Therapeutic Experience Research Articles

‘Space to hide’: experiences of remote provision across child and adolescent mental health services (CAMHS)

BackgroundThe global COVID-19 pandemic necessitated rapid adoption of remote provision across child and adolescent mental health services (CAMHS). The study aimed to understand young people’s, parents’/carers’, and professionals’ experiences of remote provision across CAMHS in one NHS Trust in the North West of England to inform future recovery practice so that remote sessions can continue where they have been well received but re-thought or replaced where they have not.MethodsThe study sample comprised three groups: (i) young people, (ii) parents/carers, and (iii) clinical staff. Semi-structured interviews and focus groups were used to collect data. Data were analysed using thematic analysis.ResultsThree overarching themes were identified: ‘Remote therapeutic experiences’; ‘Spaces and places of therapy’; and ‘Future of CAMHS’. Although remote appointments increased flexibility within the service, the quality of the relational experience was altered, typically for the worse. Clinicians felt less able to examine vital forms of non-verbal communication, which were considered instrumental in assessing and engaging people experiencing difficulties, leaving some questioning their professionalism. Although some young people suggested that remote provision increased comfort levels, others felt their place of comfort and safety was invaded.ConclusionsReduced travel time for both clinicians and families may increase capacity, enabling the service to meet the increased demand if clinical effectiveness can be preserved. In considering future models of provision, assessing clinical need, patient and family preference, and access to space and hardware are all critical when deciding which modality to use for the best outcomes for each individual.

Abstract 15236: A Systematic Review of the Quality of Life (QOL) Assessment Tools Used in Aortic Dissection in the Context of Survivorship

Introduction: The term 'survivorship' describes the therapeutic, functional, psychosocial, and financial experience of living with a chronic condition.This term acknowledges the fact that a patient’s life can be radically altered overnight because of their disease and treatment, but also designates patients as ‘survivors’, having overcome the acute phase (‘acute survivorship’) and now needing to live with, through and beyond their condition (‘extended survivorship’ and ‘permanent survivorship’). The aim of this systematic review was to identify the most frequently used quality of life (QOL) assessment tools and to determine how closely these align to the concept of 'survivorship'. Methods: A systematic literature review was conducted according to PRISMA guidelines. Embase, Medline and the Cochrane Library were electronically searched till January 2022 for studies reporting on QOL in aortic dissection patients. Observational studies and case series studies were included. Due to the degree of heterogeneity existing between the studies, a meta-analysis was not conduced. Study quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist. Results: A total of 27 studies were included, encompassing 32 QOL tools. The most common QOL tool utilised was the SF-36, across 11 studies. Only one qualitative study investigated patient perspectives of living with aortic dissection. Overall, QOL was found to be poor in aortic dissection survivors. All identified QOL tools demonstrated a poor alignment with the survivorship domains. Included studies displayed a moderate to high risk of bias, having small sample sizes and an insufficient follow-up period. Conclusion: This review highlights the absence of an aortic dissection specific QOL tool. All QOL tools identified failed to encompass the breadth of survivorship domains, with a lack of studies focusing on the patients’ perspective. Further research is urgently required to gain an insight into the quality of life of patients who have survived an aortic dissection, and to develop an aortic dissection specific QOL tool, underpinned by the survivorship domains.

