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Purpose of review: This review aimed to explore recent progress made in the past five years towards early access to, and integration of palliative care services within the haemato-oncology context to address the unique needs of patients with Haematological malignancies (HMs). Recent findings: We included 14 articles in our review. We identified three themes, namely (i) disparities in the timing of referrals remain, (ii) specialist palliative care and impact on quality of life and (iii) perceptions on early integration. Patients with HM, receive less palliative care services, regardless of their higher symptom burden compared to patients with solid tumours. Structured approaches and models of early integration have shown substantial benefits, including improved pain and symptom management, shorter hospital stays and better end of life planning. Perceptions on existing barriers include the curative treatment focus, haematologists' personal perceptions on timing of palliative care and lack of palliative care training. Summary: For early integration to happen, it is crucial to address training gaps, improve communication skills, and foster interdisciplinary collaboration. Standardised organisational pathways can facilitate early and concurrent palliative care integration. System-level flexibility and supportive policies are essential to ensure that patients with HM receive comprehensive and high-quality care. [ABSTRACT FROM AUTHOR]

Purpose of review: Dementia is a chronic progressive terminal condition. Most care is provided by family caregivers (including close friends); their wellbeing is a public health priority. Caregivers manage increasingly complex needs with disease progression, and declining cognitive and physical function. This can impact the well-being of caregivers, and meaningful support is essential. This review article aims to understand what the benefits and challenges of digital health interventions are and provide considerations for future development of digital health interventions for family caregivers for people with dementia, to improve quality of life. Recent findings: Benefits include the valuable source of support from connective platforms; 24/7 accessibility; and opportunity for remote monitoring. However, this needs to balance with challenges, including the privacy of data concerns; and the digital divide driving inequalities in care provision for family caregivers with no access to internet devices. Summary: Digital health interventions can positively impact the overall well-being of family caregivers for people with dementia. If challenges are addressed and digital health interventions are designed to meet priorities for family caregivers, this can help improve the quality of life for family caregivers of people with dementia. [ABSTRACT FROM AUTHOR]

Purpose of review: This review aims to synthesise contemporary research on symptom management for people with advanced dementia who are thought to be in the final year of life. It highlights the unique challenges faced by palliative care and dementia care specialists, offering insights into the clinical decision-making required to support those with advanced dementia in various care settings. Recent findings: Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Pain, breathlessness, and psychological distress are frequently mismanaged, which contributes to suboptimal care. Moreover, the unpredictable trajectory of dementia complicates the identification of end-of-life needs, which can result in fragmented care. Caregivers, both professional and family, struggle with managing complex symptoms, while family caregivers in home settings face added burdens in providing care without sufficient support. Summary: Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia. [ABSTRACT FROM AUTHOR]

Purpose of the review Breathlessness may evoke existential threat but may also affect the person with serious illness or their caregiver/s in other important ways which can be considered 'existential'. This review explores existential aspects of breathlessness in people with serious illness and presents recent studies of assessment and management of associated distress and suffering. Recent findings Both existential distress and breathlessness are multidimensional and include a range of constructs, many of which have behavioural consequences. Existential distress tracks closely with distressing breathing potentially due to shared underlying neurobiological processing. Paradoxically 'contagious' and isolating effects of breathlessness and related distress have been recently highlighted. Approaches to screening and assessment vary. Preliminary studies have investigated novel approaches to breathing-related anxiety and existential distress. Summary Studies with existential constructs as outcome measures in people with breathlessness are scarce. Interventions for existential distress developed for those with malignant disease may be beneficial for those with nonmalignant conditions, but adaptations may be required. Recently proposed taxonomies of existential distress/ concerns may guide assessment and direct novel therapeutic interventions in people living with serious illness and breathlessness-related distress. Neglecting existential aspects of breathlessness represents a missed opportunity to support holistic well-being in people with serious illness. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, no agreed-upon best practices exist for joining U.S. Census ZIP Code Tabulation Areas (ZCTAs) and U.S. Postal Service ZIP Codes (ZIPs). One-to-one linkage using 5-digit ZCTA identifiers excludes ZIPs without direct matches. "Crosswalk" linkage may match a ZCTA to multiple ZIPs, avoiding losses. Methods: We compared noncrosswalk and crosswalk linkages nationally and for mortality and health insurance in California. To elucidate selection implications, generalized additive models related sociodemographics to whether ZCTAs contained nonmatching ZIPs. Results: Nationwide, 15% of ZCTAs had nonmatching ZIPs, i.e., ZIPs dropped under noncrosswalk linkage. ZCTAs with nonmatching ZIPs were positively associated with metropolitan core location, lower socioeconomics, and non-White population. In California, 34% of ZIPs in the mortality and 25% in the health insurance data had ZCTAs with nonmatching ZIPs; however, these ZIPs constitute only 0.03% of total mortality and 0.44% of total insurance enrollees. Conclusions: Our study findings support the use of crosswalk linkages and ZCTAs as a unit of analysis. One-to-one linkage may cause bias by differentially excluding ZIPs with more disadvantaged populations, although affected population sizes seem small. [ABSTRACT FROM AUTHOR]

