Unveiling the burden of COPD: perspectives on a patient-reported outcome measure to support communication in outpatient consultations-an interview study among patients.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) profoundly affects physical, psychological, and social aspects of life, yet these issues often remain unaddressed. Patient-Reported Outcomes Measures (PROM) have the potential to address these issues by promoting person-centered communication. However, their impact in COPD practice remains uncertain. This study aimed to investigate how patients with COPD perceive the usefulness of a new holistic PROM for general palliative care (PRO-Pall) before and during outpatient consultations. Methods: Semi-structured telephone interviews were conducted with patients diagnosed with moderate to very severe COPD, 2-5 days after consultation at a respiratory outpatient clinic in Denmark. Interviews were transcribed verbatim and analyzed inductively using qualitative content analysis. Results: Nine patients (five males; mean age: 66 years) participated in the study with four themes emerging: (1) Unlocking thoughts: Completing PRO-Pall stimulated patients' self-reflection, which revealed previously overlooked COPD-related issues, particularly psychosocial challenges. (2) Unmasking concerns: Patients felt encouraged to be honest, rather than concealing their concerns. (3) Breaking the ice: PRO-Pall responses enabled direct questioning by healthcare professionals during consultations, initiating discussions on patients' sensitive yet vital COPD-related matters. (4) Deepening the dialogue: Healthcare professionals' targeted and attentive approach fostered more holistic and meaningful discussions, providing most patients with a deeper understanding of psychosocial issues affecting their well-being. Conclusion: Completing PRO-Pall prior to outpatient consultations prompted most patients with COPD to unveil previously unacknowledged psychosocial challenges. During consultations, addressing these challenges initiated open discussions on individual concerns, enhancing most patients' understanding of the multifaceted burden of COPD.

Vascular medicine in the 21st century: Embracing comprehensive vasculature evaluation and multidisciplinary treatment.

The field of vascular medicine has undergone a profound transformation in the 21st century, transforming our approach to assessment and treatment. Atherosclerosis, a complex inflammatory disease that affects medium and large arteries, presents a major challenge for researchers and healthcare professionals. This condition, characterized by arterial plaque formation and narrowing, poses substantial challenges to vascular health at individual, national, and global scales. Its repercussions are far-reaching, with clinical outcomes including ischemic heart disease, ischemic stroke, and peripheral arterial disease-conditions with escalating global prevalence. Early detection of vascular changes caused by atherosclerosis is crucial in preventing these conditions, reducing morbidity, and averting mortality. This article underscored the imperative of adopting a holistic approach to grappling with the intricacies, trajectories, and ramifications of atherosclerosis. It stresses the need for a thorough evaluation of the vasculature and the implementation of a multidisciplinary treatment approach. By considering the entire vascular system, healthcare providers can explore avenues for prevention, early detection, and effective management of this condition, ultimately leading to improved patient outcomes. We discussed current practices and proposed new directions made possible by emerging diagnostic modalities and treatment strategies. Additionally, we considered healthcare expenditure, resource allocation, and the transformative potential of new innovative treatments and technologies.

Information sampling differences supporting superior face identity processing ability.

Face recognition in humans is often cited as a model example of perceptual expertise that is characterized by an increased tendency to process faces as holistic percepts. However emerging evidence across different domains of expertise points to a critical role of feature-based processing strategies during the initial encoding of information. Here, we examined the eye-movement patterns of super-recognisers-individuals with extremely high face identification ability compared with the average person-using gaze-contingent "spotlight" apertures that restrict visual face information in real time around their point of fixation. As an additional contrast, we also compared their performance with that of facial examiners-highly trained individuals whose superiority has been shown to rely heavily on featural processing. Super-recognisers and facial examiners showed equivalent face matching accuracy in both spotlight aperture and natural viewing conditions, suggesting that they were equally adept at using featural information for face identity processing. Further, both groups sampled more information across the face than controls. Together, these results show that the active exploration of facial features is an important determinant of face recognition ability that generalizes across different types of experts.

