Open-minded Research Articles

OA27 A Thrombus Tale

Abstract Introduction Non catheter related arterial thrombosis is very rare in children. Our patient had a peripheral arterial thrombus with no risk factors apart from a background of recurrent Henoch-Schönlein Purpura (HSP). He had no history of trauma. Thrombosis as a complication of HSP is extremely rare with onlyeight case reports so far in children and among those eight, there is only one resembling our case with an arterial thrombus. We considered other causes of thrombosis and screened our patient for thrombophilia, infection and malignancy. Case description Our patient, a 12-year-old boy with a background of recurrent HSP for the last two years, presented with a rash on the left 2nd toe followed by blackish discolouration of the distal part of the same toe, a few days later. His initial presentation with purpuric rash, arthralgia, and abdominal pain was diagnosed as HSP and he required no intervention required for this. He continued to have regular flares of his HSP every six weeks, and these were self-limiting. His last flare was in February 2024. In April 2024, his feet appeared dusky and mottled. He presented to his local hospital with a rash on the tip of his left 2nd toe which turned gangrenous. He was otherwise systemically well. He was initially treated with antibiotics and acyclovir as a swab from the lesions grew staphylococcus aureus and the rash was bullous initially. He was referred to our tertiary rheumatology and haematology teams at Nottingham due to worsening ischemia and an absent left dorsalis pedis pulse. His examination revealed normal blood pressure, mottled, dusky lower legs, warm left foot with a faint petechial rash near left malleolus, absent left Dorsalis pedis pulse and an ischemic tip of left 2nd toe. Bilateral femoral and upper limb pulses were well felt. His respiratory, cardiovascular, abdomen & musculoskeletal examination were normal apart from an antalgic gait. His clotting and thrombophilia screen including antiphospholipid screen was normal. His D dimer was raised at 1894ug/l. A duplex scan of his left leg showed occlusions in the distal anterior and posterior tibial artery as well as in the dorsalis pedis artery with no emboli. His inflammatory markers and autoantibodies were normal. Infection screen including mycoplasma, CMV, EBV and ASOT titres were all negative. Echo was normal. A skin biopsy from the toe revealed IgA vasculitis. Discussion We had a multidisciplinary team (MDT) discussion with haematology, vascular surgery and dermatology. As per the MDT discussion, he was given a pulse of intravenous methylprednisolone after careful consideration weighing the risk versus benefit of steroids adding to the pro thrombotic state versus active vasculitis causing narrowing of the arteries. He was also commenced on Aspirin at 1 mg/kg/day. There was marked improvement in his symptoms with improvement in the discolouration and pain, his d-dimer reduced, and he was able to mobilise comfortably. We felt that active vasculitis could be causing the vascular event. As immunology screen was negative and the skin biopsy was confirmatory of HSP. There was no thrombus specifically mentioned in the duplex but with D-dimer being raised it was a reasonable assumption was that there was a thrombus occluding the peripheral arteries. As his HSP was recurring quite frequently and was bothersome, as well as the thought that the recurrences might contribute to further vascular events and complications, we started our patient on Azathioprine. We have also sent genetic tests and awaiting a catheter angiogram to complete the investigation process. Key learning points • Consider vasculitis as one of the differentials in a child with unexplained venous or arterial thrombosis. • In a child with recurrent HSP, keep an open mind for rare complications that may occur. • Recurrent HSP in an older child may need immunosuppression. • Treatment considerations in a case with vasculitis with a thrombus has to be in close connection with haematology to decide on anticoagulation and its implications on the young person and their lifestyle. • Should there be any other investigations done or alternative diagnosis though of at this point?