BACKGROUND: Air pollution has been associated with gestational hypertension (GH) and preeclampsia, but susceptible windows of exposure and potential vulnerability by comorbidities, such as prenatal depression, remain unclear. METHODS: We ascertained GH and preeclampsia cases in a prospective pregnancy cohort in Los Angeles, CA. Daily levels of ambient particulate matters (with a diameter of ≤10 μm [PM10] or ≤2.5 μm [PM2.5]), nitrogen dioxide, and ozone were averaged for each week from 12 weeks preconception to 20 gestational weeks. We used distributed lag models to identify susceptible exposure windows, adjusting for potential confounders. Analyses were additionally stratified by probable prenatal depression to explore population vulnerability. RESULTS: Among 619 participants, 60 developed preeclampsia and 42 developed GH. We identified a susceptible window for exposure to PM2.5 from 1 week preconception to 11 weeks postconception: higher exposure (5 µg/m3) within this window was associated with an average of 8% (95% CI, 1%–15%) higher risk of GH. Among participants with probable prenatal depression (n=179; 32%), overlapping sensitive windows were observed for all pollutants from 8 weeks before to 10 weeks postconception with increased risk of GH (PM2.5, 16% [95% CI, 3%–31%]; PM10, 39% [95% CI, 13%–72%]; nitrogen dioxide, 65% [95% CI, 17%–134%]; and ozone, 45% [95% CI, 9%–93%]), while the associations were close to null among those without prenatal depression. Air pollutants were not associated with preeclampsia in any analyses. CONCLUSIONS: We identified periconception through early pregnancy as a susceptible window of air pollution exposure with an increased risk of GH. Prenatal depression increases vulnerability to air pollution exposure and GH. [ABSTRACT FROM AUTHOR]

Objective: To update the current Sarculator retroperitoneal sarcoma (RPS) prognostic nomograms considering the improvement in patient prognosis and the case volume effect. Background: Survival of patients with primary RPS has been increasing over time, and the volume–outcome relationship has been well recognized. Nevertheless, the specific impact on prognostic nomograms is unknown. Methods: All consecutive adult patients with primary localized RPS treated at 8 European and North American sarcoma reference centers between 2010 and 2017 were included. Patients were divided into 2 groups: high-volume centers (HVC, ≥13 cases/year) and low-volume centers (LVC, <13 cases/year). Primary end points were overall survival (OS) and disease-free survival (DFS). Multivariable analyses for OS and DFS were performed. The nomograms were updated by recalibration. Nomograms performance was assessed in terms of discrimination (Harrell C index) and calibration (calibration plot). Results: The HVC and LVC groups comprised 857 and 244 patients, respectively. The median annual primary RPS case volume (interquartile range) was 24.0 in HVC (15.0–41.3) and 9.0 in LVC (1.8–10.3). Five-year OS was 71.4% (95% CI: 68.3%–74.7%) in the HVC cohort and 63.3% (56.8%–70.5%) in the LVC cohort (P= 0.012). Case volume was associated with both OS (LVC vs. HVC hazard ratio 1.40, 95% CI: 1.08–1.82, P=0.011) and DFS (hazard ratio 1.93, 95% CI: 1.57–2.37, P< 0.001) at multivariable analyses. When applied to the study cohorts, the Sarculator nomograms showed good discrimination (Harrell C index between 0.68 and 0.73). The recalibrated nomograms showed good calibration in the HVC group, whereas the original nomograms showed good calibration in the LVC group. Conclusions: New nomograms for patients with primary RPS treated with surgery at high-volume versus low-volume sarcoma reference centers are available in the Sarculator app. [ABSTRACT FROM AUTHOR]

