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Objective: Patients at the end of their life typically endure physical, emotional, interpersonal, and spiritual challenges. Although physicians assume a clearly defined role in approaching the physical aspects of terminal illness, the responsibility for helping their patients' spiritual adaptation is also important.Methods: This article (1) describes the terms and definitions that have clinical utility in assessing the spiritual needs of dying patients, (2) reviews the justifications that support physicians assuming an active role in addressing the spiritual needs of their patients, and (3) reviews clinical tools that provide physicians with a structured approach to the assessment and treatment of spiritual distress.Results: This review suggests that physicians can and should be equipped to play a key role in relieving suffering at the end of life.Significance Of Results: Physicians can help their patients achieve a sense of completed purpose and peace. [ABSTRACT FROM AUTHOR]

As part of the response of the Royal Thai Army to the outbreak of human immunodeficiency virus (HIV) in Thailand, a collaboration was established with the U.S. Army to jointly work toward the development of vaccines for the prevention of HIV infection. During the first decade of this collaboration, studies have been carried out in the diverse disciplines that are crucial to providing the foundations for efficacy trials of candidate HIV vaccines. Studies of host, pathogen, and vaccine interventions included studies of viral diversity, epidemiology, disease course, potential vaccine cohorts, and Phase I/II clinical trials. Collaborations were expanded to other Thai institutions and to overseas partners, resulting in the Thai AIDS Vaccine Evaluation Group. The efforts of these collaborations resulted in the development of candidate vaccines specifically designed for use in Thailand, and sequential evaluations that have lead to the threshold of the world's next and largest efficacy trial of HIV vaccines. [ABSTRACT FROM AUTHOR]

Background: Around 3 % of people are Autistic; women may be under-diagnosed. Autistic people report lack of staff understanding, stigma and environmental barriers to using midwifery services. It is not known if these issues are present in perinatal loss services., Aim: To understand Autistic people's experiences of care for perinatal loss., Methods: An online survey for Autistic adults in the United Kingdom who had been pregnant, using closed and open questions. Data were analysed descriptively, using Kruskal-Wallis tests and thematically., Results: The majority of losses appeared to be early in pregnancy. Among 67 participants, over half (58.2 %, n = 39) always sought healthcare during a perinatal loss, but 28.4 % (n = 19) never accessed care. Of those who received healthcare (n = 48; 71.6 %), over half (n = 27; 56.3 %) did not know they were Autistic at the time, and just one person told health professionals that they were Autistic. Four participants identified instances where staff were supportive or kind, but the majority of experiences were negative, with reported issues focused on communication, the way support was provided, inadequate pain relief and the hospital environment. We generated one overarching theme: "trauma"., Conclusion: Autistic people from the UK identified significant Disability-related access issues with perinatal loss care in addition to issues reported by a general population. UK Perinatal loss services need urgent investment to be able to provide person-centred care to all. Staff supporting perinatal loss should receive neurodiversity-affirming Autism training and be aware that many Autistic people experiencing perinatal loss may not have or share a diagnosis., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Aimee Grant is a non-executive director for Disability Wales. Kathryn Williams is a non-executive director for Autistic UK., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Pancreas transplantation improves glycemic control and mortality in patients with diabetes but requires aggressive immunosuppression to control the alloimmune and autoimmune response. Recent developments in "omics" methods have provided gene transcript-based biomarkers for organ transplant rejection. The tissue Common Response Module (tCRM) score is developed to identify the severity of rejection in kidney, heart, liver, and lung transplants. Still, it has not yet been validated in pancreas transplants (PT). We evaluated the tCRM score's relevance in PT and additional markers of acute cellular rejection (ACR) for PT. An analysis of 51 pancreas biopsies with ACR identified 37 genes and 56 genes significantly upregulated in the case of grade 3 and grade 2 ACR, respectively (P < .05). Significant differences were seen with higher grades of rejection among several transcripts. Of the 22 genes differentially expressed in grade 3 ACR, 18 were also differentially expressed in grade 2 ACR. The rejection signal was attributable to activated leukocytes' infiltration. Significantly higher tCRM scores were found in grade 3 ACR (P = .007) and grade 2 ACR (P = .004), compared to normal samples. The tCRM score was able to distinguish treatment-resistant cases from those successfully treated for rejection., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT., Methods: This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters., Results: A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15-20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index., Conclusion: Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present., (© 2025 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.)

