Experience In Clinical Settings Research Articles

Mobile applications on app stores for deprescribing: A scoping review.

Deprescribing is an evidence-based intervention to reduce potentially inappropriate medication use. Yet its implementation faces barriers including inadequate resources, training and time. Mobile applications (apps) on app stores could address some barriers by offering educational content and interactive features for medication assessment and deprescribing guidance. A scoping review was undertaken to examine existing deprescribing apps, identifying features including interactive and artificial intelligence (AI) elements. A comprehensive search was conducted in August 2023 to identify mobile apps with deprescribing content within the Apple and Google Play Stores. The apps found were screened for inclusion, and data on their features were extracted. Quality assessment was undertaken using the Mobile App Rating Scale. Six deprescribing-related apps were identified: the American Geriatrics Society Beers Criteria 2023, Dementia Training Australia Medications, Evidence-Based Medicine Guide, Information Assessment Method Medical Guidelines, MedGPT-Medical AI App, and Polypharmacy: Manage Medicines. These apps focused primarily on educating both patients/carers and healthcare professionals about deprescribing. Amongst them, two apps included interactive features, with one incorporating AI technology. While these features allowed for search queries and input of patient-level details, the apps provided limited personalised deprescribing advice. In terms of quality, the apps scored highly on functionality and information, and poorly on engagement and aesthetics. This review found deprescribing apps, despite being educational, have limitations in personalization and user engagement. Future research should prioritize evaluating their feasibility and user experience in clinical settings, and further explore how AI and interactivity could enhance the usefulness of these apps for deprescribing practices.

Speaking Up About Patient Safety, Withholding Voice and Safety Climate in Clinical Settings: a Cross-Sectional Study Among Ibero-American Healthcare Students.

To explore speaking up behaviours, barriers to openly expressing patient safety concerns, and perceived psychological safety climate in the clinical setting in which healthcare trainees from Ibero-America were receiving their practical training. Cross-sectional survey of healthcare trainees from Colombia, Mexico, and Spain (N = 1,152). Before the field study, the Speaking Up About Patient Safety Questionnaire (SUPS-Q) was translated into Spanish and assessed for face validity. A confirmatory factor analysis was conducted to establish the construct validity of the instrument, and the reliability was assessed. The SUPS-Q was used to evaluate voice behaviours and the perceived psychological safety climate among Ibero-American trainees. Descriptive and frequency analyses, tests for contrasting means and proportions, and logistic regression analyses were performed. Seven hundred and seventy-one trainees had experience in clinical settings. In the previous month, 88.3% had experienced patient safety concerns, and 68.9% had prevented a colleague from making an error. More than a third had remained silent in a risky situation. Perceiving concerns, being male or nursing student, and higher scores on the encouraging environment scale were associated with speaking up. Patient safety concerns were frequent among Ibero-American healthcare trainees and often silenced by personal and cultural barriers. Training in speaking up and fostering safe interprofessional spaces is crucial.

Nursing students' experience of moral distress in clinical settings: A phenomenological study.

To explore nursing students' moral distress (MD) experiences in clinical settings. An interpretative phenomenological analysis (IPA) design was employed. Purposive sampling was used. In-depth semi-structured face-to-face interviews were conducted from December 2020 to June 2021 with nursing students who were taking the internship course in clinical settings. Data analysis was conducted following Dickman etal.'s (1989) method. Ten nursing students participated in this study. Three main themes were identified, including (1) negative learning environments, (2) internal disgust and (3) threats to professional identity. Findings showed that value conflict, lack of knowledge of ethical standards and its application, and unprofessional approaches result in negative environmental learning perceptions from the nursing students. Therefore, due to being unable to change the situation, they start to feel guilt and shame and, as a result, decide to escape the problem instead of managing it. These feelings lead to internal disgust. This issue indicates the importance of improving the knowledge and perception of these situations. Thus, nursing students must be prepared for the real world, where their ideals are constantly challenged. MDs were experienced as threats to dignity, inequality, distrust, and change of mentality towards nursing, characterised as threats to professional identity. It is suggested to inquire about the process of nursing students' resiliency in morally disturbing situations to deduce the suitable approach for clinical education.

