Breaking bad news: an active learning method for medical students.

BACKGROUND: Breaking bad news is one of the most difficult aspects of communication in medicine. The objective of this study was to assess the relevance of a novel active learning course on breaking bad news for fifth-year students. METHODS: Students were divided into two groups: Group 1, the intervention group, participated in a multidisciplinary formative discussion workshop on breaking bad news with videos, discussions with a pluri-professional team, and concluding with the development of a guide on good practice in breaking bad news through collective intelligence; Group 2, the control group, received no additional training besides conventional university course. The relevance of discussion-group-based active training was assessed in a summative objective structured clinical examination (OSCE) station particularly through the students' communication skills. RESULTS: Thirty-one students were included: 17 in Group 1 and 14 in Group 2. The mean (range) score in the OSCE was significantly higher in Group 1 than in Group 2 (10.49 out of 15 (7; 13) vs. 7.80 (4.75; 12.5), respectively; p = 0.0007). The proportion of students assessed by the evaluator to have received additional training in breaking bad news was 88.2% (15 of the 17) in Group 1 and 21.4% (3 of the 14) in Group 2 (p = 0.001). The intergroup differences in the Rosenberg Self-Esteem Scale and Jefferson Scale of Empathy scores were not significant, and both scores were not correlated with the students' self-assessed score for success in the OSCE. CONCLUSION: Compared to the conventional course, this new active learning method for breaking bad news was associated with a significantly higher score in a summative OSCE. A longer-term validation study is needed to confirm these exploratory data.

A feasibility study of a peer discussion group intervention for patients with pancreatobiliary cancer and their caregivers.

OBJECTIVES: The purpose of this feasibility study was to examine the impacts of a peer discussion group intervention called "the pancreatobiliary cancer salon" on psychological distress among patients with pancreatobiliary cancer and their caregivers. METHODS: We recruited patients with pancreatic or biliary tract cancer and their caregivers. We conducted a within-group pre-post comparison study. Participants were grouped by the type of cancer and treatment. Each group consisted of four to five patients or caregivers. Hospital staff members facilitated group discussions where participants freely talked for 1 h. We evaluated participants' psychological condition using the Profile of Mood States (POMS) and their impressions of the pancreatobiliary cancer salon. RESULTS: We analyzed data from 42 patients and 27 caregivers who joined the salon for the first time. Thirty-five patients (83.3%) had pancreatic cancer. Thirty-one patients (71.4%) had unresectable pancreatobiliary cancer and 14 patients (33.3%) were being treated with second-line or third-line chemotherapy at the time of the survey. Twenty-two patients (52.4%) participated in the salon within 6 months after diagnosis. Most participating caregivers were the patient's spouse/partner (51.9%) or child (34.6%). Both patients and caregivers experienced high levels of satisfaction with the pancreatobiliary cancer salon. Both patients and caregivers had significantly lower psychological distress as assessed by POMS after the salon. SIGNIFICANCE OF RESULTS: A peer discussion group intervention might be well-received and has potential to benefit for patients with pancreatobiliary cancer and their caregivers.

[A day for families of military patients with post-traumatic stress disorder]. / Une journée pour les familles de patients militaires en état de stress post-traumatique.

The treatment of post-traumatic stress disorder is one of the priorities of the armed forces' health service, but there are few measures for families, who are nevertheless the first to be affected. At the Robert-Picqué army training hospital in Bordeaux, an information and exchange day for carers was set up in 2018. It takes place once every term. Here is a look at how it works, its benefits and its limitations.

[The discussion group "Maternity wards and cultures, exchanges around cradles"]. / Le groupe de parole "Maternités et cultures, échanges autour des berceaux".

At the Port-Royal maternity ward in Paris (14th arrondissement), a system has been set up as part of the liaison work. The discussion group "Maternities and cultures, exchanges around cradles" offers a sharing and carrying place in this so singular period of "becoming a mother" . Cultural and professional mixing is at the heart of this system. Presentation of observations of the group's movements over two years.

[A discussion group for parents of children with a digestive stoma]. / Un groupe de parole pour les parents de nouveau-nés porteurs d'une stomie digestive.

When a pathology is diagnosed at the birth of a child, the parents are confronted with an overwhelming life ordeal they have to face. A discussion group for these mothers and fathers of newborn babies who have needed a digestive stoma allows them to discuss their daily lives and share common concerns, to be reassured by the difficulties encountered, to gain confidence in the care provided and to project themselves into the future more serenely.

Comparative Study of Pharmacopoeias in Japan, Europe, and the United States: Toward the Further Convergence of International Pharmacopoeial Standards.

