Three-hour Session Research Articles

Training in Trauma-Responsive and Anti-racist Telehealth: A Model for Behavioral Health Clinicians and Providers

AbstractTelehealth's uptake in behavioral health services has been accelerated by the COVID-19 pandemic. However, many clinicians continue to lack focused training in providing trauma-informed and culturally-responsive telehealth care. This article outlines a model curriculum that was created to instruct and coach behavioral health providers in California on how to integrate anti-racist and trauma-responsive techniques into telehealth. Topics like evidence-based trauma therapies, racial/ethnic trauma, marginalized communities, digital divide, and provider selfcare were all covered in the nine-part curriculum. Every three-hour session included evidence-informed didactic content, telehealth skills practice, and concrete planning for implementation. Trauma-responsive frameworks such as the tri-phasic model of trauma recovery (Herman in Trauma and recovery: The aftermath of violence—From domestic abuse to political terror, Basic Books, 2015) and the neurosequential model of therapeutics (Perry in The handbook of therapeutic care for children, Jessica Kingsley Publishers, London, 2020) served as the foundation for the sessions. The Tools to Improve Practice (TIPs) website was created as a supplementary digital resource portal to support clinicians with continuous implementation. This model illustrates a replicable approach to strengthening workforce capacity and competence in trauma-responsive, anti-racist telehealth practices.

The effect of spaced E-Learning on knowledge of basic life support and satisfaction of nursing students: a quasi-experimental study

AimCardiopulmonary resuscitation (CPR) training is essential for all students, especially nursing students. One of the educational approaches to creating long-term learning in inclusive is spaced learning. Spaced learning consists of three or more training sessions in which information is presented over time and at intervals. The present study was conducted to investigate the effect of basic life support (BLS) training through spaced E-learning on the knowledge and satisfaction of nursing students.MethodsIn this quasi-experimental study with two groups, 106 undergraduate nursing students of Alborz University of Medical Sciences in Iran participated. The control group (n = 47) received BLS training with massed E-learning in one three-hour session, and the intervention group (n = 59) received spaced E-learning in three one-hour sessions. An electronic questionnaire including demographic information and a pre-test of BLS knowledge were sent to both groups. Also, immediately after receiving the training, two weeks later and one month later, they completed a post-test of BLS knowledge. Students were asked to indicate their level of satisfaction with the provided education by completing the SLS-OLE.ResultsThe post-test scores immediately after, two weeks later, and one month later of the intervention group were higher than the control group. The results of repeated measurement ANOVA showed that the score changes of knowledge are significant over time (p < 0.001), the number of sessions (p < 0.001), and the interactive effect of them (p < 0.001). There was no statistically significant difference in the level of satisfaction with education in both groups.ConclusionBased on the results, BLS training in both groups increased the knowledge of BLS. however, the increase in knowledge and its retention was higher in the intervention group that received the training in spaced learning.

Empowering Underserved Communities in Southern Puerto Rico: A Formal Training Program in Community Health Promotion

Community health promotion offers a potential solution to persistent healthcare challenges, with community health workers playing a pivotal role. The Community Training Institute for Health Disparities (CTIHD) implemented a problem-solving curriculum in Community Health Promotion, integrating a competency-based learning model through two courses: Introduction to Community Health Promotion and Design of an Action Plan for the Promotion of Community Health. Each course comprised ten three-hour sessions, featuring pre/post-tests, evaluations, and a cognitive debriefing. Knowledge change was assessed using pre/post-test scores among 27 community leaders from southern Puerto Rico. Cohort 1 and Cohort 2 demonstrated an overall retention rate of 62.6% and 96.7%, respectively. Although differences in knowledge gained between cohorts and courses weren’t statistically significant, a trend toward increased knowledge was noted. Cohort 1 experienced a 22% knowledge increase in Course 1 and a 24% increase in Course 2. Cohort 2 demonstrated a 41% knowledge increase in Course 1 and a 25% increase in Course 2. The CTIHD’s Community Health Promotion Program has made significant strides in elevating awareness and knowledge, marking a positive step toward reducing health disparities and fostering healthier, empowered communities in southern Puerto Rico.