RF30 | PSAT178 Severe Hyperparathyroidism in a Newborn: Response to Cinacalcet

Abstract Background Neonatal severe hyperparathyroidism (NSHPT) is a rare potentially lethal disorder caused by inactivating mutations in the calcium sensing receptor (CASR) gene. In newborns it presents with multiple bone fractures often confused with forms of osteogenesis imperfecta. Diagnostic and therapeutic experience with this condition is limited, hence here we describe a term baby we identified and treated with this disorder. Case Description A 39-week-old Hispanic female, born small for gestational age (BW 2.38 kg) via vaginal delivery to a 33-year-old G3P2 healthy mother was noted to have relative asymmetry of the thighs/hips. X-rays revealed bone demineralization and multiple fractures including distal femur and proximal tibia bilaterally and rib fractures in various stages of healing. Initially, osteogenesis imperfecta was thought likely and Endocrinology was consulted. Laboratories showed hypercalcemia (calcium 12.1 mg/dL (normal 8.5-11.2), elevated serum PTH 439 pg/mL (12-72). Serum phosphorus (4.2 mg/dL), 25-OH Vitamin D (44 ng/mL) and alkaline phosphatase (232 IU/L) were normal; urine calcium/creatinine ratio was low (0.006 mg/mg). EKG showed non-specific T wave abnormalities and echocardiogram mild pulmonary hypertension. Neck ultrasound and sestamibi scan showed no parathyroid mass. She was placed on oxygen due to desaturations and had poor tone and suck. Father had documented hypercalcemia (calcium 12.6 mg/dL, PTH 53 pg/mL). Paternal aunt and grandmother also had history of hypercalcemia. Serum levels of calcium and PTH remained elevated for 2 weeks despite treatment with IV fluids and furosemide and a low calcium/vitamin D formula. On day 12 we began a trial of cinacalcet, a type 2 calcimimetic, at starting doses of 0.4 mg/kg/day divided BID orally. Over 4 days the patient showed a dramatic reduction in serum levels of calcium and PTH to 8.6 mg/dL and 24 pg/mL, respectively. Over time her clinical course improved with better tone and suck and normal oxygenation. Cinacalcet was titrated up to 2.3 mg/kg/day (2mg PO tid) and baby discharged on day 20. Gene sequencing revealed a known heterozygous pathogenic variant in an exon 4 hotspot of the CASR gene, c.658C>T (p.Arg220Trp), consistent with familial hypocalciuric hypercalcemia. Father was confirmed to have the same pathogenic variant as the child. She has now been followed for 6 months, all fractures are healing with persistently normal PTH and calcium levels. She is thriving, her development appears to be normal, able to eat orally, sit, track and smile. Conclusion Neonatal severe hyperparathyroidism can occur in infants who are heterozygous for a CASR mutation and can manifest as multiple congenital fractures. A family history of asymptomatic parental hypercalcemia/hyperparathyroidism and targeted gene sequencing can be diagnostic of NSHPT. Activators of the CASR are a promising therapy for heterozygous CASR loss-of-function pathogenic variants and can lead to reversal of skeletal demineralization and markedly improved clinical status. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 1:18 p.m. - 1:23 p.m.

A preliminary qualitative study on helpful processes of creative expressive - bodily maps of emotions in psychotherapy with children and adolescents

ABSTRACT Research on the positive events in the therapeutic counseling process is usually undertaken from the client’s perspective. However, few studies have investigated the beneficial aspects of the therapeutic counselling process, particularly in creative expressive fields. This preliminary qualitative study aims to evaluate the therapeutic experience of utilizing Creative expressive – Bodily maps of emotions (CE-BME) with young clients in the helpful process. The CE-BME is an art therapy tool that counselling practitioners or therapists have extensively used in Malaysian mental health settings. A qualitative approach known as the grounded theory method was employed in this study through face-to-face and video call interviews with four therapists from the health setting who conducted sessions for children and adolescents using the CE-BME. As a result, six themes of the helpful process were identified: (1) facilitating emotional exploration and processing, (2) engaging relationships with young clients, (3) expanding the client’s self-awareness, (4) helping the direction of intervention, (5) release for clients, and (6) relief for therapists. Furthermore, these findings established the following outcomes regarding the CE-BME tool as a helpful process, thereby boosting researchers’ confidence in applying the main study to more therapists engaged in children’s mental health intervention.