A pharmacopoeia's core mission is to protect public health by creating and making available public standards to help ensure the quality of drugs. In recent years, pharmacopoeias around the world have harmonized their standards in the present context of globalized drug supply chains and markets. For example, the Pharmacopoeial Discussion Group has worked to harmonize excipient monographs and general chapters. In addition, the International Meeting of World Pharmacopoeias has been held by the WHO to discuss information exchange and international collaboration, among other topics. To contribute further to the protection of public health in the globalized drug market, we conducted a comparative study of the pharmacopoeias in Japan, Europe, and the United States. We aimed to examine current differences among the Japanese Pharmacopoeia, the European Pharmacopoeia, and the United States Pharmacopeia-National Formulary and to identify areas that require further collaboration among the three pharmacopoeias. In this study, we analyzed monographs and general chapters listed in the three pharmacopoeias. We identified the features of the monographs and general chapters listed in each pharmacopoeia, as well as differences across the pharmacopoeias. Moreover, on the basis of our findings, we suggest standards that require further collaboration among the pharmacopoeias in certain preferred areas. The comparison data produced by this study are expected to be used to develop strategies for future revisions of pharmacopoeias around the world.

The Impact of WhatsApp as a Health Education Tool in Albinism: Interventional Study.

BACKGROUND: Oculocutaneous albinism is a congenital disorder that causes hypopigmentation of the skin, hair, and eyes due to a lack of melanin. People with albinism are at increased risk of developing skin complications, such as solar keratosis and skin cancers, leading to higher morbidity. As education is crucial in managing albinism, leveraging information technology, such as WhatsApp, can provide an effective intervention for digital health education. OBJECTIVE: This study aims to assess the impact of WhatsApp as a tool for providing health education among people with albinism. METHODS: The design of the study was interventional. The intervention consisted of weekly health education sessions conducted in a WhatsApp group for the duration of 4 weeks. The topics discussed were knowledge of albinism, sun protection practices, the use of sunscreen, and myths about albinism. They were all covered in 4 WhatsApp sessions held in 4 separate days. A web-based questionnaire was filled out before and after the intervention by the participants. Mann-Whitney U test was used to compare the pre- and postknowledge scores. Spearman correlation was used to correlate data. RESULTS: The mean age of the study participants was 28.28 (SD 11.57) years. The number of participants was 140 in the preintervention period and 66 in the postintervention period. A statistically significant increase in overall knowledge (P=.01), knowledge of sunscreen (P=.01), and knowledge of sun protection (P<.01) was observed following the intervention. Before the intervention, a positive correlation was observed between age (r=0.17; P=.03) and education level (r=0.19; P=.02) with participants' overall knowledge. However, after the intervention, there was no significant correlation between knowledge and age or education level. A percentage increase of 5.23% was observed in the overall knowledge scores following the intervention. CONCLUSIONS: WhatsApp is an effective tool for educating people with albinism and can act as an alternative to the conventional methods of health education. It shows promising outcomes irrespective of the health literacy level of people with albinism. This educational intervention can positively impact behavior change and translate to consistent sun protection practices. The limitations of this study include the possibility of social desirability bias and data security.

[Anorexia nervosa and the perinatal period]. / Anorexie mentale et période périnatale.

As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part of a multidisciplinary approach, support groups are particularly important, offering both individual and social support. Child-parent drop-in centers can also provide a supportive space for the psychological work of parenting.

Qualitative evaluation of a support group for women with children with Zika congenital syndrome in Southern Colombia.

PURPOSE: To qualitatively evaluate the perceived benefits of participation in a support group (SG) for mothers of children with Congenital Zika Syndrome (CZS) in Southern Colombia. METHODS: The "Women of Zika" SG was running in Sourthern Colombia from August 2018 to December 2019. The evaluation was carried out between October and December 2019, 21 women participated and the information was collected in three group discussions and non-participant observation. A thematic content analysis of the data was carried out with the support of Atlas ti-v8. RESULTS: Women's discourses assessing the perceived benefits of participating in the SG were organized under three categories according to the three dimensions of social support: "Teaching and learning from each other: the SG as a source of information support," "Coping with adversity: the SG as a source of emotional support" and "Creating your own identity: the SG as a source of relational support." CONCLUSION: The SG has been an important source of social support for women with children with CZS and it meant had a shared space where they developed individual and collective agency capacities. SGs can be a useful strategy for social and therapeutic support for families with children with multiple disabilities, such as CZS.Implications for rehabilitationCaring after children with CZS has negative implications on the mental health and quality of life of these women.Specific interventions need to be developed to improve the quality of life of mothers of children with CZS.Support groups are an effective strategy for providing social support to women with children with different disabilities such as CZS.

[Talking groups, a time for growing up]. / Les groupes de parole, un temps pour grandir.

During adolescence, hospitalization, which accompanies the process of separation and individuation, is a time for self-reflection. Within the framework of the weekly discussion group for young people hospitalized at the Maison de Solenn-Maison des adolescents of the Cochin Hospital in Paris, the latter were able, thanks to group containment and its dynamics, to think about their care and to take an active part in it.