This article presents reflections and suggestions for nurse educators in a Christian institution who want to pray with students while teaching online. Suggestions primarily relate to recording prayers for class, including avoiding the appearance of coercion; being clear that students' participation in the recorded prayer will have no effect on grades; placing prayer in recorded material at a consistent location (such as the beginning or the end) so students know when it is coming; being creative in offering varying ways to pray; being authentic; and inviting student participation. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, no studies have explicitly studied the role of hypertensive disorders of pregnancy (HDP) in racial disparities in severe maternal morbidity (SMM). Methods: Using causal mediation models, we estimated the proportion of the non-Hispanic (NH) Black–White racial disparity in risk of SMM that is explained through the pathway of HDP. We linked 2006–2019 Georgia hospital discharge records with vital statistics birth and fetal death records for NH Black and NH White birthing persons. We used G-estimation of a structural nested mean model to decompose the absolute racial disparity in the incidence of SMM into pathways operating through HDP. Results: NH Black birthing people experienced an excess 56 SMM events (95% confidence interval [CI] = 52, 59) per 10,000 delivery hospitalizations compared with NH White birthing people. If counterfactual disparity measure estimation assumptions hold, the estimated absolute disparity remaining after blocking the causal pathways through HDP was 41 SMM events per 10,000 deliveries (95% CI = 38, 44), suggesting that 26% (95% CI = 12, 40) of the absolute racial disparity would be eliminated if there was no contribution of HDP to SMM risk. Conclusion: Our results are consistent with the hypothesis that intervening to prevent HDP is an important (yet incomplete) pathway for reducing the excess risk among NH Black pregnancies compared with NH White pregnancies. [ABSTRACT FROM AUTHOR]

Both personal spirituality/religiosity and perception of a spiritually respectful work climate are inversely related to burnout among nurses. In addition to briefly reviewing the empirical evidence that consistently supports these assertions, this essay offers some practical suggestions for how nurses can promote a spiritually healthy work environment. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare endovascular aortic aneurysm repair (EVAR) versus open aortic repair (OAR) on mortality and reintervention after ruptured infrarenal abdominal aortic aneurysm (rAAA) repair in the Vascular Quality Initiative (VQI). Background: The optimal treatment modality for rAAA remains debated, with little data on long-term comparisons. Methods: VQI rAAArepairs (2004--2018)werematched with Medicare claims (VQI-VISION). Primary outcomes were in-hospital and long-term mortality. Secondary outcome was reintervention. Inverse probability weighting was used to adjust for treatment selection, and Cox Proportional Hazards models and negative binomial regressions were used for analysis. Landmark analysis was performed among patients surviving hospital discharge. Results: Among 1885 VQI/Medicare rAAA patients, 790 underwent OAR, and 1095 underwent EVAR. Median age was 76 years; 73% were male. Inverse probability weighting produced comparable groups. In-hospital mortality was lower after EVAR versus OAR (21% vs 37%, odds ratio: 0.52, 95% CI, 0.4--0.7). One-year mortality rates were lower for EVAR versus OAR [hazard ratio (HR) 0.74, 95% CI, 0.6--0.9], but not statistically different after 1 year (HR: 0.95, 95% CI, 0.8--1.2). This implies additional benefits to EVAR in the short term. Reintervention rates were higher after EVAR than OAR at 2 and 5 years (rate ratio: 1.79 95% CI, 1.2--2.7 and rate ratio:2.03 95% CI, 1.4--3.0), but not within the first year. Reintervention was associated with higher mortality risk for both OAR (HR: 1.66 95% CI, 1.1--2.5) and EVAR (HR: 2.14 95% CI, 1.6--2.9). Long-term mortality was similar between repair types (HR: 0.99, 95% CI, 0.8--1.2). Conclusions: Within VQI/Medicare patients undergoing rAAA repair, the perioperative mortality rate favors EVAR but equalizes after 1 year. Reinterventions were more common after EVAR and were associated with higher mortality regardless of treatment. [ABSTRACT FROM AUTHOR]

Nurse-provided spiritual care includes support of patient spiritual practices such as prayer. However, limited evidence exists about how nurses respond when a patient requests prayer. A subsample of nurses (n = 381) from a larger study responded to two open-ended questions in an online survey in response to a prayer scenario. Among these mostly Christian nurses, 97% indicated willingness to pray. Content analysis revealed a five-component structure for praying: Open, Set the Stage, Request, Wrap-up, Close. The structure provides a template for future research and nurse prayer in clinical contexts. [ABSTRACT FROM AUTHOR]