Expert or machine? Comparing the effect of pairing student teacher with in-service teacher and ChatGPT on their critical thinking, learning performance, and cognitive load in an integrated-STEM course

ABSTRACT For student teachers’ professional development, the emergence of generative artificial intelligence (AI) represents both opportunity and challenge. This exploratory quasi-experimental study aims to investigate the effects of “Human-Human” and “Human-Machine” collaborative learning approaches on the SETM teaching training performance of student teachers. Twenty-three student teachers were divided into two groups within a single class, each adopting one learning method. The experiment lasted for two months with weekly three-hour sessions. Data were analysed focusing on critical thinking, learning performance, and cognitive load between the groups. The results indicated that student teachers using ChatGPT showed higher critical thinking systematicity, task completion efficiency, and experienced lower cognitive load. Student teachers paired with in-service teachers slightly outperformed those with ChatGPT on the final teaching design proposal. These findings underscore the potential and varying strengths of AI tools like ChatGPT and human teachers. For further research, refined collaborative learning scaffolding are recommended to explore the impact and potential of AI-assisted and in-service teacher-involved collaboration. The study’s implications could guide educators, policymakers, and AI developers in optimizing the AI-enhanced collaborative learning strategies and shed light on the new formation of human-machine collaborative intelligence in the scope of education.

Evaluation of Effectiveness of an Online Selfdirected Learning Programme in Biochemistry for First Year Medical Undergraduate Students: A Quasi-experimental Study

Introduction: Self-directed Learning (SDL) has been suggested as a principle of adult learning to promote lifelong learning abilities among students. Though SDL is not a new concept, there is a lack of uniform implementation across the institutions in India. The Competency-based Medical Education (CBME) proposed by the National Medical Commission in 2019 has emphasised SDL for medical students. Aim: To evaluate the effectiveness of an online, case-based SDL activity in Biochemistry for the first-year MBBS students. Materials and Methods: This was a quasi-experimental study conducted at Father Muller Medical College, Mangaluru, Karnataka, India from May to July 2021. A purposive sampling technique was used, and 138 first-year MBBS students were enrolled for the research. The topic of lipid metabolism was chosen for SDL. Parallel to the online didactic lectures, a casebased, team-based, online SDL was implemented. Students were provided with case scenarios and were instructed to discuss the case scenarios and find answers to the accompanying questions in allotted groups for 15 days. A three-hour session was held for the presentation of the SDL, followed by a posttest and reflections of students. The data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The significance of the difference in pretest and post-test scores was assessed by paired t-test, and the level of significance was set at a p-value &lt;0.05. Qualitative data were subjected to descriptive statistics, and thematic analysis of reflections was conducted. Results: The average post-test score of the participants was significantly higher by 99.3% compared to the pretest score (p-value &lt;0.001). On average, 108 out of 138 (78.2%) agreed (agree/strongly agree) that SDL helped them to achieve the learning objectives,115 (83.3%) agreed that SDL helped them to develop as lifelong learners, 115 (83.3%) agreed that SDL helped them to develop as a health professional, and 83 (60.1%) agreed that enjoyed learning in online mode. The inclination of 110 (79.7%) students to have more SDL sessions in the future shows a behavioural change in favour of SDL. Time constraints and internet connectivity were the main challenges. Conclusion: SDL was effective and was received positively by the majority of the students. It is the need of the hour to develop lifelong learning and critical thinking among medical students and to make learning interesting with the use of case scenarios. Future research should assess the intermediate and long-term outcomes of case-based SDL on learning, behavioural changes, and its impact on patient care and the health of society

Effect of HIF-1α inhibition with topotecan and postconditioning on cardiac and skeletal muscle biomarkers during severe hypoxia

The work used a model of severe hypobaric hypoxia (SH) – a three-hour session of rats staying at 180 mmHg (5% O2) and an attempt was made to evaluate the possibility of its use for muscle tissue by determining biomarkers of cardiac muscle and skeletal muscles damage in the blood plasma. To assess the effect of HIF1, we used the HIF-1α translation inhibitor, topotecan, which was administered intraperitoneally (5 mg/kg body weight) in a DMSO–0.09% NaCl mixture 10 min before hypoxia. For postconditioning (PostC), moderate hypobaric hypoxia was used [1]. A significant increase in the level of cardiac biomarker troponin I in the blood plasma of rats subjected to TH was shown, which indicated myocardial damage after SH. The blood level of the nonspecific muscle biomarker myoglobin did not change significantly after SH. However, when the HIF-1α inhibitor topotecan was used before SH, the amount of myoglobin in the blood plasma of rats one day after the SH session was significantly lower than in the absence of the inhibitor. Thus, it can be assumed that inhibition of the transcription factor HIF-1α before SH reduces skeletal muscle damage. Topotecan can be proposed as a means to reduce damage to injured muscles.

A96Whole System Transformed: Making Discharge Everyone’s Business

Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge. Empower any member of staff to have discharge conversations. Emphasis on early discharge conversations. Join up acute and community staff involved in the discharge process. The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families. To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session. The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants ( Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios. Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A6Virtual reality simulation as a tool for ENT training: an autoethnographic study

Autoethnography is an emerging category of qualitative research that seeks to connect the rigorous analysis of traditional science with the undeniable influence of human experience [1]. Despite remaining under-utilized within surgical and simulation-based education research [2], autoethnography has great potential for sharing systematic, personal reflections with the wider readership, particularly with surgical trainees who rely on experiential learning as a cornerstone of their training. This study examines the use of autoethnography to investigate virtual reality (VR) temporal bone (TB) drilling simulation as a learning tool for Ear, Nose and Throat (ENT) training from the perspective of a surgical novice. The primary researcher undertook 16 three-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) TB simulator from October 2021 to July 2022. Qualitative data including field notes and reflective journal logs were collected using a template. These data were coded using NVivo12 and analysed using inductive thematic analysis. Additional quantitative data on surgical simulation performance derived from the Modified Welling Scale and Modified Stanford Assessment were plotted using Microsoft Excel and statistically analysed using simple linear regression. Six themes were ultimately yielded relating to the learning experience: (1) VMT as a surgical learning tool, (2) internal and external causes of rushing leading to inaccuracy, (3) overcoming VMT technological issues, (4) reflecting on reflection and the importance of feedback, (5) the physical impact of surgery on the operator and (6) overcoming demotivation. The author’s reflections on each theme were subsequently discussed in detail and analysed in the context of the current literature to meet the study objectives. Statistical analysis of the quantitative data demonstrated statistically significant improvements in procedural skills and ability over the 16-session period ( This study demonstrates a novel application of autoethnography showing VR TB simulation to be an effective ENT training tool for learning anatomy and technical skills when used in combination with the regimented reflection and feedback of autoethnography. We found that rushing caused by assessment-driven behaviour and hunger led to errors. These errors led to demotivation and stress, emotions frequently experienced by operating surgeons [3]. Therefore, we have also demonstrated that VR TB simulation can successfully model several human factors commonly found in operating theatres which must be self-identified and prompt seeking senior support to prevent patient harm. This evidence should provide a springboard for future autoethnographic research in the field of surgical and simulation-based literature. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The effect of clinical risk management training on patient safety competency and related aspects in nursing students

Background Students’ exposure to clinical risk management during their studentships can improve their safety competency, comfort speaking up about patient safety, and attitudes toward patient safety education. This study aimed to determine the effect of clinical risk management training on nursing students’ patient safety competency, attitudes toward broader aspects of patient safety in professional education, and comfort in speaking up about patient safety. Methods This experimental study used stratified sampling to assign 56 nursing students to intervention and control groups (28 students in each group). The intervention group received clinical risk management training in three three-hour sessions. The Health Professional Education in Patient Safety Survey was used to collect data from both groups before and one month after the intervention. Results The study found no statistically significant difference in patient safety competency and its subscales between the intervention and control groups in the pretest stage, but these competencies increased significantly in the intervention group in the post-test stage compared to the control group. The mean scores of attitudes toward broader aspects of patient safety in professional education and comfort speaking up about patient safety did not differ significantly between the intervention and control groups in the pre-test stage, but they increased significantly in the intervention group in the post-test stage compared with the control group. Conclusion It is recommended that clinical risk management and patient safety training be applied to the nursing curriculum so that nursing students become competent to provide safe care in clinical settings.

