The effect of guided group reflection on the ability and convenience of breaking bad news in pre-hospital emergency staff.

BACKGROUND: Bad news refers to any information that create negative changes in a person's understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff. METHODS: This quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18. RESULTS: The mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001). CONCLUSION: According to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN.

"I couldn't say goodbye": Thematic analysis of interviews with bereaved relatives who lost their loved ones during the COVID-19 pandemic.

BACKGROUND: Delivering serious news is usually challenging for healthcare professionals and the pandemic of COVID-19 and related restrictions brought additional challenges in this process. AIMS: To explore the experience of bereaved relatives with receiving serious news from healthcare professionals during the pandemic COVID-19. DESIGN: A qualitative study using thematic analysis and a codebook approach of data collected in semi-structured interviews with bereaved relatives. SETTING/PARTICIPANTS: Data were collected from July to August 2022 in person/via phone with bereaved relatives who lost their relatives during the pandemic (from March 2020 to March 2022). Participants were recruited using a convenience sample and snowball method through social media and through one university hospital palliative care unit that invited bereaved relatives of deceased patients treated at the unit to participate in this study. RESULTS: A total of 22 participants, consisting of 4 men and 18 women, were interviewed for this study. Most of the participants were sons or daughters of individuals who had died (5 grandchildren, 14 sons/daughters, 2 spouses, 1 great-niece). Six themes were identified: Burden caused by visit ban, Fear of COVID-19, Inappropriate behaviour and communication of healthcare professionals, High need for emotional support, Need for detailed and honest communication, Tendency to make excuses for mistakes and lapses by healthcare professionals. CONCLUSIONS: Delivering serious news during a pandemic was negatively influenced by a lack of contact with patients and a lack of support and empathetic communication with staff. Overcoming these circumstances can be achieved by frequent communication using various communication tools (such as videoconferences or phone calls), and maintaining empathy and honesty in the communication process.

How to break the news in amyotrophic lateral sclerosis/motor neuron disease: practical guidelines from experts.

In amyotrophic lateral sclerosis/motor neuron disease (ALS/MND), it is necessary to communicate difficult news during the initial diagnosis and throughout the disease trajectory as the condition progresses. However, delivering difficult news to people with ALS/MND is an emotionally demanding task for healthcare and allied health professionals-one for which many feel ill-prepared because of limited training in this area. Ineffective communication of difficult news damages the patient-provider relationship and negatively impacts patient quality of life (QoL). To address this issue, we developed the A-L S-PIKES protocol based on available literature and our extensive clinical experience. It provides easy-to-follow, stepwise guidelines to effectively deliver difficult news to people with ALS/MND (PALS) that includes: Advance Preparation (preparing for the discussion logistically and emotionally); Location & Setting (creating a comfortable setting that fosters rapport); Patient's Perceptions (assessing PALS' understanding and perception of their condition); Invitation (seeking PALS' permission to share information); Knowledge (sharing information in a clear, understandable manner); Emotion/Empathy (addressing emotions with empathy and providing emotional support); and Strategy & Summary (summarizing the discussion and collaboratively developing a plan of action). A-L S-PIKES provides practical guidelines on how to prepare for and conduct these challenging conversations. