Rapid Scoping Review: Empathy in Health Sciences Curriculum.

Empathy, the process of coming to know, understand, and care for another person, is a skill that can be learned; however, there is not a shared definition of empathy or understanding of how to operationalize empathy into practice. Healthcare worker empathy has been shown to have a beneficial effect on both patient health outcomes and the emotional wellness of healthcare workers. Empathic care is associated with more efficient, cost-effective, improved healthcare, and increased provider trust. The purpose of this rapid scoping review is to identify, compare, and contrast empathy training offered to select healthcare professional students (e.g., nurses, nurse practitioners, and pharmacists) as part of the general curriculum or as an elective. We utilized a rapid scoping review approach to identify potentially relevant peer-reviewed articles and studies for inclusion. Six electronic databases were searched, including: MEDLINE; EMBASE; PUBMed; CINAHL; EBSCOHOST; and ERIC, covering the past 10 years. A total of 4977 citations, 3480 abstracts, and 428 papers were screened. Fifty studies fulfilled the eligibility criteria. Of those, 21 primarily non-randomized experimental studies published between 2012 and 2021 were included in the final review. Over 80 percent of the training took place in the classroom setting and utilized active learning strategies. There is little consensus on how to best train future healthcare providers to provide empathic care to patients.

Frequent Epigenetic Inactivation of DIRAS-1 and DIRAS-2 Contributes to Chemo-Resistance in Gliomas.

We previously reported that DIRAS-3 is frequently inactivated in oligodendrogliomas due to promoter hypermethylation and loss of the chromosomal arm 1p. DIRAS-3 inactivation was associated with better overall survival. Consequently, we now investigated regulation and function of its family members DIRAS-1 and DIRAS-2. We found that DIRAS-1 was strongly downregulated in 65% and DIRAS-2 in 100% of analyzed glioma samples compared to non-neoplastic brain tissue (NNB). Moreover, a significant down-regulation of DIRAS-1 and -2 was detected in glioma data obtained from the TCGA database. Mutational analyses did not reveal any inactivating mutations in the DIRAS-1 and -2 coding regions. Analysis of the DIRAS-1 and -2 promoter methylation status showed significantly higher methylation in IDH-mutant astrocytic and IDH-mutant and 1p/19q-codeleted oligodendroglial tumors compared to NNB. Treatment of U251MG and Hs683 glioblastoma cells lines with 5-azacytidine led to significant re-expression of DIRAS-1 and -2. For IDH-wild-type primary gliomas, however, we did not observe significantly elevated DIRAS-1 and -2 promoter methylation levels, but still detected strong downregulation of both DIRAS family members. Additional analyses revealed that DIRAS-1 and -2 expression was also regulated by histone modifications. We observed a shift towards promoter heterochromatinization for DIRAS-1 and less promoter euchromatinization for DIRAS-2 in IDH-wild-type glioblastomas compared to controls. Treatment of the two glioblastoma cell lines with a histone deacetylase inhibitor led to significant re-expression of DIRAS-1 and -2. Functionally, overexpression of DIRAS-1 and -2 in glioblastoma cells translated into significantly higher sensitivity to lomustine treatment. Analyses of DNA damage markers revealed that DIRAS-1 and -2 may play a role in p53-dependent response to alkylating chemotherapy.

Pre-stimulus brain state predicts auditory pattern identification accuracy.

Recent studies show that pre-stimulus band-specific power and phase in the electroencephalogram (EEG) can predict accuracy on tasks involving the detection of near-threshold stimuli. However, results in the auditory modality have been mixed, and few works have examined pre-stimulus features when more complex decisions are made (e.g. identifying supra-threshold sounds). Further, most auditory studies have used background sounds known to induce oscillatory EEG states, leaving it unclear whether phase predicts accuracy without such background sounds. To address this gap in knowledge, the present study examined pre-stimulus EEG as it relates to accuracy in a tone pattern identification task. On each trial, participants heard a triad of 40-ms sinusoidal tones (separated by 40-ms intervals), one of which was at a different frequency than the other two. Participants' task was to indicate the tone pattern (low-low-high, low-high-low, etc.). No background sounds were employed. Using a phase opposition measure based on inter-trial phase consistencies, pre-stimulus 7-10 Hz phase was found to differ between correct and incorrect trials ∼200 to 100 ms prior to tone-pattern onset. After sorting trials into bins based on phase, accuracy was found to be lowest at around π-+ relative to individuals' most accurate phase bin. No significant effects were found for pre-stimulus power. In the context of the literature, findings suggest an important relationship between the complexity of task demands and pre-stimulus activity within the auditory domain. Results also raise interesting questions about the role of induced oscillatory states or rhythmic processing modes in obtaining pre-stimulus effects of phase in auditory tasks.

