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Evidence suggests that change is occurring in end-of-life care in the intensive care unit (ICU). There is a growing need and appreciation for the importance of education for the multidisciplinary team, but particularly for physicians, in gaining communication skills to improve the quality of end-of-life care and provide palliative care in the ICU. Studies have indicated that families are unhappy with the communication they receive when a family member is in the ICU. Evidence also suggests that families want to be involved in decisions about their loved one's care. Interventions have been tested in numerous ICUs that others can evaluate for application to their own facility in an attempt to create a global standard for end-of-life care in the ICU. Quality indicators have been defined, and an audit tool can help assess levels of performance. [ABSTRACT FROM AUTHOR]

Endoscopy plays a key role in diagnosis, monitoring of disease activity, assessment of treatment response, dysplasia surveillance, postoperative evaluation, and interventional therapy for patients with inflammatory bowel disease (IBD). Clinical practice patterns in the endoscopic management of IBD vary. A panel of experts consisting of IBD specialists, endoscopists, and GI pathologists participated in virtual conferences and developed this modified Delphi-based consensus document to address endoscopic aspects of IBD management., Competing Interests: Disclosure The following authors disclosed financial relationships: B. Shen: Consultant for Janssen; education and research support to Columbia University from Janssen, Takeda, Abbvie, GIE Medical, and Boomerang. M. T. Abreu: Research support from the National Institutes of Health Research, Department of Defense, The Leona M. and Harry B. Helmsley Charitable Trust, and Crohn’s and Colitis Foundation; consultant and advisory board for AbbVie, Alimentiv, Arena Pharmaceuticals Inc, Bristol Myers Squibb, Celsius Therapeutics, Eli Lilly and Company, Gilead Sciences Inc, Janssen Pharmaceuticals, Janssen Pharmaceutica NV, Pfizer Pharmaceutical, Prime CME, Takeda Pharmaceuticals, and WebMD Global LLC; speaker for Amgen Inc, Janssen Pharmaceutica NV, Prometheus Biosciences, and UCB Biopharma SRL. E. R. Cohen: Advisory board and consultant for Pfizer, Takeda, and PRIME Education; speaker for Abbvie, Eli Lilly and Company, Janssen, and Takeda. F. A. Farraye: Consultant for Avalo Therapeutics, BMS, Braintree Labs, Fresenius Kabi, GI Reviewers, GSK, IBD Educational Group, Iterative Health, Janssen, Pharmacosmos, Pfizer, Sandoz Immunology, Viatris, DSMB and Eli Lilly and Company; research support to the Mayo Clinic from BMS, Creatics, Janssen, and Takeda. M. Fischer: Consultant and advisory board for Abbvie, Bristol Myers Squibb, Janssen Pharmaceuticals, Eli Lilly, Seres, Ferring, and DSMB for Rebiotix; teacher for Bristol Myers Squibb and Eli Lilly. S. Kapur: Advisory board for Pfizer; speaker for Abbvie, Jenssen, Takeda, and BMS; Speaker for Eli Lilly and Company. G. S. Kochhar: Advisory board for Eli Lilly and Company, GIE Medical, CorVetas Research Foundation, and Phramacosmos; consultant for Olympus Endoscopy, Boston Scientific Endoscopy, and Pentax Endoscopy; speaker for Eli Lilly and Company; stock options from DigBi Health. X. Liu, Consultant for Bristol Myers Squibb. U. Mahadevan: Consultant Abbvie, Bristol Myers Squibb, Boeringher Ingelheim, Celltrion, Enveda, Gilead, Janssen, Lilly, Merck, Pfizer, Protagonist, Rani Therapeutics, Roivant, and Takeda. U. Navaneethan: Consultant and advisory board for Abbvie, Janssen, Takeda, Pfizer, BMS, Lilly, and GIE Medical; speaker for Abbvie, Janssen, Pfizer, BMS, Lilly, Celltrion, and Takeda. M. Regueiro: Advisory board and consultant for Abbvie, Janssen, UCB, Takeda, Pfizer, BMS, Organon, Amgen, Genentech, Gilead, Salix, Prometheus, Lilly, Celgene, Boehringer Ingelheim Pharmaceuticals Inc (BIPI), and Celltrion. P. Sharma: Consultant for Olympus Corporation, Boston Scientific, Salix Pharmaceuticals, Cipla, Medtronic, Takeda, Samsung Bioepis, and CDx; research support from Erbe and Fujifilm. G. R. Lichtenstein: Consultant for Abbvie, American Regent, Bristol Meyers Squibb, Eli Lilly, Kabi Fresenius, MedEd Consultants, Janssen Orthobiotech, Pfizer Pharmaceuticals, Takeda, and UCB; research support from Bristol Meyers Squibb CME, Takeda, and UCB Consultant; continuing medical education sponsored by American Gastroenterological Association, American Regent (Creative Educational Concepts), Focus Medical Communication, AbbVie, Janssen, Ferring, Pfizer, Sanofi, Salix, Takeda, Bristol Meyers Squibb, Exact Sciences, Eli Lilly, Seres Pharmaceuticals, Boehringer Ingelheim, Pennsylvania Society of Gastroenterology; Data Safety Monitoring Board for Eli Lilly; royalties from UpToDate. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background: Intimate partner violence (IPV) persists as a serious challenge, globally, with regions in Central and Northern Canada reporting the highest rates of shelter use to escape abuse, of sexual assault, and of IPV in the country. Despite research into IPV, barriers and gaps exist in understanding what an effective response to IPV in rural and northern communities should look like., Methods: To enhance this understanding, qualitative interviews and focus groups with a total of 55 participants were conducted with service providers, including shelter services, victims services, the Royal Canadian Mounted Police, counselors, and others (e.g., psychologists). A grounded theory approach was used to analyze data, with findings illustrated in a schematic that conceptualize the challenges service providers experience., Results: The findings reveal how an IPV environment, characterized by oppression, abuse, and illness, requires transformation into an IPV-free environment, characterized by empowerment, positive social connections, and wellness. As service providers work to influence this transition, they become experts in understanding the sociocultural context, formal services, and informal supports accessible or not for women experiencing IPV. Service providers encourage social media use into service delivery to improve communication; lobby for rural-specific IPV specialists; and recognize isolation as a barrier to seeking out safe shelter and housing, transportation, and economic assistance., Conclusion: In order to reduce rates of IPV, the results suggest we must support service providers, document service gaps, and maximize policy change and community action based on IPV as it is experienced in rural and northern regions of Canada.