Urban park soundscapes: Spatial and social factors influencing bird and traffic sound experiences

Abstract Natural soundscapes experienced in parks are increasingly recognised as a valuable ecosystem service, yet urban parks soundscapes also commonly contain anthropogenic noise. While studies show bird calls can promote psychological restoration, the factors that might influence actual experiences of these sounds by individuals in urban parks are less clear. Equally, continual exposure to anthropogenic noise, such as vehicle traffic, is associated with negative health outcomes, but determinants influencing negative experiences of such sounds within a park soundscape are poorly understood. To address this gap we used an ex situ survey of over 4000 Australian residents and examined a range of spatial and social factors in influencing perceptions towards noticing and pleasantness of bird sounds and traffic noise within urban parks. The results indicate older age, recent park use, and valuing parks for uses such as exercising, socialising and to hear nature, were positively associated with pleasant bird sound experiences in parks. For traffic sounds, we found indicators of disadvantage, such as renting a home were associated with a higher likelihood of unpleasant experiences of traffic noise within parks. Notably, individuals using parks for social activities were still positively associated with pleasant bird sound experiences and less likely to perceive traffic sounds as unpleasant. Conversely, whilst those with greater nature‐relatedness had a strong positive association with pleasant bird sound experiences, they were more likely to perceive traffic as unpleasant. Overall, these findings suggest that whilst many types of park users can potentially experience the beneficial effects from bird sounds, the detrimental effects of traffic noise may constrain these benefits in certain social groups, particularly those of greater socio‐economic disadvantage. We discuss strategies to promote greater equity of therapeutic experiences of bird sounds in parks, whilst outlining traffic mitigation measures within urban parks. Read the free Plain Language Summary for this article on the Journal blog.

The Shared Regressive State and Understanding‐without‐Reflection in Supervision

One of the transformational therapeutic experiences is the therapeutic dyad's immersion in and recovery from shared regressive states that are often provoked by an awakened childhood fear of breakdown. I suggest that the supervisory dyad has parallel transformational experiences – the shared regressive states that follow continuous incomprehension of the unfolding therapeutic reality. Moreover, when the supervisory partners immerse themselves in a shared regressive state, a unique, inclusive, embodied, unsymbolized, and procedural understanding‐without‐reflection emerges spontaneously. Analytic writers describe such an understanding as an unconscious knowledge, and existentialist writers describe it as prereflective consciousness. Before translating this unique understanding into a therapeutic narrative, the supervisor needs to recover from the regressive state and organize it according to discursive and logical analytic principles. From this perspective, the already existing experiential and analytic theoretical knowledge serves as a platform for creating new perceptions and analytic discourses.

Saliendo de la oscuridad de la inexperiencia de la mano de Sullivan y Buechler

Entering clinical practice and being a novice psychotherapist presents a challenge for many, walking through the first steps in this profession produces anxiety and a feeling of vulnerability. This paper is meant to share the emotional and therapeutic difficulties I went through at the beginning of my clinical practice. Some theoretical, but mainly practical concepts from Harry Stack Sullivan and Sandra Buechler have helped me bear the struggles of the novice experience in the clinical setting and have also helped me locate paths for therapeutic action. Mostly, I emphasize on the importance of curiosity, not only as an emotion, but also as a clinical value that allows us to deepen in the therapeutic experience. Curiosity, along with an active inquiry, guide us ahead of the uncertainties and ambiguities of the professional work experience. Coming out of the novice darkness experience has been possible due to the calm, inspiration, and guidance that these two authors have offered me throughout their works.

The role of sodium-glucose co-transporter-2 inhibitors in frail older adults with or without type 2 diabetes mellitus.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors offer significant outcome benefits beyond glucose lowering, including reduced risk of cardiovascular death, all-cause mortality, major adverse cardiovascular events, hospitalisations for heart failure and progression of renal disease. Considering these therapeutic effects, minimal incremental risk for hypoglycaemia and simplicity of administration, this drug class appears to be an attractive therapeutic option for older adults, and post hoc analysis of trial data provides support for the use of SGLT2 inhibitors in this population. Nevertheless, despite favourable clinical trial data, there has been some hesitance in clinical practice prescribing these drugs to older frail adults due to the limited therapeutic experience in this population and insufficient long-term safety data. In this review article, we evaluate the risk–benefit profile for the use of SGLT2 inhibitors in this population and suggest that rather than being a treatment to avoid, SGLT2 inhibitors should be considered a valid therapeutic option for older frail adults with or without diabetes.

Clinical, Therapeutic, and Prognostic Experience in Patients With Glioblastoma.