Stigma towards people with mental conditions in healthcare workers: an Italian cross-sectional study

Abstract Background Stigma towards people with mental disorders (MD) in healthcare workers (HCWs) can negatively influence the quality of care provided and hinder patients from accessing healthcare. The aim of this study was to analyze stigma and its determinants among physicians and nurses in Italy, as a basis for future strategies to reduce its extent. Methods A cross-sectional study was conducted from April to September 2023. A sample of 1053 physicians and nurses working in Italy answered an online 52-item questionnaire. Variables explored demographic data, work context, burnout symptoms, and personal or family history of MD. The Opening Minds Scale for Health Care Providers (OMS-HC) was used to assess the level of stigma (score from 20 to 100, higher scores represent higher levels). Descriptive analysis and multivariable linear regression were performed. Results Females were 69.5% and median age was 48 years (IQR=37-58). Physicians were 60.5%. A total of 20% of the sample worked in psychiatric settings. Burnout symptoms were reported by 23.5%. Results showed a median OMS-HC score of 49 (IQR=43-54). Positive associations with stigmatizing attitudes were found for being a nurse (p = 0.020) and being in burnout (p = 0.017), while working in a psychiatric setting (p < 0.001) and having personal or family history of MD (p < 0.001) had negative associations. Conclusions This research unveiled a notable amount of stigma among Italian HCWs towards individuals with MD. Since people with MD experience higher rates of disability and mortality, it has to be a public health priority to develop targeted strategies to reduce stigma in HCWs, as it discourages patients from accessing healthcare. Future interventions should be tailored for different professionals and dealing with HCWs burnout. Key messages • Future interventions should consider that healthcare workers in burnout and nurses tend to have more stigma toward patients with mental conditions. • Healthcare professionals working in psychiatric settings and having personal or family history of mental disorders showed lower stigma.

Metastatic tumours to the parotid: A 20-year single institutional experience with an emphasis on 14 unusual presentations

The parotid gland is a rare site for distant metastasis. We aim to provide an overview of metastatic tumours to the parotid over the past 20 years, focusing on clinicopathological analysis of 14 rare diagnoses. To the best of our knowledge, we are the first group to present the most up-to-date and largest case series on unusual metastases to the parotid. A total of 93 metastatic cases were identified from 2004 to 2023, on the pathology information system at North West London Pathology, with squamous cell carcinoma (n = 45, 48.4 %) as the most common primary, followed by malignant melanoma (n = 29, 31.2 %) and Merkel cell carcinoma (n = 4, 4.3 %). We came across 14 rare tumours that had metastasised to the parotid, including metastatic adenocarcinoma from kidney (n = 3, 3.2 %), lung (n = 3, 3.2 %) and breast (n = 1, 1.1 %), olfactory neuroblastoma (n = 3, 3.2 %), soft tissue sarcoma (n = 2, 2.2 %), small cell carcinoma (n = 1, 1,1 %) and hidradenocarcinoma (n = 1, 1.1 %). Half of all secondary neoplastic lesions (50.5 %) were found in intra-parotid nodes, while the other half (49.5 %) were found in parotid parenchyma. Our study offers valuable insights into the various tumour types that can metastasise to the parotid across a wide age range. It underscores the necessity of maintaining a broad differential diagnosis. Keeping an open mind regarding the potential primary sources of the tumour is imperative for accurate diagnosis and effective treatment planning.

Practical exploration of BOPPPS model combined with situational teaching method in clinical training of intensive medicine: novel pedagogy and perception.