Enrichment of Anti Hoax Competency among Secondary School Students

&#x0D; Hoax and misinformation are common occurrences in the current era of social media. Nurturing critical thinking is necessary to combat the proliferation of hoaxes, especially in the younger generation. In this activity, we conducted a workshop for high school students and teachers to build awareness of hoaxes and how to identify them. This in-person workshop was held at Canisius College High School in a three-hour session. After taking part in the workshop, participants were expected to be able to explain the definition of a hoax, explain why hoaxes exist and are spread out among the community, and analyze the credibility of new information. For this purpose, the workshop consisted of three sessions. In the first session, the facilitators walked all participants through a lively discussion on what hoaxes are and how they get passed on from one person to another. In the second session, we introduced the concept of credibility to the participants. In the final session, the participants practiced evaluating the credibility of news. All sessions were delivered as paired or group discussions using authentic articles or postings from various social media platforms. The evaluation survey at the end of the activity showed that the participants agreed that the topic covered by this workshop was necessary and useful; however, they felt that the event was too short. This opportunity provided insights into how to improve similar hoax awareness-raising programs in the future.&#x0D;

Mindfulness-based childbirth and parenting for pregnant women with high fear of childbirth and their partners: outcomes of a randomized controlled trial assessing short- and longer-term effects on psychological well-being, birth and pregnancy experience

ObjectivesMindfulness-Based Childbirth and Parenting (MBCP) reduces mothers’ anticipated fear of childbirth (FOC), nonurgent obstetric interventions during childbirth and may improve childbirth outcomes in women with high FOC (Veringa-Skiba et al, 2022). The aim of this study was to examine the short- and longer-term outcomes of MBCP on psychological well-being, pregnancy and birth experience, as compared to enhanced care-as-usual (ECAU), in pregnant women with high FOC and their partners. DesignParticipants were randomly assigned to MBCP or ECAU and completed questionnaires preintervention (T1), immediately after intervention (T2), two to four weeks after childbirth (T3) and 16-20 weeks after childbirth (T4). Both intention-to-treat and per-protocol analyses were conducted. SettingThe courses were provided by trained midwives. ParticipantsParticipants included 141 pregnant women and 120 partners. InterventionMBCP comprised a nine-weekly three-hour session mindfulness group course for pregnant couples; ECAU consisted of two 90-minute individual couple consultation sessions. MeasurementsMeasures of psychological well-being included measures like stress, depression, anxiety and fatigue. Measures of pregnancy and birth experience concerned experiencing uplifts during pregnancy, experienced fear of childbirth, labour pain and satisfaction with childbirth. FindingsNo differences between MBCP and ECAU in the total group of birthing women were found. However, women with (at least an onset of) labour that participated in MBCP reported a better birth experience compared to ECAU at T3. Concerning the total partner group only one difference between MBCP and ECAU was found at T4; MBCP partners reported an increase in fatigue. However, in the partner risk group (i.e., partners with lower psychological well-being before intervention) partners experienced better psychological well-being at T2 and T3 after MBCP than ECAU. Key conclusionsMBCP and ECAU demonstrate similar effects on psychological well-being, birth and pregnancy experience. However, MBCP appears superior to ECAU for labouring women in having a better childbirth experience and for partners at risk for psychological complaints in increasing their psychological well-being. Implications for practiceMBCP only positively affects the childbirth experience of those who experience (onset of) natural birth. It might be advisable to include partners at risk for psychological complaints in the MBCP.

