Fictional Case Research Articles

How to develop a Caring and Compassionate Neighbourhood?

Background: The concept of Caring Neighbourhoods is both in Flanders and worldwide widely known. However, how to integrate the topics of serious illness, death and loss into a Caring Neighbourhood via a co-creative process with citizens and partners remain largely unknown.
 Aim: In this workshop, we will present the case of Compassionate Sint-Kruis and inspirational examples of neighbourhood actions around serious illness, death and loss. Additionally, this workshop aims to familiarise people with drafting a Theory of Change model to understand how actions can lead to certain results and outcomes.
 Participants: This workshop is for everyone interested in developing a Compassionate or Caring Neighbourhood or being an active part of it. Both people with experience in neighbourhood work around serious illness, death and loss and people without experience in the subject are welcome.
 Methods:
 1)Presenting the case of Compassionate Sint-Kruis and inspirational examples for involving the neighbourhood (e.g. Soup with chats, Nodes City Festival, involving neighbourhood committees) (25 min).
 2)Divide the participants into groups of five (2 min.)
 3)An introduction to the exercise and presenting the fictional case of Neighbourhood Welcome (3 min). ‘Neighbourhood Welcome’ is located in a semi-urbanised village with approximately 2.000 inhabitants. The neighbourhood is characterised by some challenges, e.g. a large group of older people who live alone and feel disconnected from the neighbourhood, and a large group of informal caregivers. Additionally, the neighbourhood is also characterised by some important assets e.g. residential care centres that are looking for active ways to involve the neighbourhoods and active neighbourhood committees.
 4)Doing the first part of the Theory of Change exercise (15 min). This entails that each group formulates five results/outputs they want to realise with ‘Neighbourhood Welcome’ (based on the neighbourhood challenges and assets).
 5)Plenary feedback where each group can share their chosen outputs (10 min). The two workshop leaders will write all the outputs on a whiteboard and provide some feedback per group.
 6)Doing the second part of the Theory of Change exercise (15 min). Participants are asked to formulate actions, and inputs that are in line with the chosen outputs.
 7)Plenary feedback where people can share their chosen actions and inputs (10 min). The two workshop leaders will write all the actions and inputs on a whiteboard and provide feedback.
 8)A closing moment where the workshop leaders will discuss the final Theory of Change and where people can share their experiences with the exercise (10 min).
 End goal: People will go home having had an example of what a Caring and Compassionate Neighbourhood can look like. They will have achieved the skill of drawing up a Theory of Change model that includes possible outputs and actions for integrating compassionate topics into a Caring Neighbourhood. After the workshop, an electronic version of the Theory of Change model will be distributed to all participants.

Understanding the Factors that Affect the Assessment of Student Performance in Pharmacy Practicums

ObjectiveThe purpose of this study was to explore factors that may influence a practice educator’s assessment of an entry-to-practice pharmacy student during inpatient direct patient care practicums. MethodsThis was a qualitative analysis of semi-structured interviews of existing practice educators from a variety of hospital practice environments. Participants were asked to assess a fictional case of a student’s work, which provided a framework for a broader discussion of assessment practices. Interviews were transcribed and subjectively analyzed for themes and factors that each study participant considered for the case and in their past precepting experiences. ResultsA total of 13 participants consented and were interviewed. Identified themes included the quality of student work, key aspects of the student’s performance, professionalism, and the complexity of the patient assigned to the student. There was significant heterogeneity in both the assessment of the fictional student and the factors that influenced each participant’s assessment. It was clear that not all guidance provided by the academic institution is read or followed. Participants described challenges in applying the assessment rubric, including lack of time, training, resources, knowledge of the degree requirements/structure, and psychological factors inherent in high-stakes courses. ConclusionComplex, varied, and often contradictory factors are used by experiential practice educators in their assessment of pharmacy students on practicum. These findings lead to inconsistency and heterogeneity when assessing a mock case and actual students. Educators should consider mandatory training to ensure those who assess students have an understanding of practicum course expectations and assessments.

Whose (germ) line is it anyway? Reproductive technologies and kinship.