Face and content validity of a holistic assessment questionnaire to assess cancer-related fatigue after breast cancer.

Background and objective: Cancer-related fatigue (CRF) affects the quality of life after breast cancer. In a previous study, we developed a 72-item questionnaire that assesses CRF from a holistic point of view; named the Holistic Assessment of CRF (HA-CRF) questionnaire. The current study assessed the face and content validity of the HA-CRF questionnaire. Methods: Using a mixed-method approach, ten breast cancer survivors (BCS) did a cognitive walkthrough of the HA-CRF via an app followed by a semi-structured interview about relevancy and essentiality (qualitative). In addition, ten health care professionals (HCPs) assessed the relevancy, clarity, and essentiality of each item via a questionnaire (quantitative). Results: BCS indicated minor textual improvement for four items and six items were not completely clear. The app was considered easy to use and the HC-CRF was on average completed in 18 minutes. The HA-CRF questionnaire provided openness about fatigue and gave the feeling of being heard. The items were helpful and induced self-awareness. HCPs indicated 71% of items being very clear or minor revisions proposed by the minority, with 64% of items being essential and 92% considered relevant. Conclusions: The HA-CRF showed good face and excellent content validity. Further research is needed to assess its ability to monitor in daily life.

A roadmap to knowledge-based maritime spatial planning.

The Cells of Ecosystem Functioning are natural units of management and conservation, allowing for an ecosystem-based maritime spatial planning based on an accurate knowledge of marine biodiversity and ecosystem functioning which, however, is presently insufficient and fragmentary. A five-step roadmap to fill current knowledge gaps and make ecosystem-based marine sustainability possible is proposed: Step 1: make the inventory of biodiversity. Step 2: unveil the roles of species. Step 3: understand the ecological relationships that link species with each other and with the physical environment. Step 4: frame marine biodiversity and ecosystem functioning in a five dimensional spatial and temporal context (the Cells of Ecosystem Functioning). Step 5: plan our activities so as to preserve a healthy state of ecosystems. EU legislation has drawn a careful map to guide us along this road, with a series of directives that, if successfully enforced, will be conducive to knowledge-based marine sustainability.

An Overview of the Naturopathic Medicine Protocol Used in Inpatient Yoga and Naturopathy Hospitals in India: The Prakriti Shakti Protocol.

Naturopathic medicine is a popular form of complementary and alternative medicine systems practiced worldwide. This study provides an overview of a typical inpatient yoga and naturopathy protocol followed in India. Naturopathic medicine is commonly used in the management of certain lifestyle-related disorders, such as diabetes mellitus, hypertension, obesity, cancer, musculoskeletal disorders, endocrine disorders, and neurological disorders. Moreover, naturopathic medicine integrates different lifestyle medicine practices, such as yoga, diet, acupuncture, hydrotherapy, and color therapy into its treatment plans. Moreover, India is one of the few countries that offer naturopathy treatments through inpatient hospitals. Although the clinical efficacy of naturopathic medicine practices in various pathological conditions has been confirmed, no studies have yet investigated the effectiveness of naturopathic medicines protocols in naturopathic inpatient settings. Naturopathic physicians use a set of philosophical principles when determining their therapeutic order and all therapies that upregulate physiological homeostasis.

The role of transitional probabilities in word holistic processing.

In recent years, increased attention has been devoted to visual word recognition under a perceptual expertise framework. Because the information required to identify words is distributed across the word, a holistic attentional strategy is optimal and develops with experience. It is, however, an open question the extent to which other information embedded in a word may contribute to word holistic processing, namely sublexical word properties. In the present research, we therefore explore the role of sublexical properties-specifically bigram transition probabilities-in this processing strategy. We used a common task in the holistic processing literature (i.e., composite task) and four-letter disyllabic words, where two of the bigrams reinforce the cohesiveness of each syllable and one of the bigrams reinforces the cohesiveness between the syllables. We found preliminary evidence of a role of these sublexical properties in word holistic processing.