Bringing Psychology Students Closer to People with Schizophrenia at Pandemic Time: A Study of a Distance Anti-stigma Intervention With In-presence Opportunistic Control Group

Psychology students are a target population to increase the likelihood that Persons With Schizophrenia (PWS) will receive evidence-based psycho-social interventions in the future. The willingness of future psychologists to care for PWS can be supported through anti-stigma educational interventions. During the pandemic, university education was delivered largely at-distance, which was later combined with in-presence education. This study explored whether an At-Distance Educational Intervention (ADEI), addressing stigma in schizophrenia via scientific evidence and testimony: would improve psychology students' views of PWS, at the one-month post intervention re-assessments; would be more effective of the same In-Presence Educational Intervention (IPEI). ADEI was delivered online to students of two Master’s degrees in Psychology at the University of Campania “Luigi Vanvitelli”, Caserta, Italy. IPEI was administered to a similar group of 76 students in the pre-pandemic era. Participants completed an anonymous questionnaire about their views on schizophrenia before the intervention (two three-hour sessions one week apart) and one month after its completion. Compared to their pre-intervention assessments, at post-intervention reassessments the 65 ADEI students were: more confident in the recovery and the usefulness of psychological therapies; surer of the PWS awareness and capability to report health problems to professionals; more skeptical about PWS dangerousness, social distance, and affective difficulties; more uncertain on the opportunity to discriminate PWS in hospital and psychology practices. ADEI was more effective than IPEI in five of the ten dimensions analyzed and similarly effective in the remaining others. ADEI may represent a valuable alternative to IPEI for improving future psychologists' view of PWS.

Hands-On Practice on Sustainable Simulators in the Context of Training for Rural and Remote Practice Through a Fundamental Skills Workshop.

Simulation-based education (SBE) is a sustainable method to allow healthcare professionals to develop competencies in clinical skills that can be difficult to maintain in rural and remote settings. Simulation-based skills training is necessary for healthcare professionals that experience difficulties accessing skills development and maintenance courses to address the needs of rural communities. However, simulators, a key element of simulation, are often prohibitively expensive and follow a “one-size-fits-all” approach. Using additive manufacturing (AM) techniques, more specifically three-dimensional (3D) printing, to produce inexpensive yet functional and customizable simulators is an ideal solution for learners to practice and improve their procedural skills anywhere and anytime. AM allows for the customization of simulators to fit any context while reducing costs and is an economic solution that moves away from the use of animal products to a more ethical, sustainable method for training. This technical report describes the delivery of a fundamental skills workshop to provide hands-on training to rural and remote healthcare professionals using 3D-printed simulators purposefully designed following design-to-cost principles. The workshop was delivered at a three-hour session hosted at a rural and remote medicine course in Ottawa, Canada. The workshop consisted of four technical skills: suturing, cricothyrotomy, episiotomy, and intraosseous infusion (tibial) (IO) and used a blended learning approach to train healthcare professionals and trainees who practice in rural and remote areas. In addition, the learners were granted access to a custom-designed learning management system, which provided a repository of instructional materials, and enabled them to record and upload personal practice sessions, review other learners' practice sessions, collaborate, and provide feedback to other learners. The feedback collected from participants, instructors, and observations on the delivery of the workshop will help improve the structure and training provided to learners. The delivery of this workshop annually is an ideal solution to ensure parsimonious delivery of simulation training for rural and remote healthcare professionals.

Self-Rehabilitation Through Dance: An Ethnographic Study on Candy Girls Breast Cancer Survivor Group in Kuala Lumpur, Malaysia

This study intends to examine a breast cancer survivor group called the Candy Girls. Candy Girls comprises 26 to 30 women (aged between 40 and 73 years), who are breast cancer survivors in the post-clinical phase. They all have successfully undergone various combinations of treatment such as lumpectomy, mastectomy, radiotherapy and chemotherapy for breast cancer and are on the path to recovery and post-recovery. In 2010, this group came together for a year-long research conducted by the Universiti Malaya’s Faculty of Medicine through the Department of Rehabilitation Medicine. Realising the benefits of exercise for the well-being of cancer survivors, Candy Girls decided to continue dancing on their own even after the completion of the research study. With the support of breast surgeons at the University of Malaya Medical Centre (UMMC), this group began a weekly three-hour self-administered exercise session, that is still, to this day, taking place every Saturday. Their activities focus primarily on dance. The group gradually expanded dance genres by incorporating line dance, Latin dances-based Zumba sessions, Malay folk dance forms such as joget and zapin, and Bollywood dance. While the multi-ethnic women are determined to stay healthy and happy through their weekly dance routines, they have made significant impact on women at large by performing dances at Breast Cancer Relays, Awareness Campaigns and Health Conferences. By engaging with this community of survivors, the researchers have not only been able to observe their activities but also to support them through additional yoga and dance trainings. The act of giving back to the community has further strengthened the researchers' relationship with the study subjects and has allowed deeper engagement with the community. This ethnographic research shows that dance as self-rehabilitation, not only enhances physical mobility and emotional well-being, but forges a strong group solidarity among the women as a much-needed support system for survivors.

Stigma Reduction through Addiction and Naloxone Education

Decreasing stigma levels is critical for improving treatment access and outcomes for individuals with substance use disorder (SUD). This research evaluated the effectiveness of an educational session for students in criminal justice and psychology on the science of drug addiction and naloxone use in improving attitudes toward addiction, comfort using naloxone, and reducing stigma. Students attended a three-hour session that included education about SUD and treatment, speakers in recovery, and naloxone training. Post-educational intervention surveys revealed greater acceptance of the disease model of addiction, knowledge, and comfort using naloxone and reduced stigma. Educating students before they enter mental health and criminal justice professions could help increase addiction knowledge and reduce stigma among these professional groups.

Treatment of severe anxiety and social phobia by hypnosis and neurolinguistic programming- A Case Report

Background: Hypnosis is being used in combination with different forms of psychotherapy nowadays, such as neuro-linguistic programming, to work as a complementary treatment. This pairing allows for more targeted and patient-specific approaches to treat psychological disorders, phobias, and pain. An example is our previous study, in which hypnosis was used to treat tobacco-pan addiction. Following a similar model in this case study, we investigate the effectiveness of hypnosis and neuro-linguistic programming as treatments for anxiety and phobias. &#x0D; Case Presentation: We discuss a case of a 20-year-old boy with severe anxiety and social phobia who was already taking antipsychotic drugs and antidepressants, but they did not aid in treating his condition. He was then treated with hypnotherapy and neuro-linguistic programming to address the rooted triggers for his phobia. A thorough three-hour session revealed the details of each traumatic event. Each incident was isolated and changed in the patient's subconscious mind while he was hypnotized to remove that incident's role as a trigger.&#x0D; Management &amp; Results: The patient reported approximately seventy percent recovery immediately after the first session in terms of rebuilding his confidence. The recovery was measured on DASS-21 and Rosenberg Self-Esteem Scale (RSES). The severity of his phobia was significantly controlled in a short-span of time, with almost no episode after the first hypnosis and NLP session. &#x0D; Conclusion: Hypnotherapy and neurolinguistic programming is an effective treatment for anxiety disorder and social phobia. It is also time-efficient and produces better results than other forms of treatment without accompanying side effects.

Addressing Psychosocial Stressors through a Community-Academic Partnership between a Museum and a Federally Qualified Health Center: A Qualitative Study.

Psychosocial stressors are prevalent and linked to worse health outcomes, but are less frequently addressed than physically apparent medical conditions at primary care visits. Through a community-academic partnership between an art museum and a federally qualified health center, we developed an innovative museum-based intervention and evaluated its feasibility and acceptability among diverse, underserved patients and its perceived effects on psychosocial stressors. Guided by experiential learning and constructivist approaches, the intervention consisted of a single, three-hour session that incorporated group discussions and interactive components, including art-viewing, sketching, and object-handling. We used post-intervention focus groups to elicit feedback qualitatively. From July 2017 to January 2018, 25 patients participated. Focus groups revealed that the intervention exhibited therapeutic qualities, fostered self-reflection, catalyzed social connectivity, and functioned as a gateway to community resources. These findings can guide future research and development of community-based interventions to target the growing burden of psychosocial stressors among the underserved.