Glioblastoma (GB) represents the most aggressive type of glioma with a poor prognosis despite the therapies used. As of today, data availability for therapeutic and prognosis experiences is limited.The cornerstone for this study is to create a framework overview of Mexico´sexperience throughout 17 years of research. Retrospective analysis from 2000 to 2017including patients with a histological diagnosis of GB was performed. Data were collected from the ABC Medical Center and the Neurology and Neurosurgery National Institute. One hundred and thirty-seven patients were included with a mean age of 54 years. Histological diagnosis was made in all patients, of which 58.1% had a total resection, 31.6% had a partial resection, and 10.3% of them underwent biopsy. In all cases, patients received treatment under the following conditions:10 patients were treated exclusively with stereotactic radiotherapy (RT). In 55 patients, a combination of RT and TMZ was used, the other 40 patients received RT plus CBP. Eighteen patients RT added to nitrosourea medication and lastly, 14 patients received a combination of RT/TMZ and Bevacizumab, a monoclonal antibody that inhibits the formation of blood vessels (BVZ). The progression-free survival (PFS) and overall survival (OS)were higher in the RT/TMZ/BVZ group (16.5 to 22.9 months) and the RT/TMZ group (11 to 17 months), the prognostic parameters included: Isocitrate dehydrogenase 1 mutation (IDH1), usage of BVZ and TMZ in the PLS and OS, considering as well, age range (<70 years) as a favorable prognostic factor. GB represents the most frequent intracranial neoplasia. Combined fractionated stereotactic RT added to Temozolomide and Bevacizumab received in our population reports favorable and superior results compared to the ones described in the literature. Further studies are necessary to know the biological behavior of our population.

Does practice really make perfect? A longitudinal analysis of the relationship between therapist experience and therapy outcome: A replication of Goldberg, Rousmaniere, et al. (2016).

Experience is often regarded as a prerequisite of high performance. In the field of psychotherapy, research has yielded inconsistent results regarding the association between experience and therapy outcome. However, this research was mostly conducted cross-sectionally. A longitudinal study from the U.S. recently indicated that psychotherapists' experience was not associated with therapy outcomes. The present study aimed at replicating Goldberg, Rousmaniere, et al. (2016) study in the German healthcare system. Using routine evaluation data of a large German university psychotherapy outpatient clinic, the effect of N = 241 therapists' experience on the outcomes of their patients (N = 3,432) was assessed longitudinally using linear and logistic multilevel modeling. Experience was operationalized using the number of days since the first patient of a therapist as well as using the number of patients treated beforehand. Outcome criteria were defined as change in general psychopathology as well as response, remission, and early termination. Several covariates (number of sessions per case, licensure, and main diagnosis) were also examined. Across all operationalizations of experience (time since first patient and number of cases treated) and therapy outcome (change in psychopathology, response, remission, and early termination), results largely suggest no association between therapists' experience and therapy outcome. Preliminary evidence suggests that therapists need fewer sessions to achieve the same outcomes when they gain more experience. Therapeutic experience seems to be unrelated to patients' change in psychopathology. This lack of findings is of importance for improving postgraduate training and the quality of psychotherapy in general. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ethical Issues Regarding Nonsubjective Psychedelics as Standard of Care.

Evidence suggests that psychedelics bring about their therapeutic outcomes in part through the subjective or qualitative effects they engender and how the individual interprets the resulting experiences. However, psychedelics are contraindicated for individuals who have been diagnosed with certain mental illnesses, on the grounds that these subjective effects may be disturbing or otherwise counter-therapeutic. Substantial resources are therefore currently being devoted to creating psychedelic substances that produce many of the same biological changes as psychedelics, but without their characteristic subjective effects. In this article, we consider ethical issues arising from the prospect of such potential "nonsubjective" psychedelics. We are broadly supportive of efforts to produce such substances for both scientific and clinical reasons. However, we argue that such nonsubjective psychedelics should be reserved for those special cases in which the subjective effects of psychedelics are specifically contraindicated, whereas classic psychedelics that affect subjective experience should be considered the default and standard of care. After reviewing evidence regarding the subjective effects of psychedelics, we raise a number of ethical concerns around the prospect of withholding such typically positive, meaningful, and therapeutic experiences from most patients.