Experiences of Surgical Technology Students of Their First Appearance in the Operating Room

Background: Clinical education is a critical stage of education and plays a major role in shaping students’ professional competencies. The clinical learning environment has a complex nature and has a significant impact on students, especially newly admitted ones. Thus, the initial experience in clinical settings will significantly affect the student’s performance. To this end, this study sought to explore the experiences of surgical technology students of their first appearance in the operating room. Methods: This qualitative study was conducted using a descriptive phenomenological approach. The participants were 15 secondand third-semester students of surgical technology who entered the study through purposive sampling. The data were collected through individual interviews. Data analysis was performed simultaneously with data collection through Colaizzi’s seven-step content analysis method. Results: A total of 101 primary codes were extracted from the collected data. The extracted codes were grouped into 7 subcategories. After removing duplicate codes, 3 main themes were revealed from the participants’ experiences (conflicting perceptions in the learning environment, preparedness before attending the operating room, and feelings and emotions). Conclusion: The students’ experiences of their first appearance in the operating room indicated that their expectations changed compared to what they imagined. The stressful nature of surgical technology and the students’ experiences when starting the internship highlight the need for some necessary measures to prepare students before entering the hospital and to improve the quality of clinical education for these students.

A48Large-scale simulated placements for BSc and MSc physiotherapy students: consideration of sustainability

Clinical placements are an essential part of physiotherapy education, providing students with the opportunity to gain practical experience in clinical settings. Due to the limited number of available placements [1], and the fact that simulated placements have emerged as an innovative approach to placement experience [2], we co-produced (HEI and simulation-based education provider) a placement programme for 80 BSc and 30 MSc undergraduate physiotherapy students. We describe the structure of the well evaluated and replicable large-scale simulated placement. Each student was provided with 40 simulated placement hours over one week, this was divided between hands on facilitated simulation, with follow-up synthesis and reflection of the learning outcomes. The facilitated sessions with actor role players centred around authentic scenarios which were level-matched and closely aligned with the HCPC Physiotherapy Standards of Proficiency [3]. The scenarios reflected the diverse society in which we live, with actors taking on roles of patients/relatives and colleagues, from a range of backgrounds, with differing demographics and characteristics, presenting in a broad range of situations. Students were able to reflect on their interactions, before, during and after the simulation; they received objective feedback from the actor, from the unique perspective of patient/relative or colleague, they received feedback from their peers and from the facilitator. The simulated placement, for both sets of students, was a resounding success. Both groups (BSc and MSc) worked through 10 scenarios. The larger BSc group required 20 separate facilitated sessions and 40 actors. For the MSc group, there were 5 facilitated sessions and 10 actors. As always, sustainability of programmes is linked to budget. Although a quantified analysis is yet to be completed, the time taken to organize the placement, write matched scenarios with clear learning outcomes, deliver the placement and evaluate, is time consuming. Continued co-production with shared facilitation (HEI and education provider) is a potential way forward, with re-use of scenarios and rotations; it is highly replicable, with a team of experienced facilitators and actors. Simulated clinical placements provide physiotherapy MSc and BSc students with a valuable, realistic learning experience, in a safe and supportive, facilitator-led environment. The placement was found to be effective in enhancing students’ communication skills, professionalism, empathy, and compassion. Involving actors was found to be an effective way of immersing students in realistic clinical scenarios. This is a reusable resource, so considering ‘return on investment’ would suggest repeating for future students. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