Reproductive biotechnologies can separate concepts of parenthood into genetic, gestational and social dimensions, often leading to a fragmentation of heteronormative kinship models and posing a challenge to historical methods of establishing legal and/or moral parenthood. Using fictional cases, this article will demonstrate that the issues surrounding the intersection of current and emerging reproductive biotechnologies with definitions of parenthood are already leading to confusion regarding social and legal family ties for offspring, which is only expected to increase as new technologies develop. Rather than opposing these new technologies to reassert traditional concepts of the family, however, this article will explore the opportunities that these technologies represent for re-imagining various culturally cherished values of family-making in a way that is inclusive of diverse genders, sexualities and cultures. It will consider IVF, gametogenesis, mitochondrial donation, surrogacy, artificial gestation, CRISPR-Cas9 gene editing, foster care and adoption as some of many possible pathways to parenthood, including for members of the LGBTIAUQ+ community.

Exploring the role of AI in classifying, analyzing, and generating case reports on assisted suicide cases: feasibility and ethical implications.

This paper presents a study on the use of AI models for the classification of case reports on assisted suicide procedures. The database of the five Dutch regional bioethics committees was scraped to collect the 72 case reports available in English. We trained several AI models for classification according to the categories defined by the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act. We also conducted a related project to fine-tune an OpenAI GPT-3.5-turbo large language model for generating new fictional but plausible cases. As AI is increasingly being used for judgement, it is possible to imagine an application in decision-making regarding assisted suicide. Here we explore two arising questions: feasibility and ethics, with the aim of contributing to a critical assessment of the potential role of AI in decision-making in highly sensitive areas.

How We Treat Drug-Susceptible Pulmonary Tuberculosis: A Practical Guide for Clinicians.

Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide and pulmonary TB (PTB) is the main variant responsible for fueling transmission of the infection. Effective treatment of drug-susceptible (DS) TB is crucial to avoid the emergence of Mycobacterium tuberculosis-resistant strains. In this narrative review, through a fictional suggestive case of DS PTB, we guide the reader in a step-by-step commentary to provide an updated review of current evidence in the management of TB, from diagnosis to post-treatment follow-up. World Health Organization and Centre for Diseases Control (CDC) guidelines for TB, as well as the updated literature, were used to support this manuscript.

Ancestry, race and ethnicity: the role and relevance of language in clinical genetics practice

BackgroundThe terms ancestry, race and ethnicity are used variably within the medical literature and within society and clinical care. Biological lineage can provide an important context for the interpretation of...

Leveraging Large Language Models for Decision Support in Personalized Oncology

Clinical interpretation of complex biomarkers for precision oncology currently requires manual investigations of previous studies and databases. Conversational large language models (LLMs) might be beneficial as automated tools for assisting clinical decision-making. To assess performance and define their role using 4 recent LLMs as support tools for precision oncology. This diagnostic study examined 10 fictional cases of patients with advanced cancer with genetic alterations. Each case was submitted to 4 different LLMs (ChatGPT, Galactica, Perplexity, and BioMedLM) and 1 expert physician to identify personalized treatment options in 2023. Treatment options were masked and presented to a molecular tumor board (MTB), whose members rated the likelihood of a treatment option coming from an LLM on a scale from 0 to 10 (0, extremely unlikely; 10, extremely likely) and decided whether the treatment option was clinically useful. Number of treatment options, precision, recall, F1 score of LLMs compared with human experts, recognizability, and usefulness of recommendations. For 10 fictional cancer patients (4 with lung cancer, 6 with other; median [IQR] 3.5 [3.0-4.8] molecular alterations per patient), a median (IQR) number of 4.0 (4.0-4.0) compared with 3.0 (3.0-5.0), 7.5 (4.3-9.8), 11.5 (7.8-13.0), and 13.0 (11.3-21.5) treatment options each was identified by the human expert and 4 LLMs, respectively. When considering the expert as a criterion standard, LLM-proposed treatment options reached F1 scores of 0.04, 0.17, 0.14, and 0.19 across all patients combined. Combining treatment options from different LLMs allowed a precision of 0.29 and a recall of 0.29 for an F1 score of 0.29. LLM-generated treatment options were recognized as AI-generated with a median (IQR) 7.5 (5.3-9.0) points in contrast to 2.0 (1.0-3.0) points for manually annotated cases. A crucial reason for identifying AI-generated treatment options was insufficient accompanying evidence. For each patient, at least 1 LLM generated a treatment option that was considered helpful by MTB members. Two unique useful treatment options (including 1 unique treatment strategy) were identified only by LLM. In this diagnostic study, treatment options of LLMs in precision oncology did not reach the quality and credibility of human experts; however, they generated helpful ideas that might have complemented established procedures. Considering technological progress, LLMs could play an increasingly important role in assisting with screening and selecting relevant biomedical literature to support evidence-based, personalized treatment decisions.