The Software Interface of a Hybrid FES and Mechatronic Exoskeleton System for Hand Rehabilitation in Stroke People

Abstract This paper introduces novel contributions to the field of hand rehabilitation systems designed for stroke patients. The primary objective is to enhance voluntary movements in the paralyzed upper limbs, with a particular focus on hand functionality. The system, known as MANUTEX, comprises two main components: functional electrical stimulation (FES) implemented through a textile glove with embedded electrodes, connected to a programmable neurostimulator, and a mechatronic exoskeleton resembling a glove, powered by individual linear motors for each finger. These linear motors are controlled by a programmable microcontroller on a central board. MANUTEX delivers mirror therapy, a therapeutic approach requiring a sensory glove attached to the healthy hand. This sensory glove provides reference movements for the hybrid system located on the affected, impaired hand. An application installed on a computer serves as the control interface for the entire system. It reads movement data from the healthy hand and concurrently sends commands to both the FES and mechatronic exoskeleton glove, ensuring a balanced and synchronized therapeutic experience for the patient.

Psychometric Evaluation of the Cooper-Norcross Inventory of Preferences-Therapist Version.

The Cooper-Norcross Inventory of Preferences (C-NIP) is a commonly used and psychometrically validated measure of client preferences in therapy. However, the C-NIP version for therapists (C-NIP-T) has not yet been validated. This study aimed to develop a Chinese version of the C-NIP-T and test its factor structure, reliability, and concurrent validity. A national sample of 1,054 Chinese mental health professionals completed the C-NIP-T and provided relevant demographic information. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP-T. ESEM provided stronger evidence than CFA for the hypothesized four-factor model. Internal consistency coefficients (Cronbach's α) of the four subscales ranged between .60 and .76. Full or partial scalar invariance was established across therapists' therapeutic orientations, gender, personal therapy, and clinical experience. There were significant differences in subscale scores among therapists who identified as cognitive/cognitive-behavioral, psychoanalytic/psychodynamic, and humanistic/client-centered, supporting the concurrent validity of the C-NIP-T. The C-NIP-T is a psychometrically sound measure that can be used to assess therapists' preferences about therapy.

Ma’am Mom: An Autoethnography of Being a Teacher and a Mother during the COVID–19 Pandemic

When the COVID-19 pandemic happened, people and sectors of society needed to adjust specific norms and standards to fit into the demands of the time. This paper is an autoethnography of my experiences as a mother-teacher during the peak of the pandemic. It is in the context of my experiences and other mother-teachers working from home, conflicts in the roles played by mother-teachers at home, the expectation of society, and social norms. It is about how I perceived my reproductive and productive roles. Moreover, I interviewed mother-teachers, and their stories served as counter and conforming narratives to my narratives. The following are emerging themes: the unprecedented time; a mother is born; off the rhythm; and silver lining. These themes discussed the various phases mother-teachers grappled upon and triumphed. Writing this autoethnography was a therapeutic experience for the high emotions I had to deal with during the pandemic.

Exploring self‐disclosure between the survivor‐therapist and survivor‐clients: An autoethnography of the value of ‘sisterhood’ between female survivors of sexual violence

AbstractBackgroundThis autoethnographic study explores the interrelationships between self‐disclosure and working as a survivor‐therapist with clients who are also survivors of sexual violence. Themes explored include post‐traumatic growth of the author in relation to two occurrences of therapy and within the training experience, the concept of sisterhood between female survivors, and impact of self‐disclosure from the survivor‐therapist.AimThe aim was to explore how survivor‐therapist self‐disclosure might impact the therapeutic experience for clients identifying as survivors.MethodologyAn autoethnographic three‐phased approach was created to collate and analyse data from the author's personal and reflective journals, spanning the journey from client to qualified therapist. Themes analysed were as follows: “post‐traumatic growth,” “sisterhood” and “self‐disclosure.”FindingsThis research demonstrates the value of sisterhood between female identifying survivors of sexual violence and highlights the implicit “knowing” that may deepen the therapeutic relationship where therapist self‐disclosure is used judiciously in service of the client.ImplicationsThe research is situated in contribution to an existing dialogue, and recommendations are made for practice improvement and towards generation of ongoing research within a wider social narrative.