Endoscopy plays a critical role in caring for and evaluating the patient with eosinophilic esophagitis (EoE). Endoscopy is essential for diagnosis, assessment of response to therapy, treatment of esophageal strictures, and ongoing monitoring of patients in histologic remission. To date, less-invasive testing for identifying or grading EoE severity has not been established, whereas diagnostic endoscopy as integral to both remains the criterion standard. Therapeutic endoscopy in patients with adverse events of EoE may also be required. In particular, dilation may be essential to treat and attenuate progression of the disease in select patients to minimize further fibrosis and stricture formation. Using a modified Delphi consensus process, a group of 20 expert clinicians and investigators in EoE were assembled to provide guidance for the use of endoscopy in EoE. Through an iterative process, the group achieved consensus on 20 statements yielding comprehensive advice on tissue-sampling standards, gross assessment of disease activity, use and performance of endoscopic dilation, and monitoring of disease, despite an absence of high-quality evidence. Key areas of controversy were identified when discussions yielded an inability to reach agreement on the merit of a statement. We expect that with ongoing research, higher-quality evidence will be obtained to enable creation of a guideline for these issues. We further anticipate that forthcoming expert-generated and agreed-on statements will provide valuable practice advice on the role and use of endoscopy in patients with EoE., (Copyright © 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Visitor restriction policies have been implemented on many hospital units as a result of the Covid-19 pandemic. These policies are integral to the strategies that hospitals are using to limit exposure risks during the pandemic. However, visitor restriction policies disproportionally affect hospitalized children. The trauma caused by lack of family at the bedside of adult patients during the Covid-19 pandemic has been studied but there is a lack of primary research on the impact of the Covid-19 visiting policy restrictions on pediatric patients. Long term studies are needed to understand the effect of this separation on children and their caregivers., Competing Interests: Declaration of Competing Interest The views expressed in this article are the authors' own and not an official position of their institutions. The authors declare that there are no conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The impacts of wildfires on the health of children are becoming a more urgent matter as wildfires become more frequent, intense and affecting, not only forested areas, but also urban locations. It is important that medical professionals be prepared to provide information to patients and families on how to minimize the adverse health effects on children of wildfire smoke and ash from wildfires., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Approximately 45 million children participate in some form of athletics. The COVID-19 pandemic has affected many aspects of their lives, including sports activities. Families are asking care givers questions about how best to ensure the safety of their children when returning to sports activities. The American Academy of Pediatrics has issued revised guidelines for children returning to athletic activities after COVID-19. These include strengthening the recommendations for cloth mask wearing for all children engaging in vigorous sports and clarifications of cardiac risks to children who have had COVID-19., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of Competing Interest The views expressed in this article are the authors' own and not an official position of their institutions. The authors declare that there are no conflicts of interest.