Purpose of review The prison population is growing and ageing, and many people will die from natural causes while incarcerated. This article provides a contemporary review of key issues related to palliative and end-of-life care in prisons. Recent findings Few countries have integrated prison hospices. Palliative care needs may go unrecognised in prison. Older offenders may not trust the prison to care for them and may benefit from segregation. Cancer remains a major cause of death. Training staff remains a priority, and technology can help facilitate this. The coronavirus disease 2019 (COVID-19) had a significant impact on prisons, less is known about its impact on palliative care. Compassionate release is underutilised, and the issue of medically assisted dying adds complexity to decisions around end-of-life care. Peer carers can provide reliable symptom assessment. Family members are often absent when someone dies in prison. Summary Palliative and end-of-life care in prisons requires a joined-up approach, and staff must understand the challenges of both this and custodial care in general. The relational network both inside and outside of the prison should be involved, and when possible and appropriate, we should consider alternatives to dying whilst incarcerated, such as compassionate release. [ABSTRACT FROM AUTHOR]

Purpose of review This contemporary and novel review of palliative sedation explores some of the distinctive ethical problems associated with that intervention. It is timely in light of recent reviews of palliative care guidelines on the topic and given the current public debates around the related but distinct practice of euthanasia. Recent findings The main themes discussed are patient autonomy, the nature of suffering and how to alleviate it, and the relationship between palliative sedation and euthanasia. Summary First, palliative sedation poses a significant problem for patient autonomy, both in terms of securing informed consent and in terms of the ongoing effect on individual well-being. Second, as an intervention to alleviate suffering, it is appropriate only in limited cases and counterproductive in others, for example, where an individual values their ongoing psychological or social agency more than the relief of pain or negative experience. Third, people's ethical views about palliative sedation are often coloured by their understanding of the legal and moral status of assisted dying and euthanasia; this is unhelpful and occludes the interesting and urgent ethical questions raised by palliative sedation as a distinct end-of-life intervention. [ABSTRACT FROM AUTHOR]

Purpose of review The aim of this review is to examine bereavement follow-up intervention studies in critical care, with the purpose of integrating results on the timing, content, aims and outcomes of interventions. The impact of a death in critical care is well documented, and bereavement follow-up is recognised as an important topic, but there is limited research with little consensus on the content and structure of interventions. Recent findings A total of 18 papers were selected; 11 are intervention studies, with only one randomised control trial. Six papers were from national surveys and are not the focus of this review. Bereavement follow-up mainly consisted of information giving, condolence interventions, telephone calls and meetings with families. The timing, content, aims and outcomes depended on the intervention and were influenced by the design of the study. Summary Overall, bereavement follow-up is acceptable for relatives but outcomes are mixed. Calls for more research are valid, but how do we utilise the current research to better inform the critical care community? Researchers suggest that bereavement follow-up interventions need to be designed with specific aims and outcomes, in collaboration with bereaved families that are appropriate to the intervention. [ABSTRACT FROM AUTHOR]

Purpose of review This review aims to synthesise the evidence from systematic reviews and meta-analyses on the efficacy of dignity therapy (DT) in relation to psychosocial and spiritual outcomes in the context of person-centred and culturally competent care for people with supportive and palliative care needs. Recent findings Thirteen reviews were found, including seven conducted by nurses. Most reviews were of high quality, including various study populations such as cancer, motor neurone disease and non-malignant conditions. Six psychosocial and spiritual outcomes were identified: quality of life, anxiety, depression, hopefulness, meaning and purpose in life, and suffering based on the cultural variations in the implementation of DT. Summary DT has a positive impact on anxiety, depression, suffering, and meaning and purpose in life for people with palliative care needs, but the evidence is somewhat conflicted as to whether DT is effective in improving hope, quality of life and spiritual outcomes in the context of culturally competent care. Nurse-led DT seems desirable given its pivotal role when caring for people with palliative care needs. More randomised controlled trials should be conducted for people with different cultural backgrounds to provide person-centred, culturally competent supportive and palliative care. [ABSTRACT FROM AUTHOR]