Canalicular-like pleomorphic adenomas are a relatively recently described entity, that possess features of both canalicular adenomas and pleomorphic adenomas. The presence of unusual HMGA2 -fusion partners (most commonly HMGA2::WIF1 gene fusions) has established canalicular-like pleomorphic adenoma as a distinct entity. The use of intraoperative frozen section analysis and surrogate HMGA2 IHC are 2 tools that can provide the surgical team with valuable insight into intraoperative decision making and final classification of rare tumors of the parotid gland, respectively. We present a case of canalicular-like pleomorphic adenoma and characterize its appearance on frozen section analysis. HMGA2 IHC staining was retroactively performed, assisting in the confirmation of the tumor subtype., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Apathy is common in Huntington's disease (HD) and difficult to treat. Multiple recent calls have been made to increase understanding of apathy across the spectrum of HD severity. Functional status is an important outcome in HD trials; however, no consensus currently exists regarding the impact of apathy on functional status in HD. The authors aimed to identify correlates of apathy and effects on functional status in a primarily early-stage HD sample., Methods: This study included secondary analyses of data from a study of neuropsychiatric symptoms in a clinical HD sample. Spearman correlation analyses were used to assess the relationships between apathy (with the Frontal Systems Behavior Scale-Apathy [FrSBe-Apathy] subscore), clinical variables, and patient-reported outcomes. To assess the association of apathy with functional status, two multiple regression analyses were performed, with a different functional status measure (Adult Functional Adaptive Behavior [AFAB] scale or Total Functional Capacity [TFC] scale) as the dependent variable in each analysis., Results: Statistically significant correlates of apathy included the Quality of Life in Neurological Disorders (Neuro-QoL) Satisfaction With Social Roles and Activities and Neuro-QoL Positive Affect and Well-Being scores (N=70 patients). Univariate correlation analyses also revealed statistically significant associations of FrSBe-Apathy scores with both functional status measures. In the multiple regression analyses, apathy significantly contributed to variability in functional status as measured by both the AFAB (N=49 patients) and TFC (N=56 patients) scales., Conclusions: These results underscore the need to address apathy as a target for improving functional status, social satisfaction, and well-being in HD, even for individuals with early-stage HD., Competing Interests: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the authors’ institutions.Dr. Gibson reports receiving consulting fees from Teva Pharmaceuticals. Dr. Claassen reports receiving research support from the Griffin Family Foundation and the Huntington Disease Society of America; pharmaceutical grant support from AbbVie, Acadia, Alterity, Biogen, BMS, Cerecour, Eli Lilly, Genentech-Roche, Jazz Pharmaceuticals, Lundbeck, Neurocrine, Teva Neuroscience, UniQure, Vaccinex, and Wave Life Sciences; and consulting fees from Acadia, Adamas, Alterity, Anexon, Ceruvel, Lundbeck, Neurocrine, Spark, Teva Neuroscience, and UniQure. Dr. Brown reports receiving research support from CHDI Foundation and Parkinson’s Foundation; pharmaceutical grant support from AbbVie, Alterity Therapeutics, Amylyx Pharmaceuticals, Genentech-Roche, Neurocrine Biosciences, Novartis, Orphalan, PTC Therapeutics, Sage Therapeutics, Teva Neuroscience, and UniQure; and consulting fees from Orphalan. Dr. Isaacs reports receiving research funding from Teva Neuroscience and the Tourette Association of America. The other authors report no financial relationships with commercial interests.

Objectives: To characterize the spectrum of legal options considered in cases of treatment refusal, nonadherence, and abandonment (TRNA); clinicians' thought processes regarding legal intervention; and perceived consequences of legal involvement., Methods: We conducted in-depth, semistructured interviews with 30 pediatric oncologists between May and September of 2019 regarding experiences with TRNA. The interview guide covered types of conflicts encountered; factors and strategies considered in response; effects of TRNA cases, personally and professionally; the role of ethical frameworks and legal requirements; and resources needed to manage TRNA cases. Interviews were transcribed and coded iteratively using thematic analysis., Results: Participants represented a range of institutional sizes, geographic locations, and years in practice. Twenty-five of 30 interviewees discussed legal consideration with regard to TRNA. Most participants first engaged the legal system through child protective service agencies. They considered patient age, treatment efficacy, quality of life (burden of treatment), and prognosis; family resources and social context; and preservation of therapeutic relationships and possible consequences of reporting. Experiences and outcomes of legal involvement varied., Conclusions: Clinicians struggle with the tension between obligations to report medical neglect and fears that reporting may result in more harm than benefit to the child in question. We urgently need more dialog between health care professionals and child protective services and legal professionals. Stakeholders from both groups would benefit from a greater understanding of the other's thought processes; clarity regarding the relevant facts; and mutual progress toward creative, evidence-based solutions to working out these complex challenges., (Copyright © 2024 by the American Academy of Pediatrics.)

