equity Initiative Improves Residency Educational Conferences

ABSTRACT Background Graduate medical education curricula may reinforce systemic inequities and bias, thus contributing to health disparities. Curricular interventions and evaluation measures are needed to increase trainee awareness of bias and known inequities in health care. Objective This study sought to improve the content of core noontime internal medicine residency educational conferences by implementing the Department of Medicine Anti-Racism and Equity (DARE) educational initiative. Methods DARE best practices were developed from available anti-racism and equity educational materials. Volunteer trainees and faculty in the department of medicine of a large urban academic medical center were recruited and underwent an hourlong training to utilize DARE best practices to coach faculty on improving the anti-racist and equity content of educational conferences. DARE coaches then met with faculty to review the planned 2021-2022 academic year (AY) lectures and facilitate alignment with DARE best practices. A rubric was created from DARE practices and utilized to compare pre-intervention (AY21) and post-intervention (AY22) conferences. Results Using the DARE best practices while coaching increased the anti-racism and equity content from AY21 to AY22 (total rubric score mean [SD] 0.16 [1.19] to 1.38 [1.39]; P=.001; possible scores -4 to +5), with 75% (21 of 28) of AY22 conferences showing improvement. This included increased diversity of photographs, discussion of the racial or ethnic makeup of research study participants, appropriate use of race in case vignettes, and discussion of the impact of racism or bias on health disparities. Conclusions Training coaches to implement DARE best practices improved the anti-racism and equity content of existing noontime internal medicine residency educational conferences.

Evaluation of a manual-based training program in changing auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health.

Globally, maternal mental health has been recognized as a priority public health issue. While it is crucial to integrate maternal mental health into mother and child health services, research on strengthening the knowledge and skills of primary healthcare providers on maternal mental health is limited in India. To evaluate the effectiveness of a manual-based training program in improving auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health. The present study adopted an experimental design among ANMs (N = 110) working at primary health centers, Karnataka, India. The participants were randomly assigned to either experimental group (n = 53) or control group (n = 57). The training program delivered interactive sessions based on a facilitator's manual developed specifically for ANMs in India. The assessments were done in both groups at baseline, after the intervention, at three months and at six months using self-rated questionnaires and a case vignette. The descriptive and inferential statistics were used to analyze the data. After the training program the mean knowledge, attitudes and skills scores were significantly increased in the experimental group (P < 0.001) and significant differences were found between the mean scores of the groups at 3 months and 6 months follow-up (P < 0.05). The training program was found to have a positive impact in enhancing ANMs' knowledge, attitudes, and skills related to maternal mental health in India as there is dearth for mental health professionals in primary care settings.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: Staging of lung lesions in pediatric Hodgkin lymphoma (HL) is a long standing, controversial issue. Consortium groups define lung involvement and its distinction from E-lesions differently. Application of these criteria to individual patients are technically challenging and require expertise. The SEARCH group, working to create harmonization across consortia for the staging of pediatric HL, has completed this task for lung lesions. Methods: A survey of 7 case vignettes was distributed to 26 world experts in pediatric HL, replicating the previously published survey by Connors et al in 1984. Experts were asked to stage each case as lung involvement, or an E-lesion. Similar to Connors findings, our results demonstrated that experts were greatly divided on several cases, indicating ongoing differences in interpretation. Accordingly, the SEARCH group performed a harmonization initiative for the contemporary staging criteria for lung lesions. Representatives from each major consortium group (Pediatric Hodgkin Consortium, EuroNet PHL, Children’s Oncology Group) provided their current definitions for lung involvement, and rationale for staging decisions for the lung cases presented. Based on these discussions, a Delphi survey was drafted containing 12 statements pertaining to the staging criteria for lung lesions and distributed electronically to members of the SEARCH committee representing each consortium. Consensus was defined as a score of 3.75 or greater on a 5-point Likert scale (strongly disagree [1] to strongly agree [5]). Delphi rounds continued until consensus was achieved for all statements, or until a decision was made to remove a statement. Responses were collected anonymously and scores were pooled and reviewed after each round. Extreme scores and all comments were reviewed on committee calls before proceeding to the next round. Results: 21 experts responded to the first Delphi round, including pediatric oncologists, nuclear medicine radiologists, and radiation oncologists. 8 of 12 statements met consensus in Round 1. Several statements were edited to improve clarity and 1 statement was added. A second Delphi round was completed with 20 responses. All statements met consensus with the exception of one which was ultimately removed for group consensus that further investigation was required. Final consensus statements are available in Figure 1. Keywords: Hodgkin lymphoma, non-Hodgkin (pediatric, adolescent, and young adult) No conflicts of interests pertinent to the abstract.

Adages, Aphorisms, and Proverbs in Psychiatry and Psychotherapy: Tools for Assessment and Treatment.

This study aimed to examine how adages, aphorisms, and proverbs arise in psychiatric management and psychotherapy and how they might be used to assist assessment and treatment. A selective narrative literature review was conducted to supplement clinical observations and case vignettes. Adages appear to act as heuristic cognitive structures that serve as shortcuts for assessing situations, educating, persuading, aiding emotional self-regulation, and influencing courses of action. Some types of psychotherapy-such as dialectical behavior therapy, rational emotive behavior therapy, and acceptance and commitment therapy-and self-help programs such as Alcoholics Anonymous routinely utilize adages. The extent to and contexts in which adages spontaneously arise during general psychiatric and psychotherapeutic interactions have not been systematically studied. Clinicians can ascertain patients' favorite adages and appraise how patients respond to other sayings through exploratory questioning and by evoking responses to stock series of adages. As therapeutic tools, adages may help patients more easily conceptualize clinicians' interpretations and insights and may serve as encouraging affirmations. Considering the potential utility of adages as therapeutic cognitive scaffolds, how patients and clinicians spontaneously use adages, how adages are used therapeutically, and the adages most suitable for particular patients in particular circumstances deserve further study. In psychiatric management and psychotherapy, clinicians' sensitivity to timing and patients' circumstances, culture, and receptivity may determine whether introducing a particular aphorism or proverb will have a positive impact or come across as a vapid and potentially harmful platitude.