Protocol for a systematic review of the use of narrative storytelling and visual-arts-based approaches as knowledge translation tools in healthcare

BACKGROUND: The arts are powerful, accessible forms of communication that have the potential to impart knowledge by attracting interest and developing meaningful connections. Knowledge translation aims to reduce the ‘evidence-practice’ gap by developing, implementing and evaluating strategies designed to enhance awareness and promote behavior change congruent with research evidence. Increasingly, innovative approaches such as narrative storytelling and other arts-based interventions are being investigated to bridge the growing gap between practice and research. This study is the first to systematically identify and synthesize current research on narrative storytelling and visual art to translate and disseminate health research. METHODS: A health research librarian will develop and implement search strategies designed to identify relevant evidence. Studies will be included if they are primary research employing narrative storytelling and/or visual art as a knowledge translation strategy in healthcare. Two reviewers will independently perform study selection, quality assessment, and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data will be grouped and analyzed by research design, type of knowledge translation strategy (that is, a narrative or visual-arts-based approach), and target audience. An overall synthesis across all studies will be conducted. DISCUSSION: The findings from this research project will describe the ‘state of the science’ regarding the use of narrative storytelling and visual art as knowledge translation strategies. This systematic review will provide critical information for: (1) researchers conducting knowledge translation intervention studies; (2) nursing, medicine, and allied healthcare professionals; (3) healthcare consumers, including patients and families; and (4) decision makers and knowledge users who are charged to increase use of the latest research in healthcare settings

Building Dialogues Between Medical Student & Autistic Patients: Reflections on the MD program’s Patient Immersion Experience

The Patient Immersion Experience (PIE), part of the MD Program’s longitudinal Physicianship course, pairs medical students with individuals with chronic medical conditions to promote an understanding of the lived experience of illness. In October 2017, medical students AW and SC were matched with patient mentor MF, an autistic person[1] and artist. A year later, in the fall of 2018, MF invited his autistic friend AK to participate in collaborating in developing an “interpretive project”, a required capstone component of PIE organized by faculty-lead, PBM. Transcripts of online Google Doc conversations involving SC, AW, MF and AK, that took place over a 3-month period, were used to create a multimedia learning artifact that was exhibited as part of an annual Patient Appreciation Event organized at the end of the year. Rather than simply focusing on transmission of “information”, with SC and AW (as medical students) asking questions and AK and MF responding to it, a commitment was made to an ongoing mutual exchange of ideas. Four main topics were discussed: 1) the value of open communication with others, 2) how the process of informed consent differs for autistic people, 3) hope for a better future for healthcare, and 4) moving forward. These conversations point to the relationship-enhancing possibilities of open, back-and-forth dialogue as an antidote to monological approaches to medicine, providing insights into ways dialogue can enhance both a sense of agency and relational connections, generate new creative thinking, and promote a more holistic, person-centred approach to healthcare

Integrating spirituality as a key component of patient care

Patient care frequently focuses on physical aspects of disease management, with variable attention given to spiritual needs. And yet, patients indicate that spiritual suffering adds to distress associated with illness. Spirituality, broadly defined as that which gives meaning and purpose to a person’s life and connectedness to the significant or sacred, often becomes a central issue for patients. Growing evidence demonstrates that spirituality is important in patient care. Yet healthcare professionals (HCPs) do not always feel prepared to engage with patients about spiritual issues. In this project, HCPs attended an educational session focused on using the FICA Spiritual History Tool to integrate spirituality into patient care. Later, they incorporated the tool when caring for patients participating in the study. This research (1) explored the value of including spiritual history taking in clinical practice; (2) identified facilitators and barriers to incorporating spirituality into person-centred care; and (3) determined ways in which HCPs can effectively utilize spiritual history taking. Data were collected using focus groups and chart reviews. Findings indicate positive impacts at organizational, clinical/unit, professional/personal and patient levels when HCPs include spirituality in patient care. Recommendations are offered

Health Humanities curriculum and evaluation in health professions education: a scoping review

Background The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer how and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes. Methods A focused scoping review of qualitative and mixed-methods studies that included the influence of integrated health humanities curricula in pre-registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre-registration course, with only ad-hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched (CINAHL), (ERIC), PubMed, and Medline. Results The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full-text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data were extracted from each included publication. Discussion Reported health humanities curricula focused on developing students’ capacity for perspective, reflexivity, self- reflection and person-centred approaches to communication. However, the learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step for benchmarking, clarification and comparison of evaluation strategy

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)

Art(ists) in the making : exploring narratives of coming to art in later life

Drawing on John Dewey's aesthetic theory, this inquiry was undertaken to explore the experience and significance of "coming to art" in later life. Eight women and three men participated in two in-depth conversational interviews. The participants' average age at the time of our first interview was 71.6 years. Seven participants described a serious commitment to art. The remaining participants described a somewhat more casual visual art practice. A narrative approach supported a close reading of the participants' stories which led to the identification of three primary storylines: (1) "Coming to Art," (2) "Flourishing through Art," and (3) "Art as Identity." The first storyline considered the role of chance and different influencing conditions, including how various structures and routines served to sustain the participants' focus on art. Ways in which art contributed to how the participants' enjoyed their lives comprised the second storyline, which encompassed such aspects as enhanced perception, creative excitement, flow, and feelings of intrinsic satisfaction, as well as expanding worlds of experience (through travel and new social connections). Conditional and relational aspects of the participants' art-based identity constructions are described in the last storyline. In addition, reflections on the significance of art making as a casual leisure pursuit, and music as a form of serious leisure, along with advantages and constraints of coming to art in later life, are described. This inquiry offers a site for developing new understandings regarding the possibilities of aging, and the ways that art can contribute to an ongoing process of growth and expansion in later life. Although a common view is that artists are born as such, compelled to express their talents from an early point in life, the accounts shared by the participants in this inquiry suggest that at least for some coming to art may also be a developmental opportunity that emerges with age. In addition, while health benefits have been associated with involvement in art in later life, this inquiry suggests that arts-based involvement in later life can also be about creative excitement, feeling enlivened, and vitally involved ... and also about becoming an artist.Graduate and Postdoctoral StudiesGraduat

Exploring Professionalism in Undergraduate Medical and Dental Education through Forum Theatre

Forum Theatre (FT) was created by Brazilian theatre director Augusto Boal (1985) as an approach for promoting dialogue between the audience and those performing on stage for his “Theater for the Oppressed.” FT offers an accessible, interactive approach to exploring challenging topics and situations.  In FT, a short scene is performed.  It is then replayed again and again with audience members invited to intervene and offer different options for addressing various aspects of the problematic situation.  Originally directed to helping people address and transform oppressive conditions that characterized their lives, FT has evolved and found expression in many different communities and contexts, including health professional education.  Inspired by David Diamond’s (2008) “Theatre for Living” model (which approaches living communities as a complex, living entities), we introduced FT in the “Introduction to Medicine & Dentistry” (DMED 511) course offered as part of the Undergraduate Medical Education program in the Faculty of Medicine & Dentistry (FoMD).  In this article, we describe how we have successfully engaged first year medical and dental students in discussion and critical reflection of professionalism issues relevant to their experiences of small group learning using FT.