Clinical Colleagues Research Articles

Get With the Guidelines on MS Imaging by Leveraging Peer Learning

To achieve consensus on the performance, interpretation and reporting of MS imaging according to up-to-date guidelines using the Peer Learning Methodology. We utilized the Peer Learning Methodology to engage our clinical and radiology colleagues, review the current guidelines, acheive consensus on imaging techniques and reporting standards. After implementing changes, we collected radiologist feedback on the impact of the optimized images on their interpretation. Survey responders indicated a strong preference for the new protocol in terms of overall image quality, individual lesions conspicuity and confidence in the ability to detect an MS lesion. The new protocol was preferred for both MS diagnosis and MS surveillance in 25 of 28 responses. The Peer Learning Methodology is an effective tool to standardize and improve MR imaging quality, interpretation and reporting for Multiple Sclerosis in accordance with current guidelines.

A Practical Guide for AI Algorithm Selection for the Radiology Department

There is a steadily increasing number of artificial intelligence (AI) tools available and cleared for use in clinical radiological practice. Radiologists will increasingly be faced with options provided by other radiologist colleagues, clinician colleagues, vendors, or other professionals for obtaining and deploying AI algorithms in clinical practice. It is important that radiologists are familiar with basic and practical aspects that need to be considered when assessing an AI tool for use in their practice, so that resources are properly allocated and there is an appropriate return on investment through enhancements in patient quality of care, safety, and/or process efficiency. In this review, we will discuss a potential approach for AI software assessment and practical points that should be considered when considering the acquisition and deployment of an AI tool in the radiology department.

Mast cell evaluation in gastrointestinal biopsies: should we be counting? A critical review and practical guide for the surgical pathologist.

Mast cells are residents of the tubular gastrointestinal (GI) tract, where they play an important role in host defence and other vital functions. Dysregulation of mast cells has been implicated in the pathogenesis of several neoplastic, inflammatory, and functional disorders, some of which may manifest with GI symptoms. Surgical pathologists must therefore confront when and how to evaluate GI biopsies for mast cells, and whether such decisions should be based on morphologic criteria, clinical context, or direct request from clinical colleagues. The pathologist's role in evaluation of mast cell infiltrates is best defined in the diagnosis of systemic mastocytosis, where the utility of morphologic assessment coupled with ancillary studies is well established. In contrast, in nonneoplastic mast cell disorders such as mast cell activation syndrome, irritable bowel syndrome, or so-called 'mastocytic enterocolitis', a role for histopathology, if any, is controversial. Despite this, pathologists have seen a sharp increase in requests for mast cell quantification in the latter setting, despite these requests not being supported by published evidence. Moreover, what constitutes a 'normal' number of mast cells in a luminal GI biopsy is not well established. As a result, there is considerable variation in how these requests are handled in practice. This review evaluates and summarizes the published evidence relating to mast cell evaluation in endoscopic GI biopsies in various clinical scenarios, with a goal of providing practical, evidence-based guidance for the surgical pathologist when approached with requests for mast cell quantification in GI biopsies.

Reflexive standardization and the resolution of uncertainty in the genomics clinic.

In genomics, the clinical application of Next Generation Sequencing technologies (such as Whole Genome or Exome Sequencing) has attracted considerable attention from UK policymakers, interested in the benefits such technologies could bring the National Health Service. However, this boosterism plays little attention to the challenges raised by a kind of result known as a Variant of Uncertain Significance, or VUS, which require clinical geneticists and related colleagues to classify ambiguous genomic variants as 'benign' or 'pathogenic'. With a rigorous analysis based on data gathered at 290 clinical meetings over a two-year period, this paper presents the first ethnographic account of decision-making around NGS technology in a NHS clinical genomics service, broadening our understanding of the role formal criteria play in the classification of VUS. Drawing on Stefan Timmermans' concept of 'reflexive standardisation' to explore the way in which clinical genetics staff classify such variants this paper explores the application of a set of criteria drafted by the American College of Medical Genetics and Genomics, highlighting the flexible way in which various resources - variant databases, computer programmes, the research literature - are drawn on to reach a decision. A crucial insight is how professionals' perception of, and trust in, the clinical practice at other genomics centres in the NHS, shapes their own application of criteria and the classification of a VUS as either benign or pathogenic.

