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Background: Evidence suggests empathy, an essential component of holistic patientcare, may be declining amongst medical students and residents. Yet there are only a few qualitative studies, mostly from West, exploring this phenomenon. Objective: This is a qualitative study of the learning environments of a tertiary care hospital of Pakistan, aimed to understand how junior doctors perceive and develop empathy and articulate the challenges faced by them. Methods: This case study adopted constructivist theoretical perspectives and was conducted from January 2019 to June 2019. Data was gathered from three focus group discussions and analyzed by thematic analysis. Patterns were identified and reported to generate codes, basic and organizing themes. Results: The participants were cognizant of empathy and its significance in patient management. Seniors as role models, first-hand knowledge of patients’ plights, active involvement in patient care and witnessing illnesses in dear ones were facets positively influencing empathy. Salient hindrances included enormous work load, gender bias, past negative experiences, language and literacy barriers. Some participants felt like devising their own strategies to cope with workload and providing empathetic care. There is pivotal role of workplace based learning; enabling junior doctors to handle multi-dimensional doctor-patient relationship. Conclusion: Clinical environments are significant for junior doctors’ grooming in attainment of empathetic patient care. Exhibiting empathy may be different in eastern and western diaspora. Faculty development could promote refined understanding of empathy and strategies to convey empathetic patientcare ensuring safe medical practice.

IntroductionIn an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation.MethodsWe conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques to promote rigor and validity. Participants were San Francisco Bay Area-based individuals who identified as Black or African American women with a recent hospital birth (n=20), and hospital-based perinatal clinicians (n=20).ResultsWe identified numerous actionable challenges and recommendations regarding aspects of (1) state law; (2) IBT content and format; (3) health care facility IBT implementation; (4) health care facility environment; and (5) provider commitment and behaviors. Patient and clinician insights overlapped substantially. Many respondents felt IBT would improve outcomes only in combination with other antiracism interventions.Health equity implicationsThese stakeholder insights offer policy-makers, health system leaders, and curriculum developers crucial guidance for the future development and implementation of clinician antibias interventions.

Antibias training is increasingly identified as a strategy to reduce maternal health disparities. Evidence to guide this work is limited. We conducted a community-guided scoping review to characterize new antibias research. Four of 508 projects met our criteria: US-based, publicly funded, initiated from January 1, 2018 to June 30, 2022, and featuring an intervention to reduce bias or racism in maternal health care providers. Training was embedded in multicomponent interventions in 3 projects, limiting its evaluation as a stand-alone intervention. Major public funders have sponsored few projects to advance antibias training research in maternal health. More support is needed to develop a rigorous and scalable evidence base.

Arabic Oration: Art and Function. By TAHERA QUTBUDDIN. Handbook of Oriental Studies, I, vol. 131. Leiden: BRILL, 2019. Pp. xvi + 644. $222, [euro]169 (cloth); $59, [euro]49 (paper). Arabic Oration: [...]

[This corrects the article DOI: 10.3389/fsoc.2021.636029.].

This article documents the experiences of Black birthworkers supporting pregnant and birthing people and new mamas during the first six months of the COVID-19 pandemic. Building on the methodology and outcomes of Battling Over Birth-a Research Justice project by and for Black women about their experiences of pregnancy and childbirth-the authors utilized a "community-based sheltered-in-place research methodology" to collect the narratives of Black birthworkers, including doulas, certified nurse-midwives (CNMs), homebirth midwives, lactation consultants, community health workers and ob/gyns. The article examines the impact of restrictions put in place by hospitals and clinics, including inadequate or inconsistent care, mandatory testing, separation from newborns, and restrictions on attendance by birth support people, including doulas. Birthworkers shared the innovative approaches that they have devised to continue to offer care and the ways that they have expanded the care they offer to make sure the needs of Black birthing people and new parents are being met during this uncertain time. The article also explores the threats to health, safety, and financial security faced by Black birthworkers as a result of the pandemic, and the overt and subtle forms of racism they had to navigate. Finally, it documents the sources of strength that Black birthworkers have found to sustain them at the frontlines of a maternal health care system in crisis.

This current study examined the effects of full captions (n = 37), keyword captions (n = 38), and no captions (n = 37) on students' ability to gain pictorial knowledge from a 5 minutes and 52 seconds French language video. After completing a pre-vocabulary recognition test to determine the level of equality between groups, students watched the video and immediately completed a post-visual recognition test and a post-recall protocol test to determine students' visual content gain and/or recall. Overall, the keyword captions group responded to visual questions about the video just as well as the no captions group, and somewhat better than the full captions group. In addition, the no captions group significantly outperformed the keyword and full captions groups on visual recall. Based on eye-tracking data, the more one looked within the captions field, the less one gained visually from the video. These results have implications for how one designs L2 video lessons with captions.

ObjectiveWe conducted a systematic review and appraisal of the cross-cultural adaptation and cross-cultural validity of the Health Assessment Questionnaire (HAQ) and its derivatives, and of the more recent Patient-Reported Outcomes Measurement Information System (PROMIS) functional status assessment measures (FSAMs) in rheumatoid arthritis.MethodsFour electronic medical databases were searched from inception until April 4, 2018 according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) group search strategy. Included studies were evaluated using the COSMIN tool for cross-cultural validity and were scored as excellent, good, fair, or poor.ResultsOf 58 articles identified by our search strategy and 3 by manual search, 39 were included: 29 described the translation, cultural adaptation, or cross-cultural validity of the HAQ disability index, 8 other HAQ derivatives, and 2 PROMIS measures, representing 22 languages. Of the 39 articles reviewed, 3 examined the cross-cultural validity of translated versions. These studies were rated as follows: 2 as excellent, 3 good, 13 fair, and 21 poor. Two studies examining cross-cultural validity noted differential item functioning (DIF) between Dutch and US populations for the HAQ-II and PROMIS measures, and a third study found DIF between Turkish and UK populations on the HAQ, indicating cultural differences in questionnaire response.ConclusionThis review highlights a paucity of data on the cross-cultural validity of FSAMs and the mostly poor- or fair-quality methods by which they were translated and adapted, which needs to be considered when using these measures for multinational clinical trials and for day-to-day use in clinical practice.

Over the last 5 years, multiple stakeholders in the field of spinal cord injury (SCI) research have initiated efforts to promote publications standards and enable sharing of experimental data. In 2016, the National Institutes of Health/National Institute of Neurological Disorders and Stroke hosted representatives from the SCI community to streamline these efforts and discuss the future of data sharing in the field according to the FAIR (Findable, Accessible, Interoperable and Reusable) data stewardship principles. As a next step, a multi-stakeholder group hosted a 2017 symposium in Washington, DC entitled "FAIR SCI Ahead: the Evolution of the Open Data Commons for Spinal Cord Injury research." The goal of this meeting was to receive feedback from the community regarding infrastructure, policies, and organization of a community-governed Open Data Commons (ODC) for pre-clinical SCI research. Here, we summarize the policy outcomes of this meeting and report on progress implementing these policies in the form of a digital ecosystem: the Open Data Commons for Spinal Cord Injury (ODC-SCI.org). ODC-SCI enables data management, harmonization, and controlled sharing of data in a manner consistent with the well-established norms of scholarly publication. Specifically, ODC-SCI is organized around virtual "laboratories" with the ability to share data within each of three distinct data-sharing spaces: within the laboratory, across verified laboratories, or publicly under a creative commons license (CC-BY 4.0) with a digital object identifier that enables data citation. The ODC-SCI implements FAIR data sharing and enables pooled data-driven discovery while crediting the generators of valuable SCI data.

BACKGROUND: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents. METHODS: Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 250 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 83 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use. We then checked for interaction in a matched cohort of 5130 patients (378 were NH residents) assembled from the 8024 patients. RESULTS: Among 314 matched NH residents, HRs (95% CIs) for 30-day all-cause readmission, HF readmission, and all-cause mortality were 0.78 (0.47-1.28), 0.68 (0.29-1.60), and 1.26 (0.70-2.27), respectively. Respective HRs (95% CIs) at 1 year were 0.76 (0.56-1.02), 0.68 (0.42-1.09), and 1.04 (0.78-1.38). Among 5130 matched patients, ACEI-ARB use was associated with a significantly lower risk of all outcomes at both times, with no significant interactions, except for 1-year mortality, which was only significant in the non-NH subgroup (P for interaction, 0.026). CONCLUSIONS: We found no evidence that the use of ACEIs or ARBs is associated with improved outcomes in patients with HF in the NH setting. However, we also found no evidence that this association is different in NH residents with HF versus non-NH patients with HF. Future larger studies are needed to demonstrate effectiveness of these drugs in the NH setting.

ObjectiveTo develop American College of Rheumatology (ACR) recommendations for patient-reported Functional Status Assessment Measures (FSAMs) for use in routine clinical practice in patients with rheumatoid arthritis (RA).MethodsWe convened a workgroup to conduct a systematic review of published literature through March 16, 2017 and abstract FSAM properties. Based upon initial search results and clinical input, we focused on the following FSAMs appropriate for routine clinical use: the Health Assessment Questionnaire (HAQ) and derived measures and the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point scoring method to evaluate each FSAM, allowing for overall level of evidence assessment. We identified FSAMs fulfilling a predefined minimum standard and, through a modified Delphi process, selected preferred FSAMs for regular use in most clinic settings.ResultsThe search identified 11,835 articles, of which 56 were included in the review. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 7 measures fulfilled the minimum standard for regular use in most clinic settings, and 3 measures were recommended: the PROMIS physical function 10-item short form (PROMIS PF10a), the HAQ-II, and the Multidimensional HAQ.ConclusionThis work establishes ACR recommendations for preferred RA FSAMs for regular use in most clinic settings. These results will inform clinical practice and can support future ACR quality measure development as well as highlight ongoing research needs.

E-learning has been widely used in higher education as it provides better access to learning resources online, utilising technology to enhance learning. Despite growing evidence claiming that e-learning is as effective as traditional means of learning, the evidence is still very limited. This protocol aims to measure the impact of e-learning as compared to traditional face-to-face learning, both measured and perceived, on health sciences education -- in terms of improving students'/health professionals' satisfaction, knowledge, skills, and behaviours and patient-related outcomes. We will conduct a systematic review and meta-analysis of both randomised controlled trials and non-randomised controlled trials. Major databases will be searched for studies, and will be reported in accordance with PRISMA. A thematic analysis will be conducted for the included studies. If sufficient data are available, the random-effects model for meta-analysis will be performed. The outcome of this study will provide a basis for developing the best methods of e-learning in health sciences education.

Purpose: This paper explores experiences of a physician who in one life-altering day awoke in intensive care and had to embark on a complex journey as full-time patient. It identifies the important literature, albeit limited, from a unique dual lens view of physician turned patient, and analyzes the potential for advancing medical education by recognizing the expertise that patients possess from lived experience. Methodology: An autoethnography study was undertaken to unpack data obtained from lived patient experience during a two-and-a-half-year long hospitalization. Themes were captured in a series of eleven scenarios. Findings included critical reflection from the patient, medical educator, and research perspectives. Data was cross-referenced with relevant literature. Results: Seven themes emerged upon critical analysis of the eleven scenarios that described real-life healthcare encounters of the physician turned patient. These often-neglected themes from medical education include experiential learning, reflection, what counts as medical care, vulnerability, patient-centred care, agency, and patient expertise. Conclusions: This study highlights differences between intellectual–experiential knowledge, and challenges medical education to harness the expertise that patients possess. It contributes to scholarly discourses by demonstrating the utility of autoethnography in medical education, critiques traditional medical education models, expands the breadth of what constitutes knowledge, and invites medical educators to actively involve patients as equal stakeholders in curricula. [ABSTRACT FROM AUTHOR]

This paper describes the development of a regional psychology teaching organisation, Psychology Educators of Tennessee (PET). PET is designed to enhance collaboration among teachers from local colleges, universities, and high schools. We discuss the history of PET, the themes and pragmatics associated with our annual conference, plans for expanding the organisation, and challenges we have experienced with developing and maintaining PET. We also provide evaluation data from recent participants and suggestions for institutions of higher education interested in creating a similar kind of organisation.

Study designThis is a focused review article.ObjectivesThis review presents important features of clinical outcomes assessments (COAs) in human spinal cord injury research. Considerations for COAs by trial phase and International Classification of Functioning, Disability and Health are presented as well as strengths and recommendations for upper extremity COAs for research. Clinical trial tools and designs to address recruitment challenges are identified.MethodsThe methods include a summary of topics discussed during a two-day workshop, conceptual discussion of upper extremity COAs and additional focused literature review.ResultsCOAs must be appropriate to trial phase and particularly in mid-late-phase trials, should reflect recovery vs. compensation, as well as being clinically meaningful. The impact and extent of upper vs. lower motoneuron disease should be considered, as this may affect how an individual may respond to a given therapeutic. For trials with broad inclusion criteria, the content of COAs should cover all severities and levels of SCI. Specific measures to assess upper extremity function as well as more comprehensive COAs are under development. In addition to appropriate use of COAs, methods to increase recruitment, such as adaptive trial designs and prognostic modeling to prospectively stratify heterogeneous populations into appropriate cohorts should be considered.ConclusionsWith an increasing number of clinical trials focusing on improving upper extremity function, it is essential to consider a range of factors when choosing a COA.SponsorsCraig H. Neilsen Foundation, Spinal Cord Outcomes Partnership Endeavor.

This study investigated the quantity and characteristics of student language production, discourse functions, and morphosyntactic features in three different discourse settings--face-to-face (F2F), lab-setting chatroom interactions (Lab), and any place/any device chatroom interactions (APAD). Discourse was examined through the replication and extension of Richard Kern's (1995) study. Similarities in findings between the two studies included a continuation of incomplete, and short sentence lengths among F2F students, an absence of F2F greetings, and a higher rate of assertions, verb tenses, and simple sentences in the Lab setting. Differences included a higher rate of F2F turns in the current study, an absence of greetings in the lab setting, and a greater number of commands among F2F participants. Findings underscored what Kern previously asserted: that F2F and chatroom settings tend to encourage and support slightly different goals associated with language discourse. Kern stated that more sophisticated conversation occurred in the chatroom setting. Current findings concurred but furthered that more conversational interaction took place within the F2F discourse setting due to a greater number of commands, turns, and incomplete sentences. Similarly, F2F students experienced greater input due to the increase of words heard, questions asked, and commands made.