Using visual art and collaborative reflection to explore medical attitudes toward vulnerable persons

Background: Vulnerable persons often face stigma-related barriers while seeking health care. Innovative education and professional development methods are needed to help change this.Method: We describe an interdisciplinary group workshop designed around a discomfiting oil portrait, intended to trigger provocative conversations among health care students and practitioners, and we present our mixed methods analysis of participant reflections.Results: After the workshop, participants were significantly more likely to endorse the statements that the observation and interpretive skills involved in viewing visual art are relevant to patient care and that visual art should be used in medical education to improve students’ observational skills, narrative skills, and empathy with their patients.  Subsequent to the workshop, significantly more participants agreed that art interpretation should be required curriculum for health care students. Qualitative comments from two groups from two different education and professional contexts were examined for themes; conversations focused on issues of power, body image/self-esteem, and lessons for clinical practice.   Conclusions: We argue that difficult conversations about affective responses to vulnerable persons are possible in a collaborative context using well-chosen works of visual art that can stand in for a patient

Longitudinal changes in clinical characteristics and outcomes for children using long-term non-invasive ventilation.

To describe longitudinal trends in long-term non-invasive ventilation (NIV) use in children including changes in clinical characteristics, NIV technology, and outcomes.This was a multicenter retrospective cohort of all children started on long-term NIV from 2005 to 2014. All children 0 to 18 years who used NIV continuously for at least 3 months were included. Measures and main outcomes were: 1) Number of children starting NIV; 2) primary medical condition; 3) medical complexity defined by number of comorbidities, surgeries and additional technologies; 4) severity of sleep disordered breathing measured by diagnostic polysomnography; 5) NIV technology and use; 6) reasons for NIV discontinuation including mortality. Data were divided into equal time periods for analysis.A total of 622 children were included in the study. Median age at NIV initiation was 7.8 years (range 0-18 years). NIV incidence and prevalence increased five and three-fold over the 10-year period. More children with neurological and cardio-respiratory conditions started NIV over time, from 13% (95%CI, 8%-20%) and 6% (95%CI, 3%-10%) respectively in 2005-2008 to 23% (95%CI, 18%-28%) and 9% (95%CI, 6%-14%, p = 0.008) in 2011-2014. Medical complexity and severity of the sleep-disordered breathing did not change over time. Overall, survival was 95%; mortality rates, however, rose from 3.4 cases (95% CI, 0.5-24.3) to 142.1 (95% CI 80.7-250.3, p<0.001) per 1000 children-years between 2005-2008 and 2011-2014. Mortality rates differed by diagnostic category, with higher rates in children with neurological and cardio-respiratory conditions.As demonstrated in other centers, there was a significant increase in NIV prevalence and incidence rate. There was no increase in medical complexity or severity of the breathing abnormalities of children receiving long-term NIV over time. The mortality rate increased over time, maybe attributable to increased use of NIV for children with neurological and cardio-respiratory conditions

Clinical characteristics of 624 children started on long-term non-invasive ventilation.

<p>Clinical characteristics of 624 children started on long-term non-invasive ventilation.</p

Longitudinal trends in mortality and discontinuation rates for children using long-term non-invasive ventilation.

<p>Longitudinal trends in mortality and discontinuation rates for children using long-term non-invasive ventilation.</p

Longitudinal trends in mortality rate for children using long-term non-invasive ventilation within each diagnostic category.

<p>Longitudinal trends in mortality rate for children using long-term non-invasive ventilation within each diagnostic category.</p

Summary of deaths in children using non-invasive ventilation by diagnostic categories.

<p>Summary of deaths in children using non-invasive ventilation by diagnostic categories.</p

Kaplan-meier survival curves in children on long-tern NIV by diagnostic category.

<p>Category “Unclassified” was excluded because there were no deaths in this group. There were significant differences in survival curves by diagnostic category (Log-Rank test, p<0.001). Indicated below, the number of children at risk for death within each diagnostic category per year.</p

Longitudinal trends in the technology for children using long-term non-invasive ventilation.

<p>Longitudinal trends in the technology for children using long-term non-invasive ventilation.</p