[Contributions of discussion groups in the therapeutic education of bulimic disorders]. / Apports des groupes de parole dans l'éducation thérapeutique des troubles boulimiques.

The treatment of patients suffering from bulimic disorders requires a multidisciplinary approach combining a somatic approach and a psychiatric approach. The Maison des adolescents of the Cochin Hospital offers a therapeutic education program focused on the management of compulsive binge eating. Its modalities have been modified over the years in order to better adjust to the needs of these patients. Monthly discussion groups have been added to the individual interviews, and have been key points in structuring the treatment.

[Temporality of individual psychotherapy in adolescents with anorexia nervosa]. / Temporalité de la psychothérapie individuelle chez les adolescents souffrant d'anorexie mentale.

The management of patients suffering from anorexia nervosa involves the intervention of several professionals in a complementary manner. Within the framework of the multidisciplinary approach (somatic, psychiatric, dietetic, family, etc.), several factors must be taken into account in the clinical evolution to establish the indication of an individual psychotherapy in the most efficient way possible.

Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study.

BACKGROUND: Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances. OBJECTIVE: We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population. METHODS: We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience-Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. RESULTS: Participants' baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them "a great deal" to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one's abilities to provide care to the care recipient (4/12, 33%). CONCLUSIONS: The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency.

Cancer-related Fatigue Reported in Online Discussion Groups.

Fatigue is a prevalent cancer-related symptom that is difficult to communicate, define, and treat. To obtain robust descriptions of symptoms, participants were recruited into two online groups that consisted of their dialoguing together in an asynchronous, threaded discussion forum. Participants dialogued for 5 months and completed pre- and post-participation demographic data and symptom ratings. Survey data were described, and change scores were calculated. Excerpts from the dialogue were analyzed using phenomenological techniques. The 28 participants reported low symptoms that did not change significantly from pre- to post-participation. Phenomenological analysis revealed three themes: descriptions of "bone-sucking fatigue," a search for meaning or answers about the fatigue, and attempted remedies. Online support groups provide a venue for sharing symptom experiences, adding to existing knowledge about symptoms in survivors. These descriptions provide information that will aid in developing patient-centered interventions.

Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty.

Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.

The 10th Japan Bioanalysis Forum Symposium conference: a report.

The Japan Bioanalysis Forum Symposium was held on 12-14 February 2019 (Yokohama, Japan), in celebration of its 10th anniversary, and over 370 participants from pharmaceutical industries, contractors, academia and regulatory authorities from home and abroad came together in Yokohama. The 3-day symposium particularly aimed to foster collaboration with the scientists surrounding bioanalysts, according to the theme 'Open to the Public.' The symposium also included a broad range of pioneering programs, such as lectures by speakers from DMPK/metabolomics fields, discussions of future bioanalysis and poster presentations by publicly offered presenters as well as the regular ones we had organized. This report summarizes the major topics as a conference report.

The ninth Japan Bioanalysis Forum symposium.

The ninth Japan Bioanalysis Forum symposium took place at tower hall Funabori, Tokyo, Japan, between 6 and 8 February, 2018. Bioanalytical scientists from the pharmaceutical industry, CROs, academia and regulatory bodies had many meaningful and relevant discussions on current topics of interest in bioanalysis. The 3-day symposium featured updated perspectives and experiences on regulated bioanalysis of small and large molecules, biomarker measurement and assessment of immunogenicity, as well as new areas of bioanalytical validation such as quantitative polymerase chain reaction(qPCR) and flow cytometry. There were over 260 participants from six countries, with 23 oral and 11 poster presentations, including the outcomes of Japan Bioanalysis Forum discussion groups. This report summarizes the major discussion topics from the conference.

Barriers to and facilitators of implementing quality standards in Hospital Day Care Units in Rheumatology: Qualitative approach to the VALORA study. / Barreras y facilitadores en la implantación de estándares de calidad en las unidades de hospital de día reumatológicas. Análisis cualitativo del proyecto VALORA.

OBJECTIVE: To identify barriers and facilitators in the implementation of quality standards in hospital day care units (HDCU) in rheumatology. MATERIAL AND METHODS: We analyzed appraisals of HDCU in terms of standards for structure, processes and results. The qualitative approach was conducted through 13 discussion groups created by rheumatology health professionals (7), nursing professionals (4) and HDCU patients (2). The recruitment of informants was done through purposive sampling, attending to variables that form the perceptions of the HDCU. Data analysis was performed using a descriptive-interpretive method. RESULTS: The specialization of the HDCU and specific training in rheumatology for nursing are perceived as the main facilitator for the implementation of standards. Conversely, the delay in the availability of medicines at the HDCU is identified as a barrier that prolongs patient stay and wastes resources. Differences in local regulations are perceived as a potential barrier to equitable access to medicines. The patients gave higher ratings to the care received than to structural variables or those related to process. CONCLUSIONS: The findings of this study suggest that improvements in the implementation of quality standards in HDCU may include three levels of action: the HDCU, the hospital and a third related to local regulations to access to medicines.

