American Psychiatric Association, May 4-8

The annual meeting of the American Psychiatric Association was held from May 4 to 8 in New York City, drawing participants from around the world, including clinicians, academicians, allied health professionals, and others interested in psychiatry. The conference highlighted recent advances in the prevention, detection, and treatment of psychiatric conditions.

In one study, Jessica Tran, of the University of Texas Medical Branch John Sealy School of Medicine in Galveston, and colleagues found that advertising electronic cigarettes (including vaping products, synthetic nicotine products, and other electronic nicotine delivery systems [ENDS]) on social media violates federal government and Instagram policies.

The authors evaluated 51 ENDS-related Instagram posts in December 2023 to assess the presence of health-related warnings. The researchers found that the majority of ENDS-related content on Instagram violated U.S. Food and Drug Administration and Instagram regulations, despite the agency's actions against e-cigarette ads targeting youth and the Instagram ban on sponsored ENDS content. Specifically, two-thirds of posts (34 posts) did not contain any warnings regarding age restrictions or the addictive potential of nicotine, violating FDA regulations. In addition, nearly half of posts (23 posts) were shared by vape ambassadors, reviewers, or shops, violating the Instagram branded content policy. Furthermore, key marketing appeals used in ENDS-related content on Instagram involved appeals to aesthetics, humor, and lifestyle.

"Overall engagement with ENDS-related content on Instagram was higher than the average engagement rate of other industries on Instagram," Tran said. "ENDS-related content on Instagram is largely shared by both vape ambassadors and influencers who share other forms of content (i.e., lifestyle), which risks exposing nonusers of e-cigarettes to e-cigarette content."

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In another study, Jyotishman Pathak, Ph.D., of Weill Cornell Medicine in New York City, and colleagues found that stigmatizing language in clinical documentation appears more often in the electronic health records (EHRs) of older, female, and racial-minority patients with opioid use disorder.

The authors evaluated a list of terms and phrases from the National Institute of Drug Abuse that have been shown to be associated with negative labels and/or stereotypes among individuals with substance use disorder. Programmable software was used to identify use of this language within clinical notes. Out of 2,700 patients with a diagnosis of substance/opioid use disorder included in the analysis, the researchers found that more than 85 percent had some evidence of stigmatizing language in their clinical encounter notes. Using an artificial intelligence/machine learning (AI/ML) algorithm, the incidences of such language were higher in EHRs of patients who were female, Black/African American, or Hispanic. In addition, clinicians/providers who were female or social workers had higher use of stigmatizing language in their clinical documentation.

"Stigmatizing and derogatory language is still being widely used in clinical documentation. Prior research has shown that use of such language can lead to poorer patient outcomes (i.e., lack of treatment initiation or adherence)," Pathak said. "AI/ML algorithms can be deployed to automatically detect use of such language in EHR systems."

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Elizabeth Li, M.D., of Stanford University in California, and colleagues found that a novel program involving theater and an improv-based approach can teach Asian American, Native Hawaiian, and Pacific Islander (AANHPI) medical students how to recognize and respond to racial bias in the clinical setting.

The authors piloted Acting Together, a series of multisite webinars, in which skits inspired by lived experiences of AANHPI trainees were developed to depict cultural conflict, implicit biases, and racial microaggressions in the clinical environment. In addition, an improv-based curriculum was developed to teach health care providers and trainees to effectively address these challenging scenarios in both in-group and out-group roles. The researchers noticed a hunger for this type of education and a desire for co-creating inclusive clinical training environments, with more than 100 Acting Together participants across the United States from various specialties in medicine, including nursing, social work, and clinical psychology, participating in the last year.

In before and after surveys, program acceptability and feasibility was assessed, in addition to students' perceived impact on implicit bias and their understanding of how to handle cultural dilemmas after the webinar. Overwhelmingly, students felt that the current program was adaptable and useful, and they said they would recommend it to other colleagues. Additionally, they felt significant engagement and connection to other participants and developed improved abilities and confidence in communication, recognizing implicit biases, and taking action.

"The vast majority of our participants leave our webinars feeling more equipped to face cultural dilemmas, having practiced addressing the skit challenges through improv. Acting Together participants noted how 'real' the skits feel and how easily they related to the skit scenarios," Li said. "In addition, using theater and improvisation as a tool maintained an important distinction from real life. This imparted a sense of psychological safety to allow for acting out and discussing conflicts, biases, and microaggressions which led to racial trauma. This sense of psychological safety provided the freedom to explore responses, make mistakes, and identify solutions to challenging situations. Most importantly, our participants are excited to have built a community of solidarity and allyship with each other, the first step to collective healing and nurturing a sense of belonging amongst interprofessional trainees."

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