Triage: A Global Perspective

Triage is a process by which patients are assessed, classified, and sorted based on their presenting complaint and clinical urgency, providing assurance for timely access to emergency care. The goal is to get the right person to the right place, in the right amount of time, for the right reason, and within the context of resource availability. In many countries, a standardized triage system, underpinned through the use of guidelines, is used to provide clinicians with support and guidance. Triage is a globally adopted principle, and although triage guidelines are used in many countries, no single system has been internationally adopted. This paper discusses the importance of how triage process standardization improves patient care, resource management, and benchmarking at local, national, and international levels by applying 5 internationally recognized triage systems to fictional case studies. Evaluation of similarities and differences in severity scores, with a gap analysis, occurs.

Assessment of ChatGPT in the Prehospital Management of Ophthalmological Emergencies - An Analysis of 10 Fictional Case Vignettes.

The artificial intelligence (AI)-based platform ChatGPT (Chat Generative Pre-Trained Transformer, OpenAI LP, San Francisco, CA, USA) has gained impressive popularity in recent months. Its performance on case vignettes of general medical (non-ophthalmological) emergencies has been assessed - with very encouraging results. The purpose of this study was to assess the performance of ChatGPT on ophthalmological emergency case vignettes in terms of the main outcome measures triage accuracy, appropriateness of recommended prehospital measures, and overall potential to inflict harm to the user/patient. We wrote ten short, fictional case vignettes describing different acute ophthalmological symptoms. Each vignette was entered into ChatGPT five times with the same wording and following a standardized interaction pathway. The answers were analyzed following a systematic approach. We observed a triage accuracy of 93.6%. Most answers contained only appropriate recommendations for prehospital measures. However, an overall potential to inflict harm to users/patients was present in 32% of answers. ChatGPT should presently not be used as a stand-alone primary source of information about acute ophthalmological symptoms. As AI continues to evolve, its safety and efficacy in the prehospital management of ophthalmological emergencies has to be reassessed regularly.

Evidence-Based Pharmaceutical Care in Community Pharmacies: A Survey of 595 French Pharmacists.

We assessed the use of evidence-based practice (EBP) among pharmacists working in community pharmacies in France and the factors linked to this practice. During 3 months in 2018, an online survey was sent to over 7000 active pharmacists and posted on pharmacists' social media sites. In total, 595 pharmacists completed the questionnaire. The responders were on average younger than the general population of community pharmacists. The 40-item questionnaire described four fictional clinical cases reflecting typical situations (conventional medicine and complementary and alternative medicine) encountered daily by community pharmacists. Multiple-choice responses were proposed and scored according to whether they reflected EBP. A high total score indicated behaviour in line with EBP. We observed 344/595 participants with a positive EBP score (57.8% [53.7-61.8%]). Univariate and multivariate analyses were used to evaluate factors that might explain adherence to EPB (the pharmacy's characteristics, the pharmacist's status, the mode of continuing education and sources of information). The majority relied on pharmaceutical industry and other biased and/or non-evidence-based sources, particularly concerning information on homeopathic products. The consultation of independent reviews, health agency recommendations and peer-reviewed scientific journals was associated with evidence-based decisions. In contrast, reliance on pharmaceutical industry documents, personal experience and informal handbooks was linked to lower EBP scores. The level of EBP use by French community pharmacists needs to be improved to ensure that good-quality, science-based advice is given to customers.

Can artificial intelligence replace biochemists? A study comparing interpretation of thyroid function test results by ChatGPT and Google Bard to practising biochemists.