Clinical nurses' understanding of the role of the clinical research nurse in the renal unit

Clinical research nurses (CRNs) have been recognised as drivers of success in the conduct of clinical research and clinical trials. However, despite its popularity as a career option, the CRN role is unclear and misunderstood by most clinical nurses. A survey questionnaire was developed and distributed to clinical nurses in the renal unit of a large London hospital to ascertain their understanding of the role of the CRN. Although about 90% of clinical colleagues believed that research was beneficial to patients, a significant proportion (40%) misunderstood the role and 60% were found to have limited or basic understanding. Lack of communication between the CRN and clinical nurses, and research information dissemination emerged as the major contributing factors for this. Developing an approach to address this issue to bridge the gap between these two key nursing specialties is pivotal not only to increase research output but also to augment research awareness and improve working relationships.

Sports injuries in children and adolescents

Due to active participation of children and adolescents in school sports as well as in club sports, sporting injuries in childhood are common. Because skeletal maturity is not yet complete, injury patterns in children differ from sporting injuries in adults. Knowledge of the pathophysiologic characteristics, as well as knowledge of typical injury sequelae, is of great relevance to radiologists. This review article therefore deals with common acute and chronic sporting injuries in children. Basic diagnostic imaging comprises conventional X‑ray imaging in two planes. In addition, sonography, magnetic resonance imaging (MRI) and computed tomography (CT) are used. Close consultation with clinical colleagues and knowledge of childhood-specific injuries help identify sports-associated trauma sequelae.

Cultural Variations in the Care and Support of Breastfeeding

Breastfeeding MedicineVol. 18, No. 2 EditorialFree AccessCultural Variations in the Care and Support of BreastfeedingArthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding MedicineSearch for more papers by this authorPublished Online:15 Feb 2023https://doi.org/10.1089/bfm.2023.29234.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month's issue of Breastfeeding Medicine highlights two disparate articles that on first reading seemingly have absolutely nothing to do with each other. In one, in a comment in the Perspective Section, Segev and colleagues discuss the “unique” problem of which oral contraceptives should be recommend to Orthodox Jewish breastfeeding mothers. In the Clinical Research section Cordova Ramos and colleagues report on their study of the association of the mother's primary language and subsequent breastfeeding rates.As Segev notes, traditionally, estrogen-only medications have been the recommended oral contraceptive for breastfeeding mothers because of a concern that combined therapy (estrogen/progesterone) contraceptives run the risk of reducing the mother's milk production. For the general population the increased risk of breakthrough bleeding from the use of estrogen-only pills posed a relatively “minor adverse outcome,” surely offset by the confidence that the mothers are producing their maximum capacity of milk.However, as Segev details, the concern of breakthrough bleeding is not a minor inconvenience in a population that conducts its life under strict religious (halachic) law. Per this religious code, a single menstrual-like breakthrough bleeding results in a prohibition of any sexual contact for periods of days and repeated bleeds may result in months of deferred marital relationships with all the inevitable negative consequences for the couple. Thus, not surprising for this population the risk–benefit ratio based on its particular social cultural priorities would support the use of combine hormonal contraceptive preparations.Cordova-Ramos study of the association of the mothers' primary language and breastfeeding rates and patterns is no less intriguing and enlightening. This study was performed in the context of what has already been reported about the realities of the inequalities in medical care and the need for more detailed and nuanced cultural sensitivity in developing medical services. Given the reports of the racial and ethnic disparities in human milk intake in neonatal intensive care units,1–3 such a study was clearly of high priority.What Cordova-Ramos proceed to do is expand how we categorize the mothers beyond the standard labels of race and ethnicity by adding the variable of primary language into their analysis of the results. The authors justified this expanded analysis on the assumption that the mothers' primary language would serve as a marker of cultural identity (let alone immigrant or native born status). What was found, surprisingly, was that there was different and opposite association of the mothers' primary language with mother's milk provision among different groups.For example among Hispanic mothers, non-English- versus English-speaking mothers had lower rates of milk provision, whereas among Black mothers, non-English- versus English-speaking mothers had higher rates of milk provision. These differences likely reflected a much more complex interplay of social and cultural factors that influence continuation of mother's milk provision in minority mothers and highlights the heterogeneity that exists within conventionally labeled racial/ethnic minority groups. Surely it is difficult to justify combining under the label of Hispanic data regarding third-generation Puerto Rico mothers living in New York with data regarding Mexican or other Central American immigrants living in Texas or California.4What is the common thread in these two seemingly unrelated articles and what we should learn from the data presented? The clear message that we should neither analyze the clinical manifestation of any given medical situation only utilizing the broad and somewhat at times simplistic construct of race and ethnicity. No less so, we should be careful in promoting global recommendations or standard management protocols that are not adjusted for specific groups and subgroups. Clearly there is need for greater sophistication and sensitivity to the various subsets of the standard racial and ethnic categories,Homogenizing the differences between mothers based on the standard labels without factoring the specific social, cultural, beliefs, and practices in subgroups preclude appropriate individualized care and therapy. Simply put, we need not only to be attuned to the language (and cultural context) that specific mothers are talking, but also we need to adjust, in turn, our language to be appropriately attuned to these mothers.

Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study

ObjectivesThe Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19...

Case Report of a 60-Year-Old Woman with Autoimmune Hemolytic Anaemia after Venetoclax

Background: Chronic Lymphocytic Leukaemia (CLL) is a common haematological malignant neoplasm that is characterized by proliferation of clonal B-cell lymphocytes and infiltration of blood, lymph nodes, spleen and bone marrow. Autoimmune Hemolytic Anaemia (AIHA) is a medical condition in which patient’s red blood cells are being destructed by immune system through antibodies leading to red blood cell lysis. Venetoclax is a novel BCL-2 selective inhibitor introduced amongst patients with CLL refractory to standard treatment lines. Common adverse events in Venetoclax treatment are: neutropenia, thrombocytopenia and diarrhea. Case Report: The following case study presents 60-year-old female patient that developed an autoimmune hemolytic anemia after introducing Venetoclax for CLL diagnosed nearly 13 years before and treated with many other treatment lines. AIHA was resolved after withdrawing Venetoclax and being treated with steroids, Rituximab and plasmapheresis. After that, Venetoclax was reintroduced with carefully monitored hemolysis markers as well as maintaining steroids and Rituximab treatment with good results. Conclusion: Although AIHA caused by Venetoclax is still not mentioned by producer’s summary of product characteristic (sPC), it is valuable for clinicians to have the knowledge that such adverse event may occur (diagnosed after eliminating other causes) and how it can be handled based on experiences of fellow clinicians.

Supporting staff: The role of health care chaplains

The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020–2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10–30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains’ specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.

Finding Peace Through Recurrent Loss

Finding Peace Through Recurrent Loss L. Emily Cotter I had never felt exhausted on so many levels—emotionally, physically, and professionally. It was a year and a half into the Covid pandemic, [End Page 209] and I had been working as a palliative care physician bearing witness to unspeakable suffering and loss. With the more widespread availability of Covid vaccines, my partner and I decided we were ready to try to have another child. Now we were experiencing our second consecutive miscarriage, and the grief felt immense: my uterus cramping and emptied, my heart shocked and devastated, my mind wearied and numb. It had taken us more than a year to conceive our first child, a young girl who brightened our lives with her smile and infectious joy. Born a few months before the pandemic began, we raised her in an environment we had not envisioned nor hoped for her. Despite what felt like a non-traditional childhood experience, seeing her blossom into a thoughtful human being excited us to think of her one day becoming a big sibling to help love and care for a younger one. After our first positive pregnancy test, I tried to protect my heart, knowing the prevalence of miscarriages and risks we were facing. No attempt at building defenses could shield from the uncertainty that crept in when the first ultrasound showed a length shorter than expected without convincing cardiac activity. Adding insult to injury, I was sent for a formal (and quite expensive) ultrasound to confirm what my heart knew, and then I waited for another clinic referral to discuss options for miscarriage management. I recall only a melancholy joy getting pregnant a few months later—the hope and excitement overtaken by anticipation of recurrent heartbreak. This time, cardiac activity on our first ultrasound provided an opening for optimism, although the embryo was again measuring slightly smaller than expected. Trying to put these thoughts out of my head, I continued to live life in the best way I could: being a mother to our toddler and in service as a physician. I focused my energy on a gratitude practice, thankful for my health and the ability to try to become a mother again. Spotting then appeared and intensified, and once again my heart knew this was not meant to be. While the second miscarriage ended spontaneously, the experience with follow up medical care felt worse than the first. Fellow clinicians provided unsubstantiated and non-evidence based medical advice about waiting for multiple cycles prior to trying again, despite my age and likely dwindling ovarian reserve. Anger crept in for other patients who would not be able to easily fact-check this falsehood and potentially lose precious time if they, like me, were later in their fertility years. Multiple physicians and nurses projected emotions misaligned with my own, frequently entering the room with a version of "you must be [worried/anxious/ nervous]" without an attempt to understand my lived experience. Flippant comments referenced a presumed stress level with an insinuation this was a reason for my pregnancy losses. (While I acknowledge imperfections, I thought I was maintaining a decently well-balanced life raising a thriving toddler despite working as a palliative care provider amid a global pandemic.) I felt disillusioned leaving these medical appointments, embarrassed for my own profession, and alone without medical providers who I could trust to guide me. I had been candid with friends and loved ones discussing life after our first miscarriage, hoping to break the trend of carrying these losses silently. After the second miscarriage, I found it more difficult to invite people in. I could tell close friends that it occurred, but I didn't feel ready to grieve openly. I created distance from people who might ask about my pregnancy while simultaneously feeling abandoned by my own body. It seemed my body had failed, with a cruel twist of irony that after a year of struggling to conceive our daughter, here we were, spontaneously getting pregnant yet not making it past the first trimester. I wanted space to grieve alone but didn't know how to unpack these feelings in moments of protected time when not at...