17. Medical Trainees’ Perspectives and Use of Humor in Clinical Settings: A Systematic Review and Metasynthesis

Background: Clinical settings represent the site of both patient care and clinical education for medical students and residents. Both processes involve social interaction, and humor is a fundamental component of social interaction that remains underexplored in medical education. A nuanced analysis of humor is important for understanding the relations that shape everyday experiences of medical trainees. Qualitative studies are relevant in this context, as they account for the variability across different clinical environments. The aim of this study was to examine how medical trainees perceive and use humor during clinical training, by conducting a systematic review and analysis of primary qualitative studies. Methods: In May 2021, the authors searched six databases, and selected studies according to inclusion/exclusion criteria. They assessed study quality using the Critical Appraisal Skills Program, coded data from the final selection of studies, and synthesized findings using qualitative analysis. Results: The initial search resulted in 2,098 articles, of which 36 met the inclusion criteria. Four major themes emerged on humor use in clinical training settings: (1) types of humor; (2) managing and expressing emotion; (3) facilitating interpersonal interactions; and (4) contributions of negative humor to culture of academic medicine. Humor assumed a variety of forms in clinical settings and served a range of positive and negative psychosocial functions. Humor use was important for trainees’ psychological well-being and for connecting with patients, peers, and other health care professionals. However, aggressive humor was used to tease, ridicule, or disparage trainees; to enforce social norms; and to maintain power hierarchies. Conclusion: Humor plays an integral role in medical students and residents’ everyday experiences in clinical settings. Positive use of humor should be understood as an important emotion regulation strategy and communication skill. In contrast, negative forms of humor can adversely impact clinical learning environments, by functioning as a subtle, yet powerful, medium for communicating prejudice and delegitimizing others, through processes unique to humor. Further research exploring more fully how humor works in clinical settings may identify ways to reduce adverse effects and promote well-being, diversity, and equity in medical education.

Linguistic Minority International Counseling Psychology Trainees’ Experiences in Clinical Supervision

The present study discusses clinical supervision from the perspectives of 20 international counseling psychology trainees with a focus on English-specific experiences in training. Using concept mapping, we identified four clusters of sociolinguistic experiences in clinical settings: Growth and Strength Through Embracing Vulnerability, Barriers to Showing Clinical Potential, Fear of Being Seen as Incompetent, and Self-Doubt About Therapeutic Performance and Relationships. Helpful supervisory events included seven clusters: Genuine Curiosity and Understanding, Exploration and Validation Regarding Linguistic Identity, Affirmation and Illumination of Strengths, Facilitation of Clinical Communication, Multicultural Awareness and Cultural Humility, Humanity and Compassion, and Externalization and De-emphasis of the Act of Language use Itself. Lastly, unhelpful supervisory events fell into seven clusters: Seeking Understanding From a Deficits-Lens, Lack of Self-Awareness and Cultural Humility, Acts of Disrespect, Disregard and Lack of Interest, Judgment and Over-Correction, Disempowerment, and Superficial Fixes. Implications for practice and advocacy and suggestions for future research are discussed.

\u201cNot yet a doctor\u201d: medical student learning experiences and development of professional identity

BackgroundTo become a good doctor, developing a professional identity is as important as having the right knowledge and skills. Great attention has been given to professional identity in medical school because it plays an important role in the transition from student to doctor. Nonetheless, the necessity of acquiring a tremendous amount of knowledge and skill during medical school training does not create sufficient opportunities for students to develop their professional identities. Thus, this paper pays careful attention to how students’ learning experiences in medical school affect this development. The research questions are as follows. 1) How do medical students’ perceptions of doctors change or strengthen after entering medical school in the process of professional identity development? 2) What kinds of knowledge have medical students accumulated while attending medical school? How do their learning experiences affect professional identity development? 3) What is a doctor’s role and the career’s meaning to medical students, and what understanding does this awareness bring to their learning experiences and lives as future doctors?MethodsIn-depth semi-structured interviews were conducted with 20 Korean students in their fourth year of medical school; all had more than one year of experience in clinical settings. The students’ learning experiences and professional identity development were used to analyze the data using inductive thematic analysis.ResultsWhen students first entered medical school, they perceived their identities as “given to” them by society. However, various learning experiences during the medical school years affected them, causing them to think about becoming a doctor according to their own perceptions and the meaning of becoming a doctor in the profession. Although an isolated medical community and a competitive student culture hindered them from searching for their professional identities, informal learning experiences, including active interaction with patients, senior doctors, and others outside the medical community, enabled them to develop their professional identities. The medical students experienced a conflict between individual and professional values as they considered what kind of doctor they would be in the future.ConclusionsThe findings noted in this study extend the understanding of professional identity and informal learning experiences in medical school.