Evaluating the Perceived Value of Holistic Certification Among Nurses: A Descriptive Survey Study.

Purpose: Specialty nursing certifications serve as a validation of nursing knowledge in specific areas. Holistic nursing emphasizes comprehensive patient care and incorporates complementary alternative modalities (CAM) into daily care. Despite its significance, limited research has evaluated the perceived value of holistic nursing certification among nurses. Study Design: Descriptive survey design. Methods: The Likert-scale survey Perceived Value of Certification (PVCT)-12 Tool was given to holistic certified and non-certified nurses at a large, academic Magnet hospital in the northeast United States from 10/2022 to 2/2023. Additionally, non-certified nurses were asked to select the top three barriers to certification from a list of nine. The responses between certified and non-certified nurses were compared using the Chi-square test, Fisher's exact test, or Student's t-test as appropriate. Findings: A total of 59 nurses (25 certified, 34 non-certified) met inclusion criteria. Ninety-six percent of certified nurses versus 64.7% of non-certified nurses agreed that certification demonstrates a commitment to the nursing profession, p = 0.004, but, otherwise, responses to the PVCT-12 Tool were similar. Both groups felt certification was more strongly associated with intrinsic factors (e.g., sense of accomplishment) than extrinsic factors (e.g., salary). Conclusion: Nurses were consistent in their perceived value of holistic certification, regardless of their certification status.

Nurses' justifications for morally courageous acts in ethical conflicts: A narrative inquiry.

Background: Moral courage is defined as the courage to act in ethical conflicts based on individual or professional values despite the personal risks involved. Nurses justify their decisions to act morally courageously as part of their ethical decision-making. Objective: To describe registered nurses' justifications for acting morally courageously, or not, in ethical conflicts where they needed moral courage. Research design: A narrative inquiry with a holistic content approach was used. Individual, in-depth interviews were conducted in January-February 2023. The data were analysed using holistic content analysis. Participants and research context: Fourteen registered nurses with experience in situations where they needed moral courage participated. The nurses came from the somatic, palliative, mental health, and substance abuse care fields in Finland. Ethical considerations: Good scientific practice was followed. Ethical approval was obtained before data collection from the university's ethics committee. Findings: The nurses needed moral courage in ethical conflicts with patients present and between professionals. Individual responsibility, professional ethics, and emotions were identified as bases of nurses' justifications for morally courageous acts. The justifications for acting morally courageously, or not, had individual, contextual, and organisational perspectives. Morally courageous acts included starting a discussion about the conflict with other professionals and reporting the situation in writing within one's organisation. Discussion and conclusions: The identified bases and perspectives of justifications illustrate the complexity of nurses' decision-making in ethical conflicts, either leading to morally courageous acts or not. These results can inform nursing practice and research in developing processes to strengthen nurses' moral courage and examining relationships between moral courage and other concepts, such as moral resilience.

Improving Hurricane Preparedness Among Galveston County Older Adults: Description of a Successful Community-Based Quality Improvement Model.

Older adults are at high risk of experiencing injury, exacerbations of their chronic conditions, and death when evacuations are ordered because of hurricanes or natural disasters. The Homebound seniors residing in Galveston County are at a particularly high risk of morbidity and mortality during evacuations for hurricanes. This paper described the impact of a quality improvement intervention designed and implemented by nurse practitioners during the 2022 and 2023 hurricane season. The education program aimed at increasing the hurricane preparedness of the home-bound patients. Of these patients, 190 returned pre and post surveys. Interventions showed a 43% increase in patients having an evacuation plan in the event of a hurricane, 633% increase in STEAR registration, 16% increase in patients having access to emergency supplies, and 34% increase in patients having an emergency contact list with up-to-date medication list. All improvements on hurricane preparedness items were significant (p < .0001) except for the need for assistance in case of an evacuation. Our findings suggest a need for continuous hurricane preparedness education in the community to ensure safe evacuation, improve hurricane preparation, and increase the number of seniors who registered with the State of Texas Emergency Assistance Registry.