Background: Missions were established in California in the eighteenth and nineteenth centuries to convert Native Americans to Christianity and enculturate them into a class of laborers for Californios (Spanish/Mexican settler). The concentration of large numbers of Native Americans at the Missions, along with the introduction of European diseases, led to serious disease problems. Medicinal supplies brought to California by the missionaries were limited in quantity. This situation resulted in an opportunity for the sharing of knowledge of medicinal plants between the Native Americans and the Mission priests. The purpose of this study is to examine the degree to which such sharing of knowledge took place and to understand factors that may have influenced the sharing of medicinal knowledge. The study also examines the sharing of medicinal knowledge between the Native Americans and the Californios following the demise of the California Missions., Methods: Two methods were employed in the study: (1) a comparison of lists of medicinal plants used by various groups (e.g., Native American, Mission priests, Californios) prior to, during, and after the Mission period and (2) a close reading of diaries, reports, and books written by first-hand observers and modern authorities to find accounts of and identify factors influencing the exchange of medicinal information., Results: A comparison of the lists of medicinal plants use by various groups indicated that only a small percentage of medicinal plants were shared by two or more groups. For example, none of the 265 taxa of species used by the Native Americans in pre-Mission times were imported into Spain for medicinal use and only 16 taxa were reported to have been used at the Missions. A larger sharing of information of medicinal plants took place in the post-Mission period when Native Americans were dispersed from the Missions and worked as laborers on the ranches of the Californios., Conclusions: Sharing of information concerning medicinal plants did occur during the Mission period, but the number of documented species was limited. A number of possible factors discouraged this exchange. These include (1) imbalance of power between the priests and the Native Americans, (2) suppression of indigenous knowledge and medical practices by the Mission priests, (3) language barriers, (4) reduction of availability of medicinal herbs around the Mission due to introduced agricultural practices, (5) desire to protect knowledge of medicinal herbs by Native American shaman, (6) administrative structure at the Missions which left little time for direct interaction between the priests and individual Native Americans, (7) loss of knowledge of herbal medicine by the Native Americans over time at the Missions, and (8) limited transportation opportunities for reciprocal the shipment of medicinal plants between California and Spain. Three possible factors were identified that contributed to a greater sharing of information between the Native Americans and the Californios in the post-Mission period. These were (1) more one-to-one interactions between the Californios and the Native Americans, (2) many of the Californios were mestizos whose mothers or grandmothers were Native Americans, and (3) lack of pressure on the part of the Californios to suppress Native American beliefs and medicinal practices.

The exomes of 4293 families with individuals with undiagnosed developmental disorders were sequenced to identify de novo mutations. The researchers identified 14 new genetic disorders., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care., Objective: Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non‒work-related activities and to assess the impact of these devices on in-patient care., Methods: A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues' work., Results: Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non‒work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of respondents believe that on average personal communication devices have a more negative than positive impact on patient care and 39.07% (481/1231) reported that personal communication devices were always or often a distraction while working. Respondents acknowledged their own device use negatively affected their work performance (7.56%, 94/1243), or caused them to miss important clinical information (3.83%, 47/1225) or make a medical error (0.90%, 11/1218). Respondents reported witnessing another nurse's use of devices negatively affect their work performance (69.41%, 860/1239), or cause them to miss important clinical information (30.61%, 378/1235) or make a medical error (12.51%, 155/1239). Younger respondents reported greater device use while at work than older respondents and generally had more positive opinions about the impact of personal communication devices on their work., Conclusions: The majority of registered nurses believe that the use of personal communication devices on hospital units raises significant safety issues. The high rate of respondents who saw colleagues distracted by their devices compared to the rate who acknowledged their own distraction may be an indication that nurses are unaware of their own attention deficits while using their devices. There were clear generational differences in personal communication device use at work and opinions about the impact of these devices on patient care. Professional codes of conduct for personal communication device use by hospital nurses need to be developed that maximize the benefits of personal communication device use, while reducing the potential for distraction and adverse outcomes., (©Deborah L McBride, Sandra A LeVasseur. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 13.04.2017.)

Aim: To report an analysis of the concept of distraction of clinicians by smartphones and other mobile devices in hospitals., Background: In the healthcare literature, the concept of distraction of clinicians by smartphones and other mobile devices in hospitals has no consistent definition., Design: Concept analysis., Data Sources: Journal articles published from 2003-2014., Methods: Rodgers' Evolutionary Concept Analysis Method was used to analyse the concept of distraction of clinicians by smartphones and other mobile devices in hospitals., Results: This analysis led to a definition of distraction of clinicians by smartphones as the interruption of a hospital clinician's primary task by the internally or externally initiated use of their smartphone or other mobile device. There are six attributes of distraction by smartphones and other mobile devices in hospitals. These attributes are: (1) an experience by a clinician; (2) an intrusion into a primary clinical task; (3) discontinuity of the clinical task; (4) externally or internally initiated; (5) situated in a healthcare setting; and (6) mediated by a smartphone or other mobile device., Conclusion: Use of the definition and the defining attributes of distraction of clinicians by smartphones will increase the validity and reliability of future studies. It will be extended to form a classification system of distractions within a framework of clinical practice, which will be used to unify and standardize future research studies., (© 2015 John Wiley & Sons Ltd.)

Background: Personal mobile phones and other personal communication devices (smartphones and tablet computers) provide users with an ever-increasing number and diversity of non-work-related activities while at work. In hospitals, where the vigilance of health care workers is essential for patient care, the potential distraction of these devices could be hazardous to patients., Objective: The objective of this study was to determine the frequency of non-work-related use of personal mobile phones and other personal communication devices among hospital registered nurses., Methods: In March 2014, a previously validated 30-question survey was emailed to the 10,978 members of the Academy of Medical Surgical Nurses. There were 825 respondents who met the inclusion criteria., Results: The use of a personal mobile phone or other personal communication device while working (excluding meal times and breaks) was reported by 78.1% (644/825) of respondents. Nurses reported regularly (sometimes, often, or always) sending personal emails and text messages (38.6%, 318/825), reading news (25.7%, 212/825), checking/posting on social networking sites (20.8%, 172/825), shopping (9.6%, 79/825), and playing games (6.5%, 54/825) while working., Conclusions: This study found that hospital nurses frequently use their personal mobile phones or other personal communication devices for non-work-related activities at work. The primary activity reported was to send personal emails and text messages to family and friends.

Background: The use of personal communication devices (such as basic cell phones, enhanced cell phones or smartphones, and tablet computers) in hospital units has risen dramatically in recent years. The use of these devices for personal and professional activities can be beneficial, but also has the potential to negatively affect patient care, as clinicians may become distracted by these devices., Objective: No validated questionnaire examining the impact of the use of these devices on patient care exists; thus, we aim to develop and validate an online questionnaire for surveying the views of registered nurses with experience of working in hospitals regarding the impact of the use of personal communication devices on hospital units., Methods: A 50-item, four-domain questionnaire on the views of registered nursing staff regarding the impact of personal communication devices on hospital units was developed based on a literature review and interviews with such nurses. A repeated measures pilot study was conducted to examine the psychometrics of a survey questionnaire and the feasibility of conducting a larger study. Psychometric testing of the questionnaire included examining internal consistency reliability and test-retest reliability in a sample of 50 registered nurses., Results: The response rate for the repeated measures was 30%. Cronbach coefficient alpha was used to examine the internal consistency and reliability, and in three of the four question groups (utilization, impact, and opinions), the correlation was observed to be very high. This suggests that the questions were measuring a single underlying theme. The Cronbach alpha value for the questions in the performance group, describing the use of personal communication devices while working, was lower than those for the other question groups. These values may be an indication that the assumptions underlying the Cronbach alpha calculation may have been violated for this group of questions. A Spearman rho correlation was used to determine the test-retest reliability. There was a strong test-retest reliability between the two tests for the majority of the questions. The average test-retest percent of agreement for the Likert scale responses was 74% (range 43-100%). Accounting for responses within the 1 SD range on the Likert scale increased the agreement to 96% (range 87-100%). Missing data were in the range of 0 to 7%., Conclusions: The psychometrics of the questionnaire showed good to fair levels of internal consistency and test-retest reliability. The pilot study demonstrated that our questionnaire may be useful in exploring registered nurses' perceptions of the impact of personal electronic devices on hospital units in a larger study.