Keep up with progress-Ultrasound education requires change.

Despite increasing use of ultrasound imaging even beyond the circle of radiologists, low priority is given to student training. Until today, integration of ultrasound into clinical education at medical schools still lags far behind, and a curricular structure is oftentimes missing or implemented half-heartedly on a voluntary basis. Main reasons for not having ultrasound integrated are lack of time and poor funding. Finally, residents feel inadequately prepared for daily professional practice. For patient safety and satisfaction, however, it is highly desirable that ultrasound becomes second nature to the next generations of physicians, as the stethoscope already is.1 At our university hospital, we recently developed and implemented a multidisciplinary curriculum that integrates ultrasound as a compulsory part into medical education directly from start to finish. The curriculum follows a spiral course with four levels of training in which learning activities are repeated with continuously growing complexity. Competency-centred “probe-in-the-hand” courses are held in small groups of maximum six learners. Students start to practice ultrasonography by scanning each other, attending training in skills labs and, finally, deepen experience in clinical settings. Students should prepare self-determinedly for courses using learning videos available on the university's in-house network and on publicly available e-learning platforms. On the first training level, during preclinical education, ultrasonography is closely linked to anatomy dissection- and physiology courses. With this vertical integration, basic sciences are put into context and vice versa, clinical aspects are introduced into early medical training. At the same time, specific psychomotor skills are introduced. On the second level, in the third year of medical education, students apply point-of-care ultrasound in peers, skills lab simulations and ultrasound phantoms. The skills lab will be available during semester breaks to provide the opportunity to practice outside scheduled courses. On the third level, during advanced clinical education, students select a compulsory elective ultrasound course in a specialty of their choice, held at five consecutive dates following the concept of work-based learning. This allows students to direct their own learning and to focus on their preferred specialty. From then on, they conduct ultrasound examinations in patients. During the final year, students successively adapt skills and knowledge to growing medical experience. Now they are expected to use ultrasound with a large degree of independence and confidence. Entrustable professional activities are specified and assessed concomitantly. The longitudinal curriculum might serve as an inspiring example, however, with built-in flexibility according to requirements of each medical school and changing conditions. Incidental effects including enhancement of self-determined learning and mutual benefits regarding learning success in involved disciplines are expected. Costs and time can be saved by e-learning and appointment of student tutors. As participating departments share benefits arising from integration of ultrasound, they may contribute to the costs proportionally. In the interest of both patients and students, with an eye to the future, medical schools are encouraged to remove initial obstacles and tackle full and early integration of ultrasound into their curricula.

The assessment of adverse childhood experiences in clinical settings: Practitioner competencies and perceptions.

Issues concerning the screening and assessment of adverse childhood experiences (ACEs) in healthcare settings have been subject to growing scrutiny in recent years, yet relatively little is known about practitioner perceptions and competencies related to such practices. This study examined practitioner knowledge, ability and concerns about the assessment of ACEs among parents and children in clinical settings and the acceptability of a newly validated measure (The Adverse Life Experiences Scale, ALES) for this purpose. Participants were (N = 144) healthcare practitioners (predominantly psychologists, nurses, social workers and psychiatrists). Measures were completed online, and the effects of family characteristics on practitioner perceptions were tested experimentally using case vignettes. Participants indicated moderate-to-high levels of knowledge and ability regarding the assessment of ACEs, and the ALES demonstrated high levels of acceptability across hypothetical cases involving various levels of risk. Practitioner concerns about such assessment were also found to be influenced by the level of risk indicated by case referral information. Specifically, concerns that assessment would be too upsetting or time-consuming were greater in response to a case with a high level of ACEs, compared to one with low-to-moderate ACEs (p < .05; large effect size). Practitioners demonstrated relatively high competencies regarding the assessment of ACEs and supported the use of the ALES for this purpose. Those families with the highest levels of ACEs may nonetheless be the least likely to receive such assessment in clinical settings.