To explore the application value of bridge-in, learning objective, pre-assessment, participatory learning, post-assessment, and summary (BOPPPS) model combined with situational teaching method in the clinical teaching of intensive care unit (ICU), and to provide experience for the reform of ICU clinical teaching and standardized training of intensive medicine. A randomized trial was conducted using a multi-center, prospective cohort study. A total of 293 residential physicians in ICU of Fujian Medical University Union Hospital, the Affiliated Hospital of Putian University and the First Affiliated Hospital of Gannan Medical University from January 2021 to December 2023 were selected as subjects, and the residential physicians in ICU in each medical center were divided into control group and experimental group using random number table method. The control group adopted bedside teaching and demonstration teaching method, and the experimental group adopted BOPPPS model combined with situational teaching method. Clinical teaching performance was evaluated by ICU admission examination, and study process questionnaire (SPQ) and the critical thinking disposition inventory-Chinese version (CTDI-CV) was used to evaluate the learning motivation and critical thinking ability of the two groups. At the same time, the effect evaluation and satisfaction questionnaire of ICU training (EESQ) was used to evaluate the teaching satisfaction. The scores of the experimental group in ICU theoretical knowledge, clinical thinking and skills, and the treatment of clinical critical cases were higher than those of the control group [(87.31 ± 13.15), (92.86 ± 12.35), (81.45 ± 11.28)] vs. [(83.94 ± 12.73), (88.37 ± 12.61), (78.83 ± 10.47)], the difference between the two groups was statistically significant (p < 0.05). The scores of surface motivation, deep motivation, achievement motivation and SPQ total scores of the experimental group were all higher than those in control group (p < 0.05), and the scores of seek truth, open mind, analytical ability, systematic ability, self-confidence of critical thinking and intellectual curiosity of the experimental group were also higher than those in the control group, and the CTDI total score was statistically significant (p < 0.05). In addition, the results of the questionnaire showed that the experimental group was better than the control group in terms of learning interest in ICU, improvement of humanistic care and doctor-patient communication ability, improvement of teamwork ability, improvement of job identity, ICU training harvest and satisfaction with teacher style (p < 0.05). The combination of BOPPPS model and situational teaching method is likely a more effective and helpful which may improve the clinical comprehensive ability and training quality of residential physicians, and it may be worth learning and promoting.

Diapedesis leading to hematidrosis due to abrupt emotional suffering (Review).

Hematidrosis constitutes a rare imposing phenomenon encountered millennia ago. It involves the plexus of small, mostly superficial arteries, veins and sweat glands of various parts of the human body. Bloody sweat implies skin pathology. It has been connected to psychogenic impairment and lacks a clear etiology. The present study conducted a historical review using the Thesaurus Linguae Graecae®, Gallica-BNF and Google Books databases. The year 1900 was the mark for full-text works to be included. A second review of the modern literature, over the last 20 years, was carried out using the PubMed/MedLine database. In both eras, the terms h[a]emat[h]idrosis, diapedesis, sudor sanguineus, plus various others vocables of Hellenic and Latin origin, were used as key words. Cases of persons suffering hematidrosis during stigmata as partly connected to this study were surveyed and discussed separately. References were obtained from the classical Greece, late Hellenic antiquity and Roman era. A number of 70 cases were registered from the Renaissance to 1900, and 44 cases between 2007 and 2022. The later time interval is considered as the selection of references of all time, while the 1870 to 1884 interval followed. Differences in sex were observed (males, 60.6%; and females, 39.4%; vs. males, 25.6%; and females, 74.4%). The scalp, forehead, face, trunk, arms and legs were the most common areas of appearance in both time intervals. The eyes and ears were the most common areas of appearance in the modern era. As regards the limitations of the present review, it should be emphasized that not all historical cases were available for survey. Stigmata were studied independently. Records in etiology hypothesis, pathological description and the manifestation of a cluster of post-triggering effects described were similar over time. The modern way of life, major stressful events, a fear of death, hematological disorders, vessel derangements and deep faith may trigger hematidrosis. This spectacular acute event stimulates alertness in patients, family, caregivers and physicians, and may lead to social isolation and unnecessary diagnostic and/or therapeutic interventions. The present narrative review aimed to connect science with history and religion, promote contemplation among health professionals and highlight a medical peculiarity. An open mind is warranted in order to comprehend phenomena in religion. Education for the family and a knowledge update for health professionals is also necessary.