The Practical Application of Oil Painting in the Treatment of Mental Illness.

With the rapid development of economy, politics, science, and technology and the improvement of living material level, people pay more attention to personal physical and mental development. The incidence of mental illness is on the rise. Psychological education curriculum learning and psychological counselling are based on communication; there are still many limitations. The art media enables patients to reveal their subconscious and potential emotional needs, so that interveners have the opportunity to explore these issues and build a bridge of communication with patients. In this paper, oil painting therapy of nonverbal communication is proposed as a way of psychological therapy. The patients in the psychological department of a hospital are served by six stages of therapy, each stage of treatment has different arrangements, and continuous service and treatment are adopted. Based on the art analysis principle of oil painting creation, the therapeutic experience obtained from oil painting creation and the experience gained from oil painting were divided into groups to compare the therapeutic effect and explore the role of oil painting art therapy. The results showed that the scores of the treatment group were significantly lower than those of the control group at 4 weeks and 6 weeks after the art therapy of oil painting creation, showing a significant downward trend overall. Oil painting art therapy may alleviate anxiety, providing data support for the application of oil painting art therapy in patients with depressive episodes.

Abstract 1093: BRD9 inhibition overcomes epithelial to mesenchymal transition (EMT)-associated tyrosine kinase inhibitor (TKI) tolerance in epidermal growth factor receptor (EGFR) mutant lung cancer

Abstract Advanced lung cancer patients that present with activating mutations in the epidermal growth factor receptor (EGFR) are treated with EGFR tyrosine kinase inhibitors (EGFR TKIs). While initially effective, all patients eventually develop therapeutic resistance and experience disease progression. Strategies to prevent EGFR TKI resistance are needed to improve patient outcomes. We chronically exposed H1975 cells (EGFR-L858R/T790M) to EGFR TKI osimertinib to study emergence of resistance. H1975 cells that were expanded under drug treatment (designated H1975OR) acquired an EMT phenotype and were re-sensitized to EGFR TKI upon prolonged drug withdrawal. These features led us to classify H1975OR as a model of drug tolerance rather than a model of stable drug resistance. Bulk RNA-sequencing revealed significant dysregulation of chromatin modifying genes in H1975OR. Bromodomain containing protein 9 (BRD9) was among the set of significantly upregulated chromatin regulators and was selected for further investigation as a mediator of drug tolerance. Although BRD9 is known to control stemness and EMT, its role in promoting EMT-associated TKI resistance is unknown. To test the contribution of BRD9 to EGFR TKI tolerance, pharmacological inhibition of BRD9 by the selective inhibitor, I-BRD9 significantly increased sensitivity to TKI in models with EMT phenotypes (IC50 reduced 3-4 fold). In contrast, I-BRD9 did not affect TKI sensitivity in two models where EGFR TKI resistance was genetically fixed. To gain mechanistic insights, H1975OR cells were treated with osimertinib +/-I-BRD9 and subjected to RNA-sequencing. Combination of osimertinib with I-BRD9 resulted in a significant decrease in EMT-related genes, including MMP9, Zeb2, PDGFRb and IL6. Further, use of I-BRD9 in these models diminished the mesenchymal phenotype, as measured in cell invasion assays. Genetic knockdown of BRD9 via shRNA phenocopied effects of I-BRD9 treatment, supporting BRD9 as the therapeutic target of I-BRD9 in our cell line models. To further establish a role for BRD9 in the emergence of drug tolerant cells, we exposed treatment naïve H1975 cells to EGFR TKI ± I-BRD9. I-BRD9 significantly decreased the size of the EGFR TKI tolerant population. In time course studies, I-BRD9 also delayed onset of TKI resistance. In conclusion, our data identifies BRD9 as a novel mediator of EMT-associated EGFR-TKI tolerance in EGFR-mutant lung cancer. Our data further implicates BRD9 inhibition as a novel strategy to delay the emergence of drug tolerant cells that eventually give rise to stable drug resistance. This work was supported by the Roswell Park Alliance Foundation and National Cancer Institute (NCI) grant P30CA016056 involving the use of Roswell Park Comprehensive Cancer Center’s Genomics and Bioinformatics Shared Resources. Citation Format: Hannah Calkins, Tatiana Shaurova, David W. Goodrich, Mukund Seshadri, Candace S. Johnson, Pamela A. Hershberger. BRD9 inhibition overcomes epithelial to mesenchymal transition (EMT)-associated tyrosine kinase inhibitor (TKI) tolerance in epidermal growth factor receptor (EGFR) mutant lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1093.