Sexuality, student mental health nurse and lecturer experience in education and practice

This article presents a critical reflection on an experience relating to sexuality from two perspectives, a mental health nursing student and a lecturer. It took place during stage 1 of a graduate entry nursing 2-year Master of Science mental health nursing programme at a UK university. Student mental health nurses in higher education who identify as lesbian, gay, bisexual or transgender can feel less safe than others, which affects performance. Lecturers can make a difference to the educational experience of student nurses who are lesbian, gay, bisexual or transgender and this can have an impact on clinical practice. The emotional impact of ‘coming out’ in the classroom can have far-reaching consequences for their mental health. The response of educational staff can have a huge impact on the ability to learn and the marks achieved. Student–lecturer relationships can have transformative consequences. Student mental health nurses make meaning from their educational experiences in the classroom and clinical practice. If they do not see themselves represented, this can affect engagement and motivation. Safe nursing practice is role modelled from lecturer to student and has implications for service user experience in clinical settings.

“I talked to a couple of friends that had it”: Informal feminized health networks and contraceptive method choices

Scholars recognize that social networks can influence a number of health behaviors, including women's contraceptive method choices. However, the gendered dynamics underlying the process of using non-medical information sources to make decisions about contraception has received less attention. Using 30 semi-structured interviews with women enrolled in a contraceptive initiative in the western United States, we explore how women use gendered understandings of medicine and feminized social networks to make decisions about contraceptives. Frequently categorizing their experiences in medical settings as unsatisfactory, women often turn to social support networks of other women—what we call “informal feminized health networks”—to gather information about the effects of contraceptives on women's bodies and to make decisions about which contraceptives are best. While informal feminized health networks are useful, women utilize them in light of unsatisfactory experiences in clinical settings. Working to uproot the paternalistic legacy of institutionalized medicine and improving provider-patient communication will enhance contraceptive access and help women reach their reproductive goals.

A Simulated Perioperative Clinical Day for Prelicensure Nursing Students.

The inclusion of perioperative clinical learning experiences in prelicensure nursing education reinforces foundational nursing skills. However, perioperative experiences in clinical settings are not consistently available for student learning. An unfolding perioperative simulation day was created as an alternate to traditional clinical learning. Three simulation-based experiences were designed to include nursing care of the patient during the preoperative, intraoperative, and postoperative phases of the perioperative experience. Implementation of a perioperative simulation as an alternative to traditional clinical learning in one prelicensure program had positive effects on students' ability to achieve learning outcomes, to collaborate, and to improve self-confidence. A simulated perioperative clinical day provides an engaging learning experience, reinforcing foundational clinical skills such as patient safety, infection control, patient mobility, teamwork, and communication. [J Nurs Educ. 2021;60(7):386-390.].

Going Backwards to Fill in the Missing Processes for Training and Evaluation of Clinical Bioethicists: What Has Been Needed for Decades to Move Real Professionalism Forward