The influence of behavioral relevance on the processing of global scene properties: An ERP study.

Recent work studying the temporal dynamics of visual scene processing (Harel et al., 2016) has found that global scene properties (GSPs) modulate the amplitude of early Event-Related Potentials (ERPs). It is still not clear, however, to what extent the processing of these GSPs is influenced by their behavioral relevance, determined by the goals of the observer. To address this question, we investigated how behavioral relevance, operationalized by the task context impacts the electrophysiological responses to GSPs. In a set of two experiments we recorded ERPs while participants viewed images of real-world scenes, varying along two GSPs, naturalness (manmade/natural) and spatial expanse (open/closed). In Experiment 1, very little attention to scene content was required as participants viewed the scenes while performing an orthogonal fixation-cross task. In Experiment 2 participants saw the same scenes but now had to actively categorize them, based either on their naturalness or spatial expense. We found that task context had very little impact on the early ERP responses to the naturalness and spatial expanse of the scenes: P1, N1, and P2 could distinguish between open and closed scenes and between manmade and natural scenes across both experiments. Further, the specific effects of naturalness and spatial expanse on the ERP components were largely unaffected by their relevance for the task. A task effect was found at the N1 and P2 level, but this effect was manifest across all scene dimensions, indicating a general effect rather than an interaction between task context and GSPs. Together, these findings suggest that the extraction of global scene information reflected in the early ERP components is rapid and very little influenced by top-down observer-based goals.

Does measuring body weight impact subsequent response to eating behavior questions?

OBJECTIVES: If being weighed impacts perceptions of eating behavior, it is important that the order of questionnaires and weighing be considered in research and practice. A quasi-experimental study was performed to examine whether being weighed immediately prior to completing a questionnaire affects responses to eating behavior questions. It was hypothesized that being weighed would serve as a priming stimulus and increase measures of dietary restraint, disinhibition, and hunger. METHODS: Trained researchers collected a sample of volunteers (n = 355) in 8 locations in the United States on two Saturdays in the summer of 2011. Half of the participants were weighed immediately prior to completing the Three Factor Eating Questionnaire (TFEQ), with the remaining half weighed immediately after TFEQ completion. RESULTS: A priori hypotheses were not supported despite replicating known relationships between weight, dietary restraint and disinhibition. Results indicated that being weighed first produced a difference in differences on disinhibition scores between low restraint score (95% CI = 4.65-6.02) and high restraint score (95% CI = 6.11-7.57) compared to being weighed after questionnaire completion (p = 0.003). However, this relationship was not significant when modeling restraint as a continuous variable, questioning the use of dichotomization. CONCLUSIONS: Being weighed is unlikely to be a strong enough prime to significantly change scores on eating behavior questionnaires for everyone, but may allow differences in restraint status to become more evident. Researchers assessing dietary restraint should be wary of the possibility of producing different results when treating restraint as continuous or dichotomous, which could lead to different interpretations.

Delivering away from home: the perinatal experiences of First Nations women in northwestern Ontario.

INTRODUCTION: Our objective was to understand the perinatal knowledge and experiences of First Nations women from northwestern Ontario who travel away from their remote communities to give birth. METHODS: A systematic review of MEDLINE, HealthSTAR, HAPI, Embase, AMED, PsycINFO and CINAHL was undertaken using Medical Subject Headings and keywords focusing on Canadian Aboriginal (First Nations, Metis and Inuit) prenatal education and care, and maternal health literacy. This qualitative study using semistructured interviews was conducted in a rural hospital and prenatal clinic that serves First Nations women. Thirteen women from remote communities who had travelled to Sioux Lookout, Ont., to give birth participated in the study. RESULTS: We identified 5 other qualitative studies that explored the birthing experiences of Aboriginal women. The studies documented a negative experience for women who travelled to access intrapartum maternity care. While in Sioux Lookout to give birth, our participants also experienced loneliness and missed their families. They were open to the idea of a culturally appropriate doula program and visits in hospital by First Nations elders, but they were less interested in access to tele-visitation with family members back in their communities. We found that our participants received most of their prenatal information from family members. CONCLUSION: First Nations women who travel away from home to give birth often travel great cultural and geographic distances. Hospital-based maternity care programs for these women need to achieve a balance of clinical and cultural safety. Programs should be developed to lessen some of the negative consequences these women experience.