An Enactive-Ecological Model to Guide Patient-Centered Osteopathic Care.

Osteopaths commonly face complexity and clinical uncertainty in their daily professional practice as primary contact practitioners. In order to effectively deal with complex clinical presentations, osteopaths need to possess well-developed clinical reasoning to understand the individual patient’s lived experience of pain and other symptoms and how their problem impacts their personhood and ability to engage with their world. We have recently proposed (En)active inference as an integrative framework for osteopathic care. The enactivist and active inference frameworks underpin our integrative hypothesis. Here, we present a clinically based interpretation of our integrative hypothesis by considering the ecological niche in which osteopathic care occurs. Active inference enables patients and practitioners to disambiguate each other’s mental states. The patients’ mental states are unobservable and must be inferred based on perceptual cues such as posture, body language, gaze direction and response to touch and hands-on care. A robust therapeutic alliance centred on cooperative communication and shared narratives and the appropriate and effective use of touch and hands-on care enable patients to contextualize their lived experiences. Touch and hands-on care enhance the therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. Therefore, the osteopath–patient dyad provides mental state alignment and opportunities for ecological niche construction. Arguably, this can produce therapeutic experiences which reduce the prominence given to high-level prediction errors—and consequently, the top-down attentional focus on bottom-up sensory prediction errors, thus minimizing free energy. This commentary paper primarily aims to enable osteopaths to critically consider the value of this proposed framework in appreciating the complexities of delivering person-centred care.

Real-life experience of rare hepatoid adenocarcinomas of the lung: A large retrospective french cohort.

e21091 Background: Hepatoid adenocarcinoma of the lung (HAL) is a rare subtype of lung cancer exhibiting common histological features with hepatocellular carcinomas (HCC). Therapeutic landscape is currently similar to lung adenocarcinoma standards. We report here the largest descriptive cohort of HAL with focus on (chemo)-immunotherapy (CT-IO) efficacy. Methods: In this single-center retrospective observational study, we selected all consecutive cases of HAL patients from January 2013 to January 2022. Eligible patients had primary lung tumor with positive immunohistochemical hepatocyte marker. HCC was eliminated with liver imaging. We provide a descriptive analysis of HAL population and describe our therapeutic experience. Results: A total of 21 patients were included. Main characteristics at diagnosis were: median age of 63 years [41-81], 80,9% of males, with 76,2% of PS 0-1. All patients had smoking history, with 8 active smokers. Twenty patients (95,2%) had stage IV disease. Median number of metastatic sites was 2; 7 (33,3%) patients had brain metastases. PD-L1 status was &lt; 1% (n = 10), 1-5% (n = 2), ≥50% (n = 5), unknown (n = 4). Six (28,6%) patients harbored KRAS mutation: G12C (n = 4), G60D (n = 1), G12V (n = 1). One patient had Lynch syndrome with MMR deficiency. Median follow-up was 5 months. Median overall survival (mOS) since diagnosis achieved 9 months (95% CI, 3 to 21). Early palliative care concerned 6 patients. Five patients received first-line CT-IO. Best response was: partial response (n = 3), stable disease (n = 1), progressive disease (n = 1). One patient treated with first-line pembrolizumab achieved stable disease. Four patients received second-line IO but experienced early progressive disease. Conclusions: Our results highlighted the aggressive metastatic profile of HAL accounting for the poor mOS of 9 months. Patients could benefit from upfront CT-IO but further studies are warranted to confirm it.

Circumstantial: An Evaluation of Circumcision, Breastfeeding, and Overall Dyad Success.

Circumstantial: An Evaluation of Circumcision, Breastfeeding, and Overall Dyad Success.