Aim: To explore the experiences of interdisciplinary Higher Educational Academics within Nursing, Midwifery, Pharmacy and Biomedical Science in the use of teaching squares as a formative, collaborative pedagogical tool to promote reflection., Background: One approach to enhancing academic teaching practice involves the provision of feedback to individual academics. This approach can be challenging for the reviewer, hence other less intimidating approaches are popular. One such approach is the teaching square. In this approach typically 4 other teaching staff are involved in observing their peers' teaching methods (synchronous or asynchronous) and then engaging in a cycle of personal reflection. Reflection on teaching practices of their peers can provide opportunity to improve their own teaching. Typically teaching squares involve participants from the same academic discipline, however, in this study participants from related yet different disciplines were purposely connected and the benefits of this approach assessed., Design: A qualitative descriptive design was used to explore the participants' experiences of undertaking interdisciplinary teaching squares through online questionnaires and focus group feedback opportunities., Methods: This study was undertaken between August 2022 to June 2023 at an Australian university. Sixteen academic staff members from Nursing, Midwifery, Pharmacy & Pharmaceutical science and Biological science expressed an interest in the project. Five participants elected not to continue citing time pressures and 11 staff members participated in the project. Participation involved completing the teaching square experience and a subsequent focus group that were held to explore their experiences of undertaking a teaching square. The demographic survey data were presented and the focus group interviews were recorded, transcribed and analysed thematically., Results: Triangulation of the findings resulted in the identification of four main themes: Teaching squares for professional networks; Perceptions of Safety; Stepping in and out of a reflective cycle; and Time Constraints vs. Time Value., Conclusions: The study aimed to explore the effectiveness of teaching squares in encouraging academic reflection on teaching and fostering a collaborative teaching culture within interdisciplinary higher education academics. An unexpected finding was the value and promotion of interdisciplinarity professional relationships and networks. The findings from this research project offer valuable insights into the benefits of adopting teaching squares in health education and contributes to evidence-based pedagogical practices., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Depression is common in Parkinson's disease (PD) but is underrecognized clinically. Although systematic screening is a recommended strategy to improve depression recognition in primary care practice, it has not been widely used in PD care., Methods: The 15-item Geriatric Depression Scale (GDS-15) was implemented at 5 movement disorders clinics to screen PD patients. Sites developed processes suited to their clinical workflow. Qualitative interviews with clinicians and patients provided information on feasibility, acceptability, and perceived utility., Results: Prior to implementation, depression screening was recorded in 12% using a formal instrument; 64% were screened informally by clinical interview, and no screening was recorded in 24%. Of 1406 patients seen for follow-up care during the implementation period, 88% were screened, 59% using the GDS-15 (self-administered in 51% and interviewer administered in 8%), a nearly 5-fold increase in formal screening. Lack of clinician or staff time and inability to provide the GDS-15 to the patient ahead of the visit were the most commonly cited reasons for lack of screening using the GDS-15; 378 (45%) patients completing the GDS-15 screened positive for depression, and 137 were enrolled for a 12-month prospective follow-up. Mean GDS-15 scores improved from 8.8 to 7.0 (P < 0.0001) and the 39-item Parkinson's Disease Questionnaire emotional subscore from 42.2 to 36.7 (P = 0.0007)., Conclusions: Depression screening in PD using a formal instrument can be achieved at much higher levels than is currently practiced, but there are barriers to implementing this in clinical practice. An individual site-specific process is necessary to optimize screening rates., (© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: Length of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations., Objective: To determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population., Designs, Settings, and Participants: We conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois., Intervention: None., Main Outcome and Measures: Patient-reported responses to the HCS (scored 0 [lowest health confidence] to ‒12 [highest health confidence]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30- and 90-day readmission., Results: Among 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0-12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53-day lower LOS (p < .01, 95% confidence interval [CI] [-2.11, -0.95]) than patients with a low HCS (HCS < 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question "I am involved in decisions about me" (adjusted model: odds ratio 0.83; 95% CI [0.71, 0.96]; p = .01) was associated with 90-day readmission., (© 2024 The Author(s). Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.)