Exploring the working environment of Hospital Managers: a mixed methods study investigating stress, stereotypes, psychological safety and individual resilience

BackgroundHospital managers are responsible for the delivery of organisational strategy, development of clinical services and maintaining quality standards. There is limited research on hospital managers, in particular how stress manifests and impacts managers and the presence of individual resilience. Managers must work closely with clinical colleagues, however these relationships can be hindered by the perception of stereotyping and differing priorities. This study aimed to explore the working environment of hospital managers, focusing upon the unique stresses faced, psychological safety and the presence of resilience.MethodsThis study utilised mixed methodology using an embedded approach. Participants were purposively recruited from all levels of hospital management within one National Health Service Trust in London, United Kingdom. An exploration of managers experiences was undertaken using semi-structured qualitative interviews. Psychological safety and individual resilience were additionally assessed using validated surveys. Qualitative data were analysed iteratively using inductive thematic analysis, and triangulated with quantitative data. Kruskal-Wallis statistical analysis was performed to evaluate differences in resilience and psychological safety according to seniority and background experience.ResultsTwenty-two managers were recruited and interviewed, with 20 returning completed surveys. Key findings from the thematic analysis included the importance of good working relationships with clinical colleagues, the persistence of some stereotyping, and feeling unsupported in times of challenge. Stresses described included the bureaucracy involved when delivering change, conflict with colleagues and target driven expectations.Participants described their own psychological safety as lower than desired, supported by quantitative data; but recognised its importance and strived to create it within their own teams. Sixteen participants had ‘normal’ scores for resilience, with senior managers more likely to have higher scores than those more junior (p=0.011).ConclusionPositive working relationships, high psychological safety and individual resilience are important for organisational safety and individual wellbeing. Our data illustrate unique stressors faced by hospital managers, provide detail on sometimes challenging working relationships, and demonstrate scope to improve both the psychological safety and resilience of those in managerial positions. A map for senior healthcare leaders was constructed, facilitating the identification of modifiable areas within their organisation to promote good working relationships and improve the working environment of hospital managers.

Smooth Muscle Proliferation in Hamartomatous Polyps Mimicking Prolapse in Pediatric Patients with PTEN Hamartoma Tumor Syndrome