Traditional First Nations birthing practices: interviews with elders in Northwestern Ontario.

OBJECTIVES: Traditionally, First Nations maternity care was provided by community-based midwives trained through apprenticeship. Obstetrical practices and beliefs were integrated to provide holistic care. The Sioux Lookout Meno Ya Win Health Centre has a mandate to be a centre of excellence for Aboriginal health care. We undertook a literature review and performed a qualitative research study to understand some of the traditional practices in maternity care. METHODS: We conducted qualitative semi-structured interviews in English and Oji-Cree with 12 elders who had knowledge and experience of historical birthing practices in their home communities. Research team members included nursing and medical personnel and Anishinabe First Nation members. Interviews were analyzed and themes developed and verified by member checking and triangulation. RESULTS: The hands-on training for a community-based midwife often began in her teenage years with observation of childbirth practices. Practices were handed down by oral tradition and included prescriptions for healthy diet and moderate exercise during pregnancy; intrapartum care with preparation of clean cloths, moss, and scissors; the involvement of certain supportive family and community members; careful attention to the sacred handling of the placenta and umbilical cord; and careful wrapping of the newborn in fur. Complications, sometimes fatal, included retained placentas and stillbirths. CONCLUSION: The provision of modern maternity care to Aboriginal patients should include acknowledgement of, and respect for, traditional birthing practices. Facilities providing care for these patients should consult with the relevant Aboriginal communities to understand their needs and initiate appropriate programming.

First Nations women's knowledge of menopause: experiences and perspectives.

OBJECTIVE: To understand and describe the menopause experiences and perspectives of First Nations women residing in northwestern Ontario. DESIGN: Phenomenologic approach using in-depth qualitative interviews. SETTING: Sioux Lookout, Ont, and 4 surrounding First Nations communities. PARTICIPANTS: Eighteen perimenopausal and postmenopausal First Nations women, recruited by convenience and snowball sampling techniques. METHODS: Semistructured interviews were audiotaped and transcribed. Themes emerged through a crystallization and immersion analytical approach. Triangulation of methods was used to ensure reliability of findings. MAIN FINDINGS: This study confirms the hypothesis that menopause is generally not discussed by First Nations women, particularly with their health care providers. The generational knowledge gained by the women in this study suggests that a variety of experiences and symptoms typical of menopause from a medical perspective might not be conceptually linked to menopause by First Nations women. The interview process and initial consultation with translators revealed that there is no uniform word in Ojibway or Oji-Cree for menopause. A common phrase is "that time when periods stop," which can be used by caregivers as a starting point for discussion. Participants' interest in the topic and their desire for more information might imply that they would welcome the topic being raised by health care providers. CONCLUSION: This study speaks to the importance of understanding the different influences on a woman's menopause experience. Patient communication regarding menopause might be enhanced by providing women with an opportunity or option to discuss the topic with their health care providers. Caregivers should also be cautious of attaching preconceived ideas to the meaning and importance of the menopause experience.

Measuring cross-cultural patient safety: identifying barriers and developing performance indicators.

Medical errors and cultural errors threaten patient safety. We know that access to care, quality of care and clinical safety are all impacted by cultural issues. Numerous approaches to describing cultural barriers to patient safety have been developed, but these taxonomies do not provide a useful set of tools for defining the nature of the problem and consequently do not establish a sound base for problem solving. The Sioux Lookout Meno Ya Win Health Centre has implemented a cross-cultural patient safety (CCPS) model (Walker 2009). We developed an analytical CCPS framework within the organization, and in this article, we detail the validation process for our framework by way of a literature review and surveys of local and international healthcare professionals. We reinforce the position that while cultural competency may be defined by the service provider, cultural safety is defined by the client. In addition, we document the difficulties surrounding the measurement of cultural competence in terms of patient outcomes, which is an underdeveloped dimension of the field of patient safety. We continue to explore the correlation between organizational performance and measurable patient outcomes.