A psychometric evaluation of the Opening Minds Scale for Workplace Attitudes (OMS-WA), a measure of public stigma towards mental illnesses in the workplace

The anti-stigma Opening Minds initiative (Mental Health Commission of Canada) identified the workplace as one of four critical areas for stigma evaluation and programming. Researchers found, however, that no validated tool to measure stigma in this context existed at the time. The purpose of the current research was to develop and assess the psychometric properties of a multi-component quantitative measure of public stigma towards mental illnesses in the workplace: Opening Minds Scale for Workplace Attitudes (OMS-WA). Three studies are discussed. Study 1 outlines the initial development of the OMS-WA, finding a five-factor structure with 23 items (EFA analysis; N = 207). Study 2 utilized employees from various businesses to further validate the OMS-WA, (N = 107), finding good internal consistency and good convergent/divergent validity. Study 3 utilized baseline data from two national large-scale stigma reduction and resiliency programs (first responders and general workplaces) to confirm the factor structure, finding good model fit and reliability with both samples (N = 5385; N = 1207). Together, these results provide strong evidence of the OMS-WA. Its use in measuring workplace stigma related to mental illness is recommended. Considerable future evaluation is warranted, and directions for generalizability studies, as well as suggestions for using the OMS-WA in intervention trials, are provided.

Empowering Neurodiverse Voices in Research Ethics through a Playful Card-Based Approach

Whenever carrying out research, all participants must know their rights, especially when those participants are perceived as being part of a vulnerable group; however, discussing ethics in investigation can be difficult. To solve this challenge, a playful approach was taken, as playfulness can make dull tasks – especially those that can cause discomfort and difficulties – more entertaining and help people approach them with an open mind. This study reports on four empirical approaches that used a playful process to raise awareness about ethical concerns when doing research with neurodiverse people. For this activity, 39 cards describing and illustrating several relevant and evidence-based ethical principles were created. Then, three case studies were developed, each based on a different focus group composed of ten neurodivergent self-advocates and one with professors and students from Brazil. Each neurodivergent group was also accompanied by three support workers from the partner associations (two of the groups were accompanied by the same individuals). In total, 56 participants engaged in a playful activity that consisted of a game of ‘broken telephone’ where the title of a card (representing an ethical principle) is read to one of the players who then has to whisper it to the next person in line, repeating this process until reaching the last person. The last person then says what they heard out loud, with the original message being revealed for contrast. The title of the cards was discussed by the groups to understand if it was clear and understandable or difficult and confusing. Although not all the cards were validated through the activity, 14 were flagged by neurodivergent people as "needing changes". The feedback was recorded and is presented here. This study set out to validate a set of cards in easy-to-read language that could introduce ethical concepts to participants in research projects through a playful activity. Future study will see the cards iterated upon through the feedback gathered along with the creation of a small guide on how they may be used in playful activities.

협업의 덕목을 통한 디자이너 갈등의 역기능 해소 방안 탐색

The purpose of this study is to resolve the dysfunction of designer conflict through the virtue of collaboration. The scope of the study is limited to the dysfunction of conflict between individuals and groups. This study was a basic study and was conducted through the literature research method, and the following conclusions were drawn. First, in collaboration, the virtues of clarity and justice are highly likely to resolve the dysfunctional elements of conflict, such as energy distribution and group cohesion destruction. Second, in collaboration, the virtues of responsibility and ownership are highly likely to resolve energy distribution, passive participation in the team, and negative organizational atmosphere from work, which are dysfunctional elements of conflict. Third, in collaboration, the virtues of interest and respect are highly likely to resolve psychological anxiety, passive participation, and insufficient progress, which are dysfunctional elements of conflict. Fourth, the open mind and honesty virtue in collaboration is highly likely to resolve energy distribution, negative organizational atmosphere, and group cohesion from work, which are dysfunctional elements of conflict. This study is expected to be used as basic data for a study on how to resolve conflict dysfunction through the virtue of collaboration.

CANVAS For A Diagnosis: Can You Hear The Hooves Of Zebras?