As the field of clinical bioethics has moved from its pioneers, who turned their attention to ethics problems in clinical medicine and clinical and animal research, to today's ubiquity of university degrees and fellowships in bioethics, there has been a steady drumbeat to professionalize the field. The problem has been that the necessary next steps-to specify the skills, knowledge, and personal and professional attributes of a clinical bioethicist, and to have a method to train and evaluate mastery of these standards-are lacking. Ordinarily, the path to professionalism in medicine starts with the intellectual pioneers. Then come those who develop early experience in clinical settings. Then comes the specification of the skills, knowledge, and personal and professional attributes needed to perform the activities of the new specialty or subspecialty. And only then, after a method to train and evaluate levels of mastery from novice to advanced practitioner has been developed, comes credible credentialing and certification/licensing. Unfortunately, the field of clinical bioethics has skipped these steps. Rather, a credential, that is, the Healthcare Ethics Consultant (HEC) certification, was created by a small group within the bioethics professional association, the American Society of Bioethics and Humanities (ASBH), without community agreement or necessary input. Further, the testing of processes to train HECs and to evaluate their levels of mastery of competencies was prematurely forwarded as sufficient evidence of competence in clinical ethics. That is, the credential, offered by the ASBH for a fee upon passing an exam, based on how many hours one has been involved in clinical consultation, about which there is no field agreement on how such consultations ought to be conducted and for which controversial standards have been set by a few, is being touted as evidence of competence in clinical bioethics. In their article, "Competencies and Milestones for Bioethics Trainees," Sawyer and colleagues identify the central weakness of these claims to professionalization and provide the field the first substantive assessment tool and method to train and evaluate competencies. The tool these authors present is the real next step forward for true professionalization of the field of clinical bioethics.

Exploring Health Technology Management Relevance to Safety and Quality in Hospital Care

Technology management is a key issue for innovation and quality in health care sector, which, in turn, implies effectiveness and safety considerations. It is valuable, to explore the influence of technology to safety management and quality in health environment, and so to dig into what topics arise from this relationship. The purpose of this study is to explore the relevance of Health Technology Management to safety and quality in health organizations from health professional’s perceptions and scientific evolution perspectives. Methodology and Theoretical Orientation: An exploratory based qualitative study was conducted. A semi-structured interview was administered to health professionals with professional and academic experience in clinical settings in Matanzas territory. There were selected the main issues raised from professional’s opinions. Additionally, there was examined the scientific development of this subject by means of a review of research documents published in Sciencedirect and Scielo databases. Findings: Main views were similar as to technology use, assessment and innovation impact on human errors, how they may condition clinical and therapeutic practices, health recovery as well as a risky care environment for patients and personnel. Conclusion &amp; Significance: It is confirmed the importance of health technology management to safety and quality of health care as well as research.

Nurses' knowledge, attitudes and preparedness to manage women with intimate partner violence.

To investigate nurses' knowledge, attitudes and practices related to intimate partner violenceamong women in SaudiArabian healthcare settings. There is a global focus on abuse experiences in clinical settings. However, nurses' practice in managing intimate partner violence patients in Saudi healthcare settings has not yet been examined. Intimate partner violence is a health issue that can lead to mortality and morbidity. It has recently received attention in an Arabian context. Thus, scrutinizing nurses' role in responding to intimate partner violence patients is needed to fill a current gap. A cross-sectional study was conducted with a convenience sample of 114 nurses from two hospitals in Saudi Arabiausing a questionnaire. Minimal previous intimate partner violence training was reported, as 63% of nurses had not received training related to intimate partner violence, and 52% believed that they did not receive adequate training to respond to intimate partner violence survivors. The results show that nurses had both low perceived knowledge and low preparedness in managing intimate partner violence, and only had basic intimate partner violence knowledge. Results indicated that nurses did not have appropriate attitudes towards intimate partner violence. The majority were not aware about intimate partner violence protocols or policies in their institutions. Only 2.6% had diagnosed intimate partner violence in the last six months. There were gaps in nurses' perceived preparedness, knowledge, attitudes and behaviours. There was also limited training and preparation for nurses to assess and address intimate partner violence. The study suggests the need for clear institutional health policies related to detecting, responding to, and preventing intimate partner violence. Guidelines about integrating intimate partner violence in nursing curricula and implementing in-service training should be developed and implemented. A multi-level intervention that enables nurses to respondto intimate partner violence is also needed.