Palliative care of First Nations people: a qualitative study of bereaved family members.

OBJECTIVE: To understand cross-cultural hospital-based end-of-life care from the perspective of bereaved First Nations family members. DESIGN: Phenomenologic approach using qualitative in-depth interviews. SETTING: A rural town in northern Ontario with a catchment of 23 000 Ojibway and Cree aboriginal patients. PARTICIPANTS: Ten recently bereaved aboriginal family members. METHODS: Semi-structured interviews were conducted, audiotaped, and transcribed. Data were analyzed using crystallization and immersion techniques. Triangulation and member-checking methods were used to ensure trustworthiness. MAIN FINDINGS: First Nations family members described palliative care as a community and extended family experience. They expressed the need for rooms and services that reflect this, including space to accommodate a larger number of visitors than is usual in Western society. Informants described the importance of communication strategies that involve respectful directness. They acknowledged that all hospital employees had roles in the care of their loved ones. Participants generally described their relatives' relationships with nurses and the care the nurses provided as positive experiences. CONCLUSION: Cross-cultural care at the time of death is always challenging. Service delivery and communication strategies must meet cultural and family needs. Respect, communication, appropriate environments, and caregiving were important to participants for culturally appropriate palliative care.

So many databases, such little clarity: Searching the literature for the topic aboriginal.

OBJECTIVE: To describe the scope, content, and organization of commonly used medical databases and search strategies, using a search of the topic aboriginal to illustrate the various ways the topic is covered in each of the databases. DESIGN: Comparison of literature searches. METHOD: Seven common medical databases were searched using all the MeSH terms that are permutations of aboriginal. A secondary analysis using the "remove duplicates" function in Ovid was done to identify articles specific to each database. MAIN OUTCOME MEASURES: Number of articles found by each search. RESULTS: Searching by MeSH terms often produces very different information from that found when searching by text word. A unique term, such as Ojibway, is best found with a text word search. A more general term, such as Aborigines, is best searched by subject using a MeSH term. Many databases can be searched through Ovid and might all use different MeSH terms for the same reference. PubMed default searches that use MeSH terms and text words simultaneously often produce very large numbers of articles. In searching for North American aboriginal using MeSH terms, MEDLINE and PubMed produced the most references, followed by Healthstar. Calculating distinct "all aboriginal" references in EMBASE, Healthstar, and PsycINFO indicated that MEDLINE produced nearly all the articles found in Healthstar. In fact, MEDLINE alone produced 88% of the articles found in MEDLINE and EMBASE and 79% of the articles found in MEDLINE and PsycINFO. CONCLUSION: Although several researchers and medical librarians have noted that MEDLINE and EMBASE are quite distinct databases, suggesting both need to be searched for a complete search, we did not find that to be the case for the topic aboriginal. The results of this study demonstrate that using MEDLINE produces the most extensive coverage of literature on the topic aboriginal. To fully capture the complete body of available literature on other subjects might require searches of many databases, depending on the topic.

Healing the community to heal the individual: literature review of aboriginal community-based alcohol and substance abuse programs.

OBJECTIVE: To understand the development of culturally based and community-based alcohol and substance abuse treatment programs for aboriginal patients in an international context. SOURCES OF INFORMATION: MEDLINE, HealthSTAR, and PsycINFO databases and government documents were searched from 1975 to 2007. MeSH headings included the following: Indians, North American, Pacific ancestry group, aboriginal, substance-related disorders, alcoholism, addictive behaviour, community health service, and indigenous health. The search produced 150 articles, 34 of which were relevant; most of the literature comprised opinion pieces and program descriptions (level III evidence). MAIN MESSAGE: Substance abuse in some aboriginal communities is a complex problem requiring culturally appropriate, multidimensional approaches. One promising perspective supports community-based programs or community mobile treatment. These programs ideally cover prevention, harm reduction, treatment, and aftercare. They often eliminate the need for people to leave their remote communities. They become focuses of community development, as the communities become the treatment facilities. Success requires solutions developed within communities, strong community interest and engagement, leadership, and sustainable funding. CONCLUSION: Community-based addictions programs are appropriate alternatives to treatment at distant residential addictions facilities. The key components of success appear to be strong leadership in this area; strong community-member engagement; funding for programming and organizing; and the ability to develop infrastructure for longterm program sustainability. Programs require increased documentation of their inroads in this developing field.