Abstract Background A 75year old male presented to a Movement Disorder Service with complex multimorbidity including: chronic pain, type 2 diabetes mellitus, hypoventilatory obesity syndrome, biliary calculus, moderate aortic stenosis, marked orthostatic hypotension, pulmonary hypertension, coronary artery bypass grafting, permanent pacemaker for complete atrioventricular block, carpal tunnel release bilaterally, polypharmacy and bilateral cataracts. History elucidated a distal to proximal sensory loss over 20years and neuropathic pain without nerve conduction confirmation; and progressively ataxic gait over several years. He also complained of hypophonia, bruxism, excessive daytime somnolence, passages, transitions, visual agnosia, textural illusion, oscillopsia, irritability, inflexibility, hoarding, impulsivity, disorganisation, inattention, apathy, depression and aspontaneity. He was intolerant of nocturnal continuous positive airway pressure device. Epworth score was 21. Methods Examination demonstrated: marked orthostatic hypotension, preserved cognition, hypersomnolence, dyspraxic dysgraphia, palmar and antecubital agraphaesthesia, downbeat horizontal nystagmus at eccentric gaze positions, square wave jerks, bidirectionally impaired head impulse test, dysmetric saccades, asymmetric cerebellar signs in upper and lower limbs, rightward Pisa syndrome, kinesigenic dystonic axial posturing, rightward laterocollis and equivocal Babinski/Oppenheim reflexes. Gait assessment demonstrated sensory and cerebellar ataxic features with marked apraxia. No pes cavus. Results Computed tomography of brain had Fazekas 1 small vessel disease, Medial temporal atrophy score 1, Koedam 1 and age-commensurate cerebral and cerebellar atrophy. RFC1 gene testing confirmed biallelic intronic AAGGG repeat expansion disorder. Conclusion Cerebellar Ataxia Neuropathy and Vestibular Areflexia Syndrome (CANVAS) should be considered in patients with presentations from mid-life of progressive sensory ataxic neuropathy, altered vestibular ocular reflex, gaze evoked nystagmus and prominent dysautonomia. CANVAS is a rare autosomal recessive genetic disorder with a protean presentation. Referral to Genetics Services should be undertaken for family counselling. Keeping an open mind in complex, multimorbid patients to a potentially unifying diagnosis is important to guide prognostication. The rumble of hooves in the distance is not always that of horses.

Bringing Christmas Cheer: Carols to Nurture and Witness the Faith

Western European cultures may vary in their adherence to any form of Christianity, but the feast of Christmas has a special place in society in keeping an open ear, mind and heart. Concerts and carolling are common to Orthodox and non-Orthodox cultures alike, providing an annual opportunity to engage audiences in the Mystery of the Incarnation in a paraliturgical context. This paper will explore the benefits to singers and audiences, and the way that both may be nurtured through Christmas music. The Mosaic Choir, in London, UK, provides a central case study, a choir of Orthodox singers from many different backgrounds. Audiences, clergy and choir members, past and present, provide additional insights into one of the most rewarding musical times of year.

Metastatic cholangiocarcinoma in a cow presenting as suspect bovine tuberculosis in Ireland

AbstractCholangiocarcinoma is a malignant tumour of bile duct epithelial cells, an uncommon primary hepatic neoplasm in cattle. A 9‐year‐old Simmental cow presented with watery diarrhoea, crusty skin lesions, loss of appetite and hepatomegaly. Suspecting severe liver disease, the cow was euthanased due to poor prognosis. During gross postmortem examination, large numbers of multifocal to coalescing nodules often with soft necrotic centres ranging from miliary to 7 cm in size were present in the liver, lung, mesentery, peritoneum and lymph nodes. These features were suggestive of bovine tuberculosis. However, direct tissue smears stained by Ziehl Neelsen stain were negative for the presence of acid‐fast bacteria, and subsequent histopathological and immunohistochemical investigations confirmed the presence of metastasizing cholangiocarcinoma. This case reminds clinicians and pathologists to keep an open mind during the diagnostic process and serves to highlight the value of histopathology in diagnosing seemingly characteristic gross lesions.