Public awareness of artificial intelligence (AI) is increasing and this novel technology is being used for a range of everyday tasks and more specialist clinical applications. On a background of increasing waits for GP appointments alongside patient access to laboratory test results through the NHS app, this study aimed to assess the accuracy and safety of two AI tools, ChatGPT and Google Bard, in providing interpretation of thyroid function test results as if posed by laboratory scientists or patients. Fifteen fictional cases were presented to a team of clinicians and clinical scientists to produce a consensus opinion. The cases were then presented to ChatGPT and Google Bard as though from healthcare providers and from patients. The responses were categorized as correct, partially correct or incorrect compared to consensus opinion and the advice assessed for safety to patients. Of the 15 cases presented, ChatGPT and Google Bard correctly interpreted only 33.3% and 20.0% of cases, respectively. When queries were posed as a patient, 66.7% of ChatGPT responses were safe compared to 60.0% of Google Bard responses. Both AI tools were able to identify primary hypothyroidism and hyperthyroidism but failed to identify subclinical presentations, non-thyroidal illness or secondary hypothyroidism. This study has demonstrated that AI tools do not currently have the capacity to generate consistently correct interpretation and safe advice to patients and should not be used as an alternative to a consultation with a qualified medical professional. Available AI in its current form cannot replace human clinical knowledge in this scenario.

Cream Skimming in an Early College High School: A First-Year Principal’s Dilemma in a High-Performing Campus

Schools of choice need to provide equitable access and opportunities to all students, including students with disabilities and emergent bilinguals. In the context of Early College High Schools, principals and school districts should be partners in ensuring admissions processes are non-discriminatory. In this fictional case, a new principal in a high-performing early college high school becomes concerned that the school has been denying or not actively recruiting students with disabilities and emergent bilingual students. However, when she raises her concern with her supervisors and predecessor, she gets no support. The teaching notes of this case review the literature on ethical leadership, school administration dilemmas, and bounded ethicality.

Benefits of deprescribing for older people with frailty and polypharmacy: part one.

The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with age and as a result it is likely that multiple medicines will be prescribed for older people, leading to polypharmacy. This is a concern because polypharmacy is associated with various adverse effects and an increased medicine burden in this population, as well as a financial burden for the healthcare system. This article, the first of two parts, explains the physiology of ageing and frailty, and considers the adverse effects of polypharmacy on older people with frailty, using a fictional case study to illustrate this. Part two will use the case study to explore the use of medication reviews and deprescribing benefits as part of medicines optimisation.

Physicians' assessment of complications after gynecological surgery in Sweden: The GYNCOM survey.

Complications after gynecological surgery in Sweden are registered in the well-established Swedish National Quality Register of Gynecological Surgery, GynOp. The aim of this study was to analyze interrater reliability in assessing complications according to the methods in GynOp, and to explore physicians' perceptions of registering complications. A digital survey was sent to gynecologists and residents in gynecology in Sweden. Participating clinics were recruited through the Swedish network for national clinical studies in Obstetrics and Gynecology, SNAKS. Twenty fictional cases, intended to represent normal postoperative course, failure to cure, and varying degrees of complications, were developed by the research group. The clinical scenarios included abdominal and laparoscopic surgery of the uterus and adnexa, vaginal hysterectomies, as well as hysteroscopy. The respondents graded each case on the presence of a complication (yes/no). Type of complication, severity, and what action the complication required according to Clavien-Dindo was registered if a complication was acknowledged, according to the method in GynOp. Interrater reliability and the opinions of the respondents were presented descriptively. More than 80% of respondents making the same assessment was considered as agreement. The response rate was 41%, with 104 responding physicians from 16 gynecological clinics. Type and severity of complication was considered relevant to register by 88% and 89% of respondents, respectively. Agreement on whether the case described a complication was >80% in 85% (17/20) of cases and agreement using the Clavien-Dindo classification was >90% in 80% (16/20) of cases. There was high agreement in assessments of classically severe complications, such as pulmonary embolism and ureteral damage, in both presence of complication and severity, as well as Clavien-Dindo (>90% for all methods). Cases with agreement <80% on whether the case described a complication were bordering between normal postoperative course and minor complication. This study provides validation for the methods used to register complications after gynecological surgery according to the GynOp register, including the use of Clavien-Dindo in gynecology. However, the results indicate a need to define what should be considered symptoms inherent to each type of surgery.

Knowledge of Child Abuse and Neglect among General Practitioners and Pediatricians in Training: A Survey.

