The Royal Ottawa Mental Health Centre, also known as "ROMHC" or "The Royal" (formerly the Royal Ottawa Hospital) is a 284-bed, 400,000 square-foot psychiatric hospital located in Ottawa, Ontario, Canada. It is a major branch of the Royal Ottawa Health Care Group (ROHCG), which also encompasses the Brockville Mental Health Centre, the University of Ottawa Institute of Mental Health Research and the Royal Ottawa Foundation for Mental Health.
BackgroundSocial stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists’ ‘Making Abortion Safe’ programme, aimed to understand providers’ experiences of abortion stigma in four African countries with restrictive legislation.MethodsIn-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe.ResultsFour themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as ‘dirty work’, conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers’ well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in ‘doing the right thing’ helped them resist stigma.ConclusionsLegal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.
An essential component of social work practice, advocacy encompasses activities to influence systems and attitudes. Drawing on a larger sequential mixed-methods study of frontline social workers' experiences, this paper uses descriptive statistics and reflexive thematic analysis of an online survey (n = 43) and in-depth interviews (n = 12) to highlight factors facilitating social workers' advocacy practices as they support client, family, and community well-being. Findings illustrate previous experiences, social work education, and peer support best prepared participants. Effective formal platforms, fostering professional growth, and dedicated time with a clear mandate were identified as organizational mechanisms to better embed advocacy efforts. Social work advocacy is critical for advancing the social determinants of health for people with severe mental illness. It is also a key mechanism for operationalizing the profession's commitment to social justice. To understand how social workers are prepared and supported in doing this work, we conducted a survey and interviews with mental health hospital social workers in Ontario, Canada. We determined the value of social work education, learning through experience, and peer support in this work. We also identified key ways in which organizations can embed advocacy through formal communication platforms, professional development and training opportunities, and dedicated time and mandates for this work.
e14060 Background: Gliomas have few approved targeted therapies. Given frequent blood-brain-barrier disruption in gliomas, molecular targets with FDA-approved therapies in other solid tumors represent relevant precision-oncology opportunity. Methods: A total of 235 glioma tumor tissue samples underwent targeted next-generation sequencing at Datar Cancer Genetics. Clinical actionability was assessed using ESCAT. Subgroup analyses were performed based on IDH status. Results: Of 235 samples, 6 were grade I (2.6%), 17 grade II (7.2%), 38 grade III (16.2%), and 159 grade IV (67.8%); grade was unavailable in 15 (6.4%). Overall, 43.8% (103/235) harbored ≥1 tumor-agnostic or cross-indication actionable alteration with an FDA-approved therapy in solid tumors. Tumor-agnostic biomarkers included TMB-H (11.6%; 16/138), dMMR (1.7%; 2/116), BRAF V600E (4.9%; 11/225), and NTRK fusions (0.6%; 1/178); HER2 amplifications and RET fusions were not detected. Canonical CNS alterations included IDH1/2 (24.0%; 54/225), TERT promoter (36.1%; 73/202), TP53 (42.4%; 95/224), H3F3A (3.8%; 7/185), ATRX (8.2%; 18/219), EGFR amplification (21.2%; 43/203), CDKN2A/2B loss (18.8%; 38/202), EGFRvIII (12.9%; 23/178), and EGFR mutations (10.7%; 24/225). Cross-indication alterations involved PI3K-AKT-mTOR ( PIK3CA 8.4% [19/225], PTEN 18.3% [41/224]) and FGFR (4.3%; 10/235); KIAA1549-BRAF and PTPRZ1-MET fusions were each detected in 1.1% (2/178). ESCAT Tier I alterations were present in 29% (69/235) and Tier II–III in 56% (132/235). Though incidence of tumor-agnostic biomarkers was similar in IDH -mutant and IDH -wildtype ( IDH -WT) gliomas (13.0% [7/54] vs 11.6% [21/181]), the cross-indication biomarkers were enriched in IDH -WT gliomas (40.9% [74/181] vs 20.4% [11/54]). In grade IV gliomas, cross-indication biomarkers were more frequent in IDH -WT than IDH -mutant tumors (45.3% [62/137] vs 18.2% [4/22]), with similar findings in combined grade III–IV gliomas (42.9% [66/154] vs 25.6% [11/43]). Conclusions: Despite poorer prognosis, IDH -WT gliomas are enriched for cross-indication actionable alterations, reflecting biological actionability without established clinical benefit, and supporting comprehensive molecular profiling to guide indication-expanded therapies, clinical trial enrolment, and prospective interventional basket trials. Tumor-agnostic and cross-indication actionable alterations in gliomas. Biomarker Overall % (n/N) IDH -WT (%) IDH -Mutant (%) Approved Indication PTEN mutations 18.3 (41/224) 21.8 7.4 Breast FGFR1/2/3 alterations 4.3 (10/235) 5.5 0.0 Multiple ERBB2 mutations 0.0 (0/179) 0.0 0.0 Multiple BRCA1/2 mutations 0.6 (1/156) 0.8 0.0 Multiple PIK3CA mutations 8.4 (19/225) 7.6 11.1 Breast TMB-H 11.6 (16/138) 8.9 23.1 Tumor-agnostic dMMR/MSI-H 1.7 (2/116) 2.0 0.0 Tumor-agnostic NTRK fusions 0.6 (1/178) 0.7 0.0 Tumor-agnostic
Background: Cognitive deficits in schizophrenia significantly impair functional outcomes, yet no approved pharmacological treatments exist. Low-dose psychostimulants, such as methylphenidate extended-release (ER), have shown preliminary promise for cognitive enhancement but raise concerns about psychosis exacerbation. This study evaluates the safety of low-dose methylphenidate ER in clinically stable schizophrenia patients. Methods: An open-label, randomized, fixed-dose crossover trial (NCT05414058) was conducted at the Royal Ottawa Mental Health Centre from September 2022 to October 2024, enrolling 24 participants with schizophrenia spectrum disorders. Participants received 4 weeks of methylphenidate ER (18 mg for wk 1, 36 mg for wk 2 to 4) and 4 weeks of treatment-as-usual in a crossover design, with a follow-up at week 12. Results: No serious adverse events occurred, and there was no evidence of psychotic symptom exacerbation. PANSS-6 scores showed no worsening attributable to treatment; detailed efficacy results are reported elsewhere. Vital signs showed minimal, nonsignificant changes: mean weight decreased by 2.28 lbs ( P >0.05), heart rate increased by 3.67 bpm ( P >0.05), and systolic blood pressure rose by 3.6 mmHg ( P >0.05). The CADDRA checklist indicated significant appetite reduction ( P <0.001), reduced fatigue ( P =0.002), and decreased sadness ( P <0.001) during treatment, with effects resolving post-treatment. One participant reported transient passive suicidal ideation, resolving without intervention. Eleven participants withdrew, primarily due to subjective side effects within the first 2 weeks. Conclusions: Low-dose methylphenidate ER appears safe in stable schizophrenia patients on antipsychotics, with no significant psychosis exacerbation and minimal physiological changes.