Navigating Data Acquisition and Data Quality Validation of Large Databases: Practical Lessons

ObjectiveHave you ever been frustrated when working to acquire data? Have you experienced the trials and tribulations of readying data? ‘Best laid plans often go awry’. ‘A problem shared is a problem halved’ and we’d like to share our experiences and lessons learned with you. We are a Canadian provincial organization with over 20 years experience working with large comprehensive data currently in the midst of validation work on newly acquired data. This behind the scenes and sometimes forgotten work can take considerable time, but it is crucial and integral for research. ApproachData acquisition is complex, particularly when adding new data to existing data files. Many validation steps are vital to ensuring that data used in research are the highest quality possible and limitations are understood. The process began with preparing the agreement and list of new variables to add in 2018 for 4 databases (hospital, drug, physician, emergency), to signatures in 2023, and it is ongoing. While we have a plan to do this work, it requires flexibility and constant updates based on new information learned. ConclusionInvestigating errors, deciding level of acceptance of errors, managing relationships, and communication are the most critical aspects of the work. Contingency plans are important when it takes longer than expected. Data are never perfect, but a thoughtful approach to validation and documentation of limitations and decisions support using the data appropriately. Also, a kind demeanor, an open mind, and a sense of humour can go a long way!

Revisiting Epistemological and Psychological Composition of Religious Experience

The impact of Carl Jung and William James on the early 20th-century Indian subcontinental semi-philosophical and semi-psychological tradition is examined in this article. To analyse and assess these traditions, a qualitative research design was used. Relevant documents, academic works, and philosophical literature were examined to provide context-rich understanding. Iqbal made a concerted effort to use intellectual and psychological frameworks to legitimize religious experience, notably referencing the concepts of William James. But significant conflations resulted from this integration, especially between prophetic and non-prophetic experiences, which diminished the uniqueness of Islamic Religious thought in the end. This attitude has open mindedly and happily accepted the fictitious versions of religion but this acceptance is disastrous and lethal than the explicit denial. To ensure the preservation of Islamic thought, it is crucial to approach Western philosophical ideas with caution and avoid conflating religious experiences. A re-evaluation of Iqbal's intellectual legacy is necessary to understand religious experiences from a non-Western perspective.

Tackling adversity with open minds: Team personality composition facilitates shared leadership and team resilience

AbstractResilient teams can efficiently resolve disruption and overcome adversity. Despite growing interest in building and maintaining resilient teams, our understanding of the factors that promote team resilience necessitates further theorizing and empirical testing. Based on conservation of resources and shared leadership theories, we propose that team member personality (i.e., mean openness to experience) serves as a resource that facilitates team resilience via shared leadership. Further, we argue that the strength of influence of shared leadership on team resilience is contingent on the variance of openness to experience scores among team members. We draw our conclusions from three studies (i.e., two recall experiments and a multi‐source field study) involving working professionals in virtual teams. Our findings shed light on the interactive role of team member personality in explaining team resilience, thereby extending our knowledge of the personality predictors of shared leadership and team resilience.

Non-traditional mental health clinical placements: An effective means for reducing self-stigma in pre-registration nursing students.

Pre-registration nursing students report high rates of stigma, leading to low help-seeking attitudes when seeking help for mental health issues. Traditional mental health clinical placements can improve stigma related to attitudes and social distance for pre-registration nursing students. There are nil recorded clinical placement interventions that have decreased self-stigma for pre-registration nursing students, with this study highlighting a clinical placement model that is effective in significantly decreasing self-stigma. The knowledge around the mental health struggles experienced by pre-registration nursing students, and the effect of a non-traditional mental health placement in decreasing self-stigmatizing attitudes in this population, is important for the future of retaining mental health nurses. There is an opportunity to use the clinical placement model presented, and design interventions for nursing students that aims to promote help-seeking behaviours. INTRODUCTION: Traditional mental health clinical placements can improve pre-registration nurse stigma toward mental illness, particularly in measures of attitudes and social distance. However, they have not yet been shown to improve self-stigma, which affects mental health disclosure and help-seeking behaviour. The present study investigates nursing students' stigma following a non-traditional mental health placement immersed alongside people living with mental illness. Three stigma subtypes were measured using the Opening Minds Scale for Healthcare Providers: Attitudes, Social Distance, and Disclosure/Help-seeking. Pre-registration nurses (N = 848) completed the instrument pre- and post-placement. A multivariate analysis of variance (MANOVA) identified a large effect of placement on stigma (p < .001, = .101). Post hoc pairwise comparisons revealed all three types of stigma decreased after the non-traditional placement (Attitudes: p < .001, = 0.09, Social Distance: p < .001, = 0.07, Disclosure/Help-seeking: p < .001, = 0.04). These findings emphasize that attending a non-traditional mental health clinical placement can effectively reduce multiple types of nursing student stigma. Further research in this area could focus on which attributes of the clinical placement setting foster positive help-seeking. These results are noteworthy for stigma surrounding disclosure/help-seeking, as traditional (i.e. hospital-based) mental-health clinical placements have been found ineffective in reducing nursing student stigma in this domain. Further research into the effectiveness of non-traditional clinical placements in reducing nursing students' stigma regarding mental health disclosure and help-seeking, is required.