Transepithelial transport of nanoparticles in oral drug delivery: From the perspective of surface and holistic property modulation.

Despite the promising prospects of nanoparticles in oral drug delivery, the process of oral administration involves a complex transportation pathway that includes cellular uptake, intracellular trafficking, and exocytosis by intestinal epithelial cells, which are necessary steps for nanoparticles to enter the bloodstream and exert therapeutic effects. Current researchers have identified several crucial factors that regulate the interaction between nanoparticles and intestinal epithelial cells, including surface properties such as ligand modification, surface charge, hydrophilicity/hydrophobicity, intestinal protein corona formation, as well as holistic properties like particle size, shape, and rigidity. Understanding these properties is essential for enhancing transepithelial transport efficiency and designing effective oral drug delivery systems. Therefore, this review provides a comprehensive overview of the surface and holistic properties that influence the transepithelial transport of nanoparticles, elucidating the underlying principles governing their impact on transepithelial transport. The review also outlines the chosen of parameters to be considered for the subsequent design of oral drug delivery systems.

Sending a Signal: Evaluating the Impact of Program and Geographic Preference Signaling on the Internal Medicine Residency Match.

Background For over a decade, the number of residency applications has surged, a trend known as "application inflation." COVID-19 further intensified this trend, leading the Association of American Medical Colleges (AAMC) to address the issue by introducing a supplemental application in the 2021-2022 cycle, allowing programs to identify applicants with a connection to their program or geographic region. For the 2022-2023 cycle, the number of program signals increased from five to seven. The impact of the supplemental application and the increase in signals on the likelihood of an applicant matching with a program has yet to be evaluated. Methods This retrospective cohort study evaluated the impact of program signaling and geographic preference on the matching likelihood in our internal medicine residency program. Data from MyERAS® and the Supplemental Application for 640 applicants who applied to our large, urban, university-based program in the Southeastern United States during the 2020-2021 and 2022-2023 application cycles were included. Using univariate and multivariate analysis, we examined the correlation between program signal, geographic preference, and final match location. Results Applicants who sent a program signal had nearly three-fold higher odds of matching with our program. Geographic preference was numerically but not statistically associated with higher odds of matching. Both signaling a preference for matching with a program in an urban environment and couples matching correlated with decreased odds of matching with our program. Geography was an important predictor of match location as residing in our AAMC geographic region, our four-state area, and our specific state had increased odds of matching with our program. Conclusions Signaling our program was associated with increased odds of matching with our program. Geographic preferences were less predictive of a match with our program; however, they did predict the likelihood of a match at a program within that region. Future studies are needed to ensure external validity.

Nursing students' attitudes and beliefs towards addressing sexual health: A multicentre study and latent class analysis.

BACKGROUND: To provide competent and respectful sexual health care, a critical and comprehensive assessment of students' attitudes towards sexuality is needed, which implies using reliable and valid questionnaires. AIM: To assess whether the extended version of the Students Attitude Towards Addressing Sexual Health (SA-SH-Ext) provides different, additional information about students' attitudes towards providing sexual healthcare compared to the Sexual Attitude and Beliefs Survey (SABS), to explore SA-SH-Ext potential response patterns through latent class analysis and to assess students' attitudes towards providing sexual healthcare and evaluate the differences in their attitudes to the cultural background and sociodemographic characteristics. DESIGN: Multicentre, descriptive, analytical, comparative, and correlational cross-sectional study at three nursing faculties. PARTICIPANTS: Nursing students n = 514 (Serbia n = 180, Poland n = 150 and Lithuania n = 184). METHODS: A general questionnaire for obtaining sociodemographic data, SA-SH-Ext and SABS were used as students' report measures. RESULTS: One part of the variance of each instrument does not overlap with the other, indicating that these instruments, in addition to the shared variance, provide different, additional information. A solution with three latent classes was found in the domain of responses to the SA-SH-Ext items. The response pattern placed nursing students in the class Comfortable and prepared in some situations, and the SABS score revealed students' moderately positive attitudes towards providing sexual healthcare. Significantly more conservative attitudes were demonstrated by students from Poland, those identifying their religious affiliation as Catholic and females, while first-year students showed more positive attitudes than those in later years of study. CONCLUSIONS: The SA-SH-Ext and SABS enable a reliable and quick assessment of nursing students' comfort and competence in providing sexual healthcare. However, the differences in students' attitudes towards sexuality concerning belonging to a specific group imply a need for curriculum redesign and facilitating students to be more open to communication about sexuality with people with mental illnesses and intellectual and physical disabilities.