Função de Cuidar na Educação Infantil: Contribuições de Grupos de Discussão de Trabalho com Educadoras / Role of Caring in Early Childhood Education: Contributions from Working Discussion Groups with Educators / Función de Cuidado en la Educación Infantil: Grupos de Discusión de Trabajo con Maestros

As educadoras que atuam na Educação Infantil participam da subjetivação de bebês e crianças pequenas, o que pode ser extremamente exigente. Nesse sentido, este estudo teve como objetivo oferecer um espaço de escuta para educadoras, com vistas a refletir sobre os desafios da função de cuidar de bebês e crianças bem pequenas na Educação Infantil. Foram realizadas duas edições de um grupo de discussão de trabalho, nas quais participaram cinco educadoras. O material produzido no grupo de discussão de trabalho, juntamente com relatos discutidos em supervisão, foi analisado qualitativamente, a partir de análise temática indutiva. Os resultados evidenciam que o cuidado exige presença, previsibilidade, intimidade e sensibilidade, o que, muitas vezes, é solicitado pelos próprios bebês/crianças que convocam o adulto. Entretanto, responder a essas demandas de forma individualizada num ambiente coletivo pode trazer desconforto, mal-estar e angústia. O grupo de discussão de trabalho oportunizou às educadoras tomarem consciência de como se utilizavam, por vezes, de um estilo de cuidado mais mecanizado e controlador, de forma a se protegerem dessas demandas. Em síntese, o bebê/criança desacomoda o adulto e o convoca a (re)pensar sobre seu fazer, apontando a importância de espaços de escuta e reflexão aos profissionais da educação.

Working in Early Childhood Education implies that the adult caregiver participates in the subjectivation of babies, which can be extremely demanding. This study aimed to offer a listening space for nursery educators to reflect on the challenges of the role of caring for babies and very young children in Early Childhood Education. Two editions of the work discussion group were held, in which five educators participated. The material was qualitatively analyzed, considering the inductive thematic analysis. The results showed that care requires presence, predictability, intimacy, and sensitivity, requests often made by the babies and the children themselves who call the adult to respond from this place. However, responding to this demand individually in a collective environment can bring discomfort, malaise, and anguish. The group made it possible for educators to become aware of how they used a more mechanized and controlling style of care, to protect themselves from these demands. In summary, the baby and the children discomfort the adult and invite him/her to (re) think about his actions, pointing out the importance of spaces for listening and reflection to education professionals.

Trabajar en Educación Infantil implica que el adulto cuidador participe enlasubjetivación de los bebés, lo que puede ser extremadamente exigente. Por eso, este estudio tuvo como objetivo ofrecer un espacio de escucha a los educadores, con el fin de reflexionar sobre los retos del cuidado de los bebés y niños muy pequeños en la Educación Infantil. Se realizaron dos ediciones de los grupos de discusión de trabajo, en las que participaron cinco educadores. El material fue analizado cualitativamente, a partir del análisis temático inductivo. Los resultados muestran que el cuidado requiere presencia, previsibilidad, intimidad y sensibilidad, peticiones, muchas veces, realizadas por los propios bebés y niños que convocan al adulto. Sin embargo, responder a esta demanda de forma individual en un entorno colectivo puede traer malestar y angustia. Los grupos hizo posible que los educadores tomaran conciencia de cómo utilizaban un estilo de atención más mecanizado y controlador, para protegerse de estas demandas. En resumen, el bebé y los niños incomodan al adulto y lo invitan a (re) pensar en sus acciones, señalando la importancia de los espacios de escucha y reflexión de los profesionales de la educación.

The 8th Japan Bioanalysis Forum symposium.

The 8th Japan Bioanalysis Forum symposium, the Tower Hall Funabori, Tokyo, Japan, 8-9 February 2017 The 8th Japan Bioanalysis Forum (JBF) symposium was successfully held between 8 and 9 February 2017 at the Tower Hall Funabori, Tokyo, Japan. In total, 24 speakers from Japan, USA and Europe gave presentations regarding the immunogenicity of biopharmaceuticals, ICH S3A Q&A microsampling, ICH M10 bioanalytical method validation, large molecule analysis through LC-MS, auditing activities for bioanalysis and biomarker bioanalysis. Achievements regarding eight diverse themes were also shared by Japan Bioanalysis Forum discussion groups. Over 300 scientists from regulatory agencies, industry and academia actively took part in discussions during the symposium. This article provides the highlights of all the topics discussed in this symposium.