Open your eyes, open your mind: The profile of cognitive liberalization and intergroup contact experiences

AbstractAccording to the cognitive liberalization hypothesis, exposure to intergroup contact improves cognitive outcomes related to open‐mindedness and out‐of‐the‐box thinking. In a sample of Italian adults (N = 708), we: (a) investigated the profile of cognitive liberalization through a latent profile analysis including cognitive (i.e., cognitive flexibility, socio‐cognitive mindfulness, curiosity and low need for structure) and socio‐cultural (i.e., deprovincialization, beliefs supporting societal diversity and low social dominance orientation [SDO]) dimensions of cognitive liberalization; (b) tested how intergroup contact experiences differed between the profile of cognitive liberalization and the other profiles. Results showed three profiles: Cognitive Liberalization (high scores in both cognitive and socio‐cultural dimensions of cognitive liberalization), Cognitive Rigidity (low scores on cognitive, high scores in socio‐cultural dimensions) and Anti‐Liberalization (low scores on all liberalization variables). Individuals belonging to the Cognitive Liberalization profile reported less negative, and more positive and intimate contact experiences with the outgroup compared with the other two profiles; they had a higher proportion of outgroup members in their acquaintances, and perceived those outgroup members involved in positive contact as more representative of their outgroup. Diversity of contacted outgroup members did not matter for the profiles. Close and positive relationships with the outgroup could be key to cognitive liberalization. Please refer to the Supplementary Material section to find this article's .

The Determinants of Nurses’ Critical Thinking by Documenting the Nursing Process in the Regional General Hospital of Banda Aceh Municipality, Indonesia

Documenting the nursing process remains an issue in hospital settings. It is still found that nurses have not developed adequate critical thinking skills. Documentation of the nursing process from assessment to evaluation has not been described completely and precisely. This study aimed to expound the determinants of nurses’ critical thinking by documenting the nursing process at the Regional General Hospital Banda Aceh Municipality. Quantitative research with a cross-sectional study design was employed. The research population was 247 nurses, sample size was determined using the Cohen table with a total of 151 respondents and 151 medical records, sampling used purposive sampling. Data collection tools used the California Critical Disposition Thinking Inventory (CCTDI) questionnaire, data analysis used descriptive and inferential statistical tests; chi-square. The results showed that there was a relationship between truth seeking (p=0.017), open mindedness (p=0.006), analysis (p=0.005), systematicity (p=0.011), self-confidence (p=0.017), curiosity (p=0.011), maturity (p=0.004), and critical thinking (p=0.041) with documentation of the nursing process. Based on the results of this research, it was necessary to maintain and improve positive critical thinking skills in nurses so that they were able to document the nursing process well so as to improve quality nursing care.

Informed Inclusion Model: Medical Student Wheelchair User in an Obstetrics and Gynecology Clerkship.