Child abuse and neglect is a common, underreported, and worldwide problem. Health care providers play an important role in detecting and reporting this problem. This study examined the knowledge on the clinical signs and mimickers of child abuse among Belgian trainees in family medicine and pediatrics. Participants filled out an anonymous online survey of 15 fictional but realistic cases with either suspicious or non-suspicious signs of abuse or neglect in the context of primary or emergency care. The overall score on all cases, the number of correct answers per case, and the median score were calculated, and the association of the participant's demographic characteristics with their score was examined using regression analysis. A total of 70 participants completed the survey. The overall median score was 73.3% (IQR 20.0%). The suspicious cases were solved more correctly than the non-suspicious cases (median: 85.7% versus 62.5%, p < 0.001). Regression analysis could not reveal a significant association of type and level of education with the performance on the survey. Knowledge of the clinical signs of child maltreatment among pediatricians and general practitioners in training is good, but there is still room for improvement.

Assessing and managing pain in older people with dementia.

There is little evidence to suggest that people with dementia experience less pain than those without dementia, however they are less likely to report their pain due to the cognitive impairments they experience as their dementia progresses. A comprehensive pain assessment that involves family members, carers and/or friends in the process is crucial to gain an understanding of a person's medical and pain history, and to ensure effective pain management in people with dementia. This article describes the identification, assessment and management of pain in older people with dementia. The author includes a fictional case study with the aim of supporting nurses to reflect on possible indicators of pain in a person with dementia and to consider the tools they may use when identifying and assessing this pain.

Fictitious cases as a methodology to discuss sensitive health topics in focus groups

ABSTRACT Purpose It can be challenging to research aspects of people’s health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the effectiveness in focus groups using prostate cancer and screening as an example. Method We developed a fictitious case and employed it as a projective technique in focus groups on prostate cancer and screening. The participants were men and their partners who lived in Denmark. Results The technique encouraged emotional and cognitive openness in focus group discussions about the risk of prostate cancer, the benefits and harms of screening, and decision-making about screening. It appeared that using the fictitious case allowed the participants to personally distance themselves from the topic, project emotions onto the case, and thereby openly talk about their emotions. Conclusion This article presents a methodological contribution to communication about sensitive topics in focus groups, using prostate cancer screening as an example. Further refinement of the methodology is needed to enable participants to transfer improvements in knowledge to their own decision about screening.

Neurotic Feminine Aspirations in the Characters of Maya, Bimla, Nanda and Monisha with Reference to Anita Desai’s Fictionracters of Maya, Bimla, Nanda and Monisha

This article aims to investigate the representation of women by Anita Desai from psychoanalytical perspective.Desai, being a post-colonial writer has diverted the attention of many critics and perusers towards her astonishing style of portraying feminine desires and urges in such a minute way that startles the readers. Desai has amplified the unconscious desires of her female characters which are usually muted and suppressed in overarching patriarchal system. Desai has penetrated their unvoiced miseries and unfulfilled wishes which get chronic and later take the shape of neurotic trauma, so Desai debunks this aspect of ruthless chauvinistic society to give space to women voices in true sense. This angle of investigating characters remined unexplored by many writers for a very long time. Through her eminent novels like Fire on the Mountain, Cry the Peacock, Voices in the City and Clear light of the day, readers are well aware of the minute details she presents, these voices are echoed by her sorrowful and agonizing characters. Anita Desai has augmented these females with power of voice and reaction to challenge the power structures. The predicament and unaddressed sorrows of these female characters also pave way to recognize the miserable plight, contemporary women is facing in her life, in that way her characters supplement the perusers with fictional case studies to have broader comprehension of understanding the traumas of the females ultimately addressing those issues to build a healthy and balanced environment for women around.

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.

Road resilience: adaptive education for emerging challenges

The reality of paramedicine can cause students emotional distress, especially if this tests their values or beliefs. Therefore, educating students to be resilient and prepared for unpredictable, distressing events should be considered. The need to increase professional longevity in paramedicine has shifted employers' focus from road readiness to road resilience, which presents a complex challenge for educators. This article is the first of a series to discuss the use of supporting sciences to build road resilience in undergraduate paramedicine programmes. A review of the literature on paramedic education demonstrates there is new knowledge, based on experience in clinical practice and research, that paramedic educators can draw on to develop their discipline. Paramedics with postgraduate qualifications can shape the future of their professional discipline when their research produces a new discourse that informs a curriculum which can meet contemporary challenges. Discussion of a fictional case study illustrates how an emotional crisis could provide a platform for reflective learning and make a student more effective as a paramedic, and the educational environment needed to facilitate this.