Effects of grading rubrics on EFL learners' writing in an EMI setting.

Despite considerable evidence that supports the use of grading rubrics (GRs) as tools for written corrective feedback, there is a paucity of research that investigates which of the different types of GRs best develops learners' International English Language Testing System (IELTS) writing scores in English as a medium of instruction (EMI)-contested settings. This study attempted to explore which rubric types (i.e., holistic, ESL composition profile, correction code, and IELTS) best assist English as a Foreign Language (EFL) learners in writing proficiency and which type leads to improving IELTS scores when such practice is embedded in EMI-disputed settings. Therefore, 351 male and female Saudi EFL learners were recruited to participate voluntarily. These participants were distributed equally among four groups corresponding to rubric type. For almost four months, the participants were exposed to a process-genre approach in which they were required to draft topics based on the comments received from their peer colleagues and teacher. The comments provided depended on the rubrics specified for their group type. The participants' pretest, midterm, and posttest scores were analyzed using one-way analysis of variance, t-tests, and paired samples t-tests. The results revealed that the ESL composition profile developed gradually, followed by the correction code group. However, the holistic groups did not improve. The tests were also assessed by specialists using the IELTS rubric. The findings revealed that the IELTS groups outperformed the other groups in all tests, followed by the female group in the ESL composition profile in the posttest. Meanwhile, other groups failed to improve. We discussed the results, considering the importance of GRs for improving EFL learners' scores. Finally, we outlined the pedagogical implications for writing teachers in EMI settings. This study aimed to contribute to the growing research on EMI in relation to GRs, especially in the context of tertiary education in Saudi Arabia.

Changing the narrative: Addressing American Indian/Alaska Native mental health needs through academic holistic support.

American Indian/Alaska Natives (AIAN) have some of the highest health disparities and poorest outcomes of all racial or ethnic minority groups in the United States. Across all age groups, suicide is 2.5 times higher in AIANs than the national average (National Indian Council on Aging, 2019). Cultural and institutional barriers prevent AIAN undergraduate and graduate college students from seeking mental health services, and many serious mental health problems remain untreated. While numerous barriers to mental health services exist for AIAN students, Indigenous faculty and support staff who share deep understanding of history, culture and traditional view of health and wellness can reduce the barriers and promote mental health and wellness for students. Shifting the focus to introduce a new narrative gives way to greater recognition of factors that create health and may help academic institutions provide holistic support for AIAN and other underrepresented students. The new narrative includes holistic strength-based support, social support, and fostering cultural identity and pride enhances mental health and success. Indigenization of the doctoral nursing curriculum supports faculty who are committed to decolonizing course content and institutionalized pedagogy. Improved health outcomes for Indigenous individuals and other underrepresented students will positively affect communities through increasing diversity of APRNs, nursing faculty, and nursing scholars.

Advancing trauma studies: A narrative literature review embracing a holistic perspective and critiquing traditional models.

Background: Trauma is commonly understood as a psychological and emotional response to distressing events. The subjective nature of trauma experiences has led to ongoing debates about the best theoretical frameworks for understanding and addressing trauma. This review aims to comprehensively critique traditional biomedical and psychological models and advocates for more inclusive and culturally sensitive frameworks. Methods: A narrative literature review was conducted, synthesizing data from 96 peer-reviewed journal articles, books, and authoritative reports from databases such as PubMed, PsycINFO, and Google Scholar. The review focused on studies related to trauma, post-traumatic stress disorder (PTSD), complex trauma, and related disorders, emphasizing both individual and socio-cultural aspects. Results: The review identifies several key criticisms of trauma models. For biological models, critiques include the oversimplification of trauma experiences, insufficient developmental considerations, failure to capture diverse trauma responses, limited cultural sensitivity, and inadequacy of the categorical approach. For psychological models, criticisms encompass an overemphasis on internal processes, neglect of developmental impacts, limited focus on symptom diversity, challenges in addressing socio-cultural contexts, and incomplete integration of emotional and relational aspects. These findings underscore the need for more comprehensive, culturally sensitive, and developmentally informed trauma frameworks. Conclusion: The findings emphasize the importance of adopting a holistic perspective in trauma research and treatment. By integrating individual, interpersonal, and socio-cultural dimensions, future research and interventions can better support trauma survivors. This approach necessitates ongoing interdisciplinary collaboration and the inclusion of diverse voices, including those of trauma survivors, to refine current methodologies and enhance therapeutic outcomes.

Imaging biobanks: operational limits, medical-legal and ethical reflections.

The extraordinary growth of health technologies has determined an increasing interest in biobanks that represent a unique wealth for research, experimentation, and validation of new therapies. "Human" biobanks are repositories of various types of human biological samples. Through years the paradigm has shifted from spontaneous collections of biological material all over the world to institutional, organized, and well-structured forms. Imaging biobanks represent a novel field and are defined by European Society of Radiology as: "organized databases of medical images, and associated imaging biomarkers shared among multiple researchers, linked to other biorepositories". Modern radiology and nuclear medicine can provide multiple imaging biomarkers, that express the phenotype related to certain diseases, especially in oncology. Imaging biobanks, not a mere catalogue of bioimages associated to clinical data, involve advanced computer technologies to implement the emergent field of radiomics and radiogenomics. Since Europe hosts most of the biobanks, juridical and ethical framework, with a specific referral to Italy, is analyzed. Linking imaging biobanks to traditional ones appears to be a crucial step that needs to be driven by medical imaging community under clear juridical and ethical guidelines.

Impact of Holistic Application Scoring on Interview Offers.

OBJECTIVE: We aimed to develop a holistic screening tool for surgical residency application processing to capture the diverse skills and attributes of the applicant, based on characteristics most commonly associated with success in our residency program. DESIGN: We developed an application-scoring rubric with 4 domains based on ACGME Holistic reviewing criteria: academic potential, experiences, personal attributes, and clinical competency. We scored academic potential based on a composite of Step 2 score, MSPE tier rank, surgery clerkship grade, college honors, publications, and presentations. An additional score accounted for personal adversity overcome or "distance travelled". This included previous homelessness, first-generation college student or immigrant status, noted socioeconomic hardship, disability overcome, or other stated personal experience of discrimination including underrepresented in medicine status. We sorted the list of top 200 candidates by adversity score, Step 2 score, academic potential score, and total overall score to compare the groups in terms of interview offers. SETTING: We are an academic surgical residency program housed within a private medical college in the Northeast region. PARTICIPANTS: All categorical applicants to our program were managed with our holistic screening approach. RESULTS: There were 29 students with the highest adversity score (AS) of 4 and 26 (90%) were selected to interview based on holistic overall score and reviewer comments. Fourteen students had an AS of 3, and 12 (86%) were selected to interview. Twenty-five students had an AS of 2, and 23 (92%) were selected to interview. If Step 2 score alone had been used to determine which applicants should be interviewed, only 11 students (38%) with an AS of 4 would have been interviewed. If the academic potential alone was used for screening, only 10 (35%) of students with an AS of 4 would have been interviewed. Taking all students with any adversity score into account (n = 70), when screened with only Step 2 scores, just 31(44%) would have been interviewed. When ranked by academic potential score, 35 (50%) would have been interviewed. When applying our holistic overall score alone, 56 (80%) would have been interviewed. CONCLUSIONS: Performing a holistic application review and ranking students not only by standardized exam scores, but also considering other history of academic achievement, personal attributes, experiences in leadership or service, and clinical competency can allow for mitigation of implicit bias. Allowance for an adversity score can help programs recognize students who have significantly longer "distance traveled" to make it through medical education and who have the potential to be fantastic residents.