Lived experience of medical veterans transitioning from military service to civilian nursing education

Many veterans take advantage of the educational benefits afforded them after service. As veterans, students in higher education are a special population with subsequent needs. The purpose of this study was to explore the lived experience of medic student veterans attending a full-time Bachelor of Science in Nursing (BSN) program. This study used the hermeneutic phenomenology research approach to explore the lived experiences of student veterans with military medic experience enrolled in a Bachelor of Science in Nursing (BSN) program. While our study revealed diverse student experiences among these veterans, common themes included staying true to military training, normal life, and fitting in as a university student. Findings in this study substantiate medic student veterans attending nursing school represent a unique cohort which can benefit from customized services from the university.

Nusinersen for older patients with spinal muscular atrophy: A real-world clinical setting experience.

Clinical trials data concerning use of nusinersen in older spinal muscular atrophy (SMA) patients is lacking. We describe our center's experience in using intrathecal nusinersen for older patients in the clinical setting. Retrospective study. Twelve patients (12-52 years old) were treated with nusinersen. Mean follow-up duration was 17.4 months (range, 4-26 months). All patients had scoliosis; 10 had spinal fusion/instrumentation. All procedures (30 cervical and 57 lumbar punctures) were technically successful. The only side effects were postprocedural headache (9%) and site pain (5.7%). Functional assessments showed stability in 6/9 patients and improvement in 3/9 patients. Subjective improvements in endurance, hand strength, and bulbar functioning critical for activities of daily living were reported in 8/12 patients. None of the patients has discontinued treatment so far. Intrathecal nusinersen can be safely delivered in older SMA patients. Available functional outcome measures are not adequate to capture meaningful subjective improvements.

Parents’ Journeys to Acceptance and Support of Gender-diverse and Trans Children and Youth

Over the past 5 years in Canada, clinicians have observed an increasing number of gender-diverse and trans children and youth (GDTCY) accessing clinics for gender-affirming care. GDTCY who are able to access care are usually accompanied by their families, which provides a unique opportunity to integrate them into the treatment team. GDTCY have better health and social outcomes when strongly supported by their parents/caregivers. To optimize young people’s health and well-being, it is essential that we learn more about family experiences in supporting their GDTCY and in overcoming barriers to accessing services. This project is one of the first qualitative studies that aims to develop a deeper understanding of GDTCY and their parents/caregivers’ experiences of the gender-affirming care setting. This paper explores their journeys in coming to terms with their child’s gender identity, including reactions to the child’s coming out, struggles and facilitators of acceptance, and experiences in clinical settings.

Response to Lenvatinib Is Associated with Optimal RelativeDose Intensity in Hepatocellular Carcinoma: Experience in Clinical Settings.

Background: Lenvatinib is currently available as the first-line treatment for advanced unresectable hepatocellular carcinoma. We evaluated the relationship between its relative dose intensity (RDI) and response in clinical settings. Methods: From March 2018 to May 2019, 93 patients were administered lenvatinib at the Nagasaki University Hospital and its related facilities. Among these, 81 patients (66 men, 15 women, median age 72.0) who received lenvatinib were analyzed retrospectively. Results: Fourteen patients were Child–Pugh grade B, and 15 had received other systemic therapy. According to Response Evaluation Criteria in Solid Tumors (RECIST), the objective response (OR) rate was 17.3%. The overall survival (OS) was significantly better in the OR group (p = 0.011). There was a significant difference in RDI between the OR and non-OR groups (p < 0.05). The area under the receiver operating characteristics curve for OR prediction by the 4, 8, 12, and 16-week RDI were 0.666, 0.747, 0.731, and 0.704, respectively. In the 8-week RDI ≥67.0% group, OS was significantly better than in the 8-week RDI <67.0% group (p = 0.003). Conclusions: Because a sufficient RDI is required to achieve an OR, it is strongly recommended that lenvatinib should be administered to patients with good hepatic function and status.