Effect of empowerment program on basic nursing skills of novice nurses in Iran: A randomized control trial study

Purpose: This study aimed to determine the effect of the empowerment training program on performing basic nursing skills in novice nurses. Methods: This randomized control-group pretest-posttest design study was conducted on 60 nurses with less than 6 months of working experience in a hospital, southeast Iran, 2019. The subjects were divided into the intervention (n=30) and control (n=30) groups. Data were collected using the Performance Assessment Checklist, which consisted of six domains, including skills of patient safety, cardiopulmonary resuscitation (CPR), infection control, firefighting, communication, and reporting. The intervention, empowerment program, consisted of six three-hour sessions within six weeks (each topic a week), which were presented and demonstrated by experts. Data were analyzed using Chi-square, independent t-test, analysis of covariance, and Mann-Whitney U test. The significance level was set as &lt;0.05. Results: Independent t-test revealed no significant difference in the mean scores of skills between the control and intervention groups before the intervention (P =0.775). However, after the empowerment program, the mean score of skills increased significantly in the intervention group compared with the control ones (P &lt;0.001). Besides, novice nurses’ skills in the intervention group in patient safety, CPR, infection control, firefighting, communication, and reporting domains were dramatically increased after the empowerment program (P &lt; 0.001). Conclusions: The empowerment program enhances nurses’ professional skills by boosting their skills. Therefore, continuing education and empowerment programs should be implemented for novice nurses to improve their professional skills.

Virtual Reality exposure therapy for public speaking anxiety in routine care: a single-subject effectiveness trial

ABSTRACT Virtual Reality (VR) can be used as a therapeutic tool to conduct efficacious in-session exposure therapy by presenting virtual equivalents of phobic stimuli, yet past hardware restrictions hindered implementation in routine care and effectiveness studies. The current study examines the effectiveness of a VR-assisted treatment protocol for public speaking anxiety with demonstrated efficacy, this time in routine care, using affordable VR hardware. Participants (n = 23) were recruited via a private clinic and treated by one of four psychologists with only minimal VR-training. Using a single-subject design and dual-slope modeling (adjusting the treatment-onset slope for treatment effects), we found a significant, large decrease in self-rated public speaking anxiety following the primary three-hour session, similar in magnitude to the previous efficacy trial. Multilevel modeling of in-session process measures suggests that the protocol works as intended, by decreasing catastrophic belief expectancy and distress, and increasing perceived performance quality. Adherence to the online transition program that followed—encouraging in-vivo exposure—was relatively poor, yet symptoms decrease continued. No change was observed over the three-month follow-up period. We conclude that VR exposure therapy can be effective under routine care conditions and is an attractive approach for future, large-scale implementation and effectiveness trials.

Removal of baclofen with hemodialysis is negligible compared to intact kidney excretion in a pediatric overdose: a case report

Introduction Severe baclofen toxicity can result in respiratory failure, hemodynamic instability, bradycardia, hypothermia, seizures, coma, and death. While hemodialysis (HD) is well-described in treating acute baclofen toxicity in patients with end-stage kidney disease or acute kidney injury, the utility of HD for patients with normal kidney function is uncertain. Implementing HD to speed recovery after a large acute baclofen ingestion is appealing, considering: (a) potential for prolonged coma and ventilator-associated morbidity, and (b) baclofen’s low protein-binding, low molecular-weight, and moderate volume of distribution. Methods We report a 51 kg, 14-year-old girl who presented to the emergency department (ED) with hypotension, obtundation, and status epilepticus after an intentional ingestion of 1200 mg baclofen. Her post-intubation neurologic examination was concerning for coma. A 14-hour post-ingestion baclofen concentration was 882 ng/mL (therapeutic range 80–400 ng/mL). Three urgent-HD sessions were performed to reduce her time on the ventilator. Results The total baclofen removed in the first three-hour HD session was 3.05 mg. The total urinary elimination of baclofen 42 mg over 24-hours on day one. She was discharged without neurologic deficits to psychiatry on day-14. Conclusion In this case, the amount of baclofen recovered during HD is negligible in comparison to the amount cleared by kidney elimination in this patient with normal kidney function.