Objective: The Transatlantic Australasian Retroperitoneal Sarcoma Working Group conducted a retrospective study on the disease course and clinical management of ganglioneuromas. Background: Ganglioneuromas are rare tumors derived from neural crest cells. Data on these tumors remain limited to case reports and single-institution case series. Methods: Patients of all ages with pathologically confirmed primary retroperitoneal, intra-abdominal, and pelvic ganglioneuromas between January 1, 2000, and January 1, 2020, were included. We examined demographic, clinicopathologic, and radiologic characteristics, as well as clinical management. Results: Overall, 328 patients from 29 institutions were included. The median age at diagnosis was 37 years with 59.1% of patients being female. Symptomatic presentation comprised 40.9% of cases, and tumors were often located in the extra-adrenal retroperitoneum (67.1%). At baseline, the median maximum tumor diameter was 7.2 cm. One hundred sixteen (35.4%) patients underwent active surveillance, whereas 212 (64.6%) patients underwent resection with 74.5% of operative cases achieving an R0/R1 resection. Serial tumor evaluations showed that malignant transformation to neuroblastoma was rare (0.9%, N=3). Tumors undergoing surveillance had a median follow-up of 1.9 years, with 92.2% of ganglioneuromas stable in size. With a median follow-up of 3.0 years for resected tumors, 84.4% of patients were disease free after resections, whereas recurrences were observed in 4 (1.9%) patients. Conclusions: Most ganglioneuromas have indolent disease courses and rarely transform to neuroblastoma. Thus, active surveillance may be appropriate for benign and asymptomatic tumors particularly when the risks of surgery outweigh the benefits. For symptomatic or growing tumors, resection may be curative. [ABSTRACT FROM AUTHOR]

Objective: This study explored surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. Background: The American College of Surgeons Geriatric Surgery Verification Program includes communication standards designed to facilitate goal-concordant care, yet little is known about how surgeons believe these standards align with clinical practice. Methods: Semistructured video-based interviews were conducted from November 2020 to January 2021 with academic surgical oncologists purposively sampled based on demographics, region, palliative care certification, and years in practice. Interviews addressed: (1) adherence to standards documenting care preferences for life-sustaining treatment, surrogate decision-maker, and goals of surgery; and (2) factors influencing their adoption into practice. Interviews were audio-recorded, transcribed, qualitatively analyzed, and conducted until thematic saturation was reached. Results: Twenty-six surgeons participated (57.7% male, 8.5 mean years in practice, 19.2% palliative care board-certified). Surgeons reported low adherence to documenting care preferences and surrogate decision-maker and high adherence to discussing, but not documenting, goals of surgery. Participants held conflicting views about the relevance of care preferences to preoperative conversations and surrogate decision-maker documentation by the surgeon and questioned the direct connection between documentation of quality standards and higher value patient care. Key themes regarding factors influencing adoption of quality standards included organizational culture, workflow, and multidisciplinary collaboration. Conclusions: Although surgeons routinely discuss goals of surgery, documentation is inconsistent; care preferences and surrogate decision-makers are rarely discussed or documented. Adherence to these standards would be facilitated by multidisciplinary collaboration, institutional standardization, and evidence linking standards to higher value care. [ABSTRACT FROM AUTHOR]

Integral to holistic "big picture" nursing care is an empathy that strives for social justice. Social empathy requires more than technical skills or even interpersonal empathy or other-focus; it also requires a perspective that appreciates the impact of social determinants and seeks action to address them. This study sought to measure social empathy and potentially associated demographic, personal, and work-related factors among nurses. This cross-sectional, observational study used online survey methods to collect data from 614 registered nurses employed in a faith-based health care system in the northwestern United States. Constructs measured included social empathy, social advocacy, self-compassion, emotional exhaustion, and trust/mistrust in God. Parametric statistical tests, including multiple logistic regression, allowed analyses. Findings indicated that social empathy was high in this sample. Younger nurses, those more inclined to advocate, those more self-compassionate, those less burned out, those working part-time (in contrast only with those working overtime), and those with at least a baccalaureate degree in nursing were more socially empathic. Findings highlight further rationale for creating healthy work environments that foster self-compassion and minimize burnout. [ABSTRACT FROM AUTHOR]

Although clinical and empirical literature documents the variety of spiritual care interventions available to palliative care clinicians, the frequency with which they are provided is rarely and inadequately measured. Given the growing interest in implementing spiritual care across Asia, including South Korea, this study sought to cross-culturally validate the Korean version of the Nurse Spiritual Care Therapeutics Scale (NSCTS-K), a scale initially developed in the United States. The World Health Organization process for cross-cultural adaptation of scales and Polit and Yang's process for evaluating validation were implemented. With data from a sample of 252 Korean nurses providing care to patients with life-threatening illnesses, various statistical procedures for evaluating validity and reliability were applied during this cross-sectional, observational study. Exploratory factor analysis for the structural validity of the Korean scale generated 3 factors that accounted for 69.40% of the variance. The Cronbach α was 0.95. The NSCTS-K is one of the few scales available to determine the impact of nurse-provided spiritual care frequency on patient outcomes. Thus, this tool can quantify the frequency of spiritual care better and be used in quality improvement initiatives or palliative care research. [ABSTRACT FROM AUTHOR]