Students with physical disabilities are underrepresented in medicine, driven in part by ableist beliefs about the ability of individuals with disabilities to complete procedure-based or surgically oriented clerkships, including obstetrics and gynecology (Ob/Gyn). There is a growing commitment to disability inclusion by medical and specialty training associations. Yet published case studies and accommodation protocols for medical student wheelchair users navigating an Ob/Gyn clerkship are absent in the literature. This article describes successful disability inclusion for an Ob/Gyn clerkship, including accommodations for medical student wheelchair users. The authors share mechanisms to address and combat ableist assumptions and facilitate access for future medical students by working collaboratively with student and key stakeholders to develop an inclusive and accessible training experience.These recommendations are shared through the story of a third-year medical student who rotated through the longitudinal clerkships at the Cleveland Clinic Lerner College of Medicine. The student, an individual with osteogenesis imperfecta who uses a power wheelchair with a seat elevator, completed third-year rotations and thrived in her clinical experiences. The authors describe her journey through a robust 4-week Ob/Gyn clerkship, in which she fulfilled the required clinical core conditions and observation skills with reasonable accommodation. Given the high acuity, surgery, and outpatient demands in Ob/Gyn-and the transferrable skills to other clerkships-the student's experience is an excellent exemplar for demonstrating disability inclusion and reasonable accommodation.Ob/Gyn clerkship directors and clinical faculty can broadly use the recommended timelines and communication protocols to create accessible training environments. With student input, minor scheduling adjustments, ongoing communication, reasonable accommodations, and an open mind, medical students on the clinical wards who are wheelchair users can successfully navigate the required expectations of medical training.

The relationship between personality and cognition in older adults with and without early-onset depression.

It is well established that personality traits impact cognition, as certain personality factors are associated with performance in specific cognitive domains. However, the findings on the relationships between the Big Five traits and cognition are mixed. Additionally, few studies have explored these relationships in older adults with a history of depression. The present study aimed to (a) evaluate the impact of the Big Five personality traits in older adults with and without a lifetime history of depression; and (b) test the hypotheses that higher trait neuroticism would correlate negatively with cognitive performance, while openness to experience would correlate positively with cognition. The sample consisted of 138 participants between the ages of 55 and 78 (M = 65.56, SD = 6.36). Sixty-two participants met criteria for current or remitted Major Depressive Disorder, while 76 had no history of depression or other mental health disorders. Participants underwent comprehensive neuropsychological testing. Personality was assessed using the NEO Personality Inventory-Revised (NEO-PI-R), while depression status was determined using the Structured Clinical Interview for DSM-5 (SCID-5). Following a series of Pearson correlations of cognitive variables and the five personality factors, linear regression models were estimated for each significant correlation. Demographic variables (i.e., age, education and sex) were entered in block 1, depression status (never vs. ever) was entered in block 2, and the personality factor score, or sub-facet was entered in block 3. Neuroticism was not associated with cognitive performance on any outcome measure. The facets Openness to Feelings and Openness to Values were positively related to phonemic fluency. Further Openness to Values was positively related to cognitive flexibility. Our results suggest that older people who are (a) more capable of identifying and understanding their feelings and the feelings of others, and (b) who are more willing to re-examine social, political, and religious values perform stronger on tasks measuring verbal fluency and cognitive flexibility, which are aspects of executive functioning. Interventions that aim to enhance open mindedness in older adults may have a parallel impact on improving executive functioning, though this would need to be examined prospectively.

Adapting the Opening Minds Stigma Scale for Healthcare Providers to Measure Opioid-Related Stigma.

The opioid crisis in Canada continues to cause a devastating number of deaths. Community-based naloxone programs have been identified as one of the solutions for combatting this crisis; however, there are disparities in which pharmacies stock and offer naloxone. Opioid-related stigma is a major barrier for limited naloxone distribution through pharmacies. Therefore, the development of anti-stigma interventions is crucial to improve naloxone distribution in Canada. However, there is no validated tool to specifically measure opioid-related stigma. The Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) is a validated scale used to measure mental illness-related stigma. This study will adapt the OMS-HC by using four different opioid-related terminologies to determine which is the most stigmatizing to use in an opioid-related anti-stigma intervention. Pharmacy students completed four versions of the adapted OMS-HC. The average OMS-HC scores and Cronbach's α co-efficient were calculated for each version. The term "opioid addiction" was found to be the most stigmatizing term among participants and will be used in the adapted version of the OMS-HC in a future anti-stigma interventions.