Abstract Introduction/Objective In the field of pediatric pathology, it is vital to find recognize cases that could be associated with cancer predisposition syndromes. PTEN hamartoma tumor syndrome (PHTS) is an inherited set of disorders caused by germline inactivating mutations of the PTEN tumor suppressor gene. In the GI tract, PHTS is associated with hamartomatous polyps that can display smooth muscle overgrowth. We therefore present a series of three cases of colonic polyps with smooth muscle overgrowth, mimicking prolapse, in pediatric patients with PTEN mutations. Methods/Case Report The first case is a 19-year-old male with PHTS who underwent colonoscopy due to hematochezia. Two pedunculated polyps were removed from the transverse and descending colon. Both polyps showed prominent smooth muscle and ganglion cells in the lamina propria. In the second case, a 9-year-old male with PHTS also underwent colonoscopy due to hematochezia. At least 20 sessile 2-4mm polyps were present in the colon. Histology showed smooth muscle proliferation and ganglion cells in the lamina propria. The third case is a 13-year-old male with undiagnosed PHTS, but a history of Chron’s disease, trichilemmoma, and plantar wart like lesions. He underwent upper and lower endoscopy for Chron’s disease assessment. Three polyps were removed from the descending colon. One was a juvenile polyp while the other two showed prominent smooth muscle proliferation and ganglion cells in the lamina propria. Results (if a Case Study enter NA) NA Conclusion Histologically, all hamartomatous polyps had smooth muscle overgrowth, confirmed by SMA immunostain, which could easily be confused with prolapse type changes such as in solitary rectal ulcer syndrome. The key in distinguishing between the two is by recognizing ganglion cells within the lamina propria, confirmed by S100 immunostain. Additional clues include identifying mucosal ganglion cells, disarray of crypt architecture, and fibromuscular proliferation as well as considering the location and number of polyps. It is vital for pathologists to recognize the differential diagnosis of polyps with smooth muscle proliferation, especially in pediatric populations where a diagnosis of cancer predisposition syndromes may not be established. Furthermore, is important to discuss pursuing PTEN genetic testing with clinical colleagues as it has immense medical implications and requires a thorough future medical following.

117. Clinical lessons learned from Translational Molecular Profiling of Cancer and Somatic Disease

Our pediatric, tertiary care institution developed a translational protocol to evaluate the genomic landscape of hematologic disease, solid tumors, and somatic disease among pediatric and adolescent patients. We aim to provide results that refine diagnosis, identify targeted therapeutics, determine eligibility for clinical trials, inform prognosis, and identify germline cancer predisposition. Translational research findings are discussed at multidisciplinary conferences, involving clinicians, pathologists, surgeons, radiologists, radiation oncologists, and genomic medicine. Findings that may impact patient care are confirmed in our CAP-accredited, CLIA-certified clinical lab and reported in the patient medical record. Over four years, 448 patients were nominated onto this protocol, 380 (85%) consented, and 346 (77%) sequenced using paired disease-involved/germline comparator exome sequencing and RNA-sequencing. DNA-based methylation was performed on a subset of solid tumor cases (n=188). Germline findings were identified in 99 (22%) patients, including 9 with Li-Fraumeni syndrome, 6 with neurofibromatosis type 1 (NF1), 5 with rhabdoid tumor predisposition syndrome (RTPS), and 3 with Noonan syndrome. Notably, a diagnosis was established from this translational testing with follow up clinical confirmation and appropriate genetic counseling for 11 (2.5%) individuals (Li-Fraumeni syndrome n=5, Lynch syndrome n=2, schwannomatosis n=2, Noonan syndrome n=2, RTPS n=1, NF1 n=1). Outcome data was captured on 251 (56%) individuals thus far, with refinement/reclassification of diagnosis for 82 (33%) individuals, refinement of treatment for 32 (13%) individuals, and refined prognostication for 66 (26%) individuals. Through multidisciplinary collaboration with a team of clinician colleagues, we demonstrated clinical utility in identifying germline disease and characterization of medically meaningful somatic findings.

Critical conversations on patient blood management with clinical colleagues

Although a subspecialty-trained transfusion medicine (TM) physician brings value to the clinical bedside, hospital transfusion service oversight often falls under the responsibility of pathologists primarily focused on surgical pathology. Yet, pathologists who lack TM fellowship training may not be quite as confident in their role as the TM physician in-charge, especially when the need to communicate with another clinician arises. Given that blood is a resource subject to frequent shortages, there is a need for constant monitoring of blood utilization such that those responsible for transfusion service oversight need to handle challenging clinical interactions when transfusion guidelines are breeched. Generally, the average pathologist is more knowledgeable regarding blood component therapy than other clinician. Yet, disagreements concerning patient transfusion management can arise, in spite of established evidence-based hospital transfusion guidelines. Since authoritative fact stating is not likely to be effective in changing the entrenched practices, pathologists must engage in strategies that will develop meaningful working relationships with their clinical colleagues. Such strategies include being a visible part of direct patient care, such as attendance at patient rounds or provision of mini-consultations by phone regarding transfusion management. Inviting clinicians to attend the hospital transfusion committee meetings and scheduling educational grand rounds are also useful strategies. Clinicians may be more receptive to blood conservation during times of shortages if open communication is established, particularly if hospital leadership is involved in urgent crisis messaging to the clinicians and other hospital staff involved in patient care.