Clinical and socio-demographic profile of children receiving pediatric palliative care in a tertiary hospital of a metropolitan city in India.

Pediatric palliative care is a holistic care of children suffering from life-threatening or life-limiting illnesses and encompasses care of a child's body, mind, and spirit and involves giving support to the family. According to the Global Atlas of Palliative Care, 6% of the global need for palliative care is in children. In order to provide palliative care, one needs to identify and diagnose the conditions requiring palliative care. There has always been a confusion in identifying pediatric conditions requiring palliative care. There is a lot of inconsistency in the diagnosis of such conditions particularly in pre-verbal patients. This study attempts to generate more data about the common palliative care conditions and complaints with which the children present to tertiary care hospitals. To study the socio-demographic details, clinical profile, CCC (complex chronic conditions) designation, and the ACT/ RCPCH (Association for Children with Life-threatening or Terminal Conditions and the Royal College of Pediatrics and Child Health) classification of children suffering from chronic conditions requiring palliative care. The study was conducted as a single-center retrospective observational study of pediatric patients enrolled for palliative care at a tertiary care hospital in a metropolitan city in India from 01.06.2021 to 31.06.2022. The total sample size was 400. The socio-demographic data and the clinical profile were recorded from the case records of all the 400 patients. Classification of the conditions was done as per the CCC as well as the ACT/ RCPCH classification system. The mean age in our study was 5.15 years and there was a slighter male (59.5%) preponderance. They presented in OPDs with acute symptoms such as fatigue and fever, and they had other symptoms like tightness of the body, constipation, seizures, and difficulty in swallowing. Majority of the children (55%) were suffering from neurologic and neuromuscular conditions as per CCC followed by hematologic and immunologic conditions (10%). Category 4 (irreversible but non-progressive conditions causing severe disability, leading to susceptibility to health) was reported as the most common category according to the ACT/RCPCH.    Conclusion: Children suffering from chronic disease conditions requiring palliative care usually suffer from multiple symptoms which affect their daily life. As most of the patients belong to category 4 according to ACT/RCPCH which is an irreversible but non-progressive life-limiting condition, the course of the disease is prolonged, therefore requiring comprehensive care and services for a long time. It is necessary to establish more pediatric palliative care units to address the needs of such children. What is known: • Pediatric palliative care is a specialized area within palliative care, which focusses on the needs of children with life-limiting illnesses. • Data on pediatric palliative care has largely been limited to oncological conditions. There is a paucity of literature documenting the needs among children suffering from non-cancerous chronic conditions. What is new: • This study provides vital information with respect to palliative care burden among children mainly suffering from non-oncological conditions. • It also provides clinical and socio-demographic profile of the children suffering from chronic life-limiting conditions requiring palliative care in a tertiary hospital setting in a LMIC (low- or middle-income country).

System Innovation: A Holistic Approach to Disrupting With Love and Human Caring, by Julie Kennedy Oehlert and Kathleen Sitzman.

The bright vision presented by this book provides an invigorating push to bring out the inner anarchist hidden in even the most complacent of health professionals. This book renews the ongoing discussion of how theory-driven change can be used to ground and promote the integration of love and human caring into system innovation. Each chapter of this book provides concrete and realistic application strategies to front-line practice and gives intensive guidance on how to linguistically and intellectually challenge the barriers within an organization that can undermine a vision of holistic caring. For leaders of teams, this book provides invaluable tools to build a culture of caring and maintain a team that perceives caring from both leadership and the organization as a whole. For team members, this book is a reminder that an expectation of workplace culture that is positive, supportive, and fosters growth is not out of reach; it simply has yet to be implemented within their system.