Performance of a vascular anomaly center: a retrospective analysis of 461 cases over seven years.

Vascular malformations are rare diseases that are best managed in multidisciplinary vascular anomaly centers (VAC). So far, there are few published data on the logistic structure, patient allotment, and internal workflow in an interdisciplinary VAC. To demonstrate the referral structure and patient allotment in a European VAC. A retrospective cohort study was conducted. All patients treated in the VAC since its establishment in April 2014 until June 2020 were identified. A total of 461 patients were included in this study. Most often, a venous malformation was diagnosed (49.9%), followed by arteriovenous malformations (8.7%) and syndromal vascular malformations (8.2%). Only 45.1% of referral diagnoses were correct. Of referrals, 35.1% were internal on-campus references, 28.0% were external references through physicians in private practice, and 19.7% came via external cooperating hospitals. Of the patients, 17.1% were self-admissions without a referral. The most important referring clinics are internal medicine, pediatric, and vascular surgery. A substantial proportion of referrals came from private practices. Recruiting these cooperation partners should be considered a high priority when establishing a new VAC. The rate of misdiagnosis is high, and more education of fellow clinicians is urgently needed. Therefore, patients with vascular malformations should be referred to and treated in dedicated centers for vascular anomalies.

The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia

ObjectivesTo examine how characteristics of clinical colleagues influence quality of care.DesignWe conducted a cross-sectional observational study examining the associations between quality of care and a provider’s coworkers, controlling for individual...

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

A new pedagogical approach to enhance palliative care and communication learning: A mixed method study

BackgroundAs palliative care increases in importance due to chronic illnesses in ageing populations, there is a need to develop primary palliative care, including patient-centred communication for nursing graduates. Simulation-based education was adopted to develop students clinical skills and communication in a safer and more controlled environment prior to their clinical practice. However curricula in palliative care and communication remain limited. The current study was to develop a simulation-based programme with clinical modelling prior to the simulation experience. Authentic case scenarios were also constructed through collaboration between the researchers and clinical colleagues in palliative care. ObjectivesTo explore the effects of palliative care simulation-based experience on nursing students' palliative care and caring communication. DesignMixed-methods with pre- and post-questionnaires and focus groups after the simulation-based experience. SettingsA nursing school at a university in Hong Kong. ParticipantsTwenty-nine senior-year undergraduate nursing students. MethodsStudents shadowed senior nurses in a palliative clinical setting, then engaged in simulation learning with two palliative scenarios in a laboratory environment. Focus group debriefings were conducted after the simulations. ResultsQuantitatively, findings from the pre- and post-questionnaires revealed an improvement in the students' knowledge (t = −2.83, p = 0.02), attitudes (t = −4.21, p = 0.00), and efficacy (t = −2.07, p = 0.05) in palliative care after participating in this study. Results from the focus groups also indicated an enhancement in the students' learning of palliative care and communication. ConclusionThis collaborative design of palliative scenarios and clinical shallowing with senior nurses in a palliative care setting followed by simulation enhanced the students' confidence, knowledge, skills, and attitudes in palliative care and communication.

Survey study on the emotional labor of physicians in Korea

Background: Currently, research on emotional labor is increasing. The purpose of this study was to measure the level of emotional labor of Korean physicians and analyze its differences according to the physicians’ individual and group characteristics.Methods: The 2020 Korean Physician Survey was conducted from November 19, 2020, to January 10, 2021, through an online questionnaire. Participants were selected from the member database of the Korean Medical Association by stratified quota sampling. The target population was 57,714, out of which 6,507 participants answered the questionnaire. Out of the 6,507 participants, 5,563 were included for the analysis as they were clinically experienced in patient care.Results: It was found that Korean physicians engaged significantly in emotional labor (average score=70.03). Further, the level of emotional labor was high in women and physicians <40 years of age, as well as in fellow clinicians, physicians in clinic, physicians in private medical institutions, and psychiatrists.Conclusion: Education, legal protection, mandatory holidays, and counseling programs might be necessary to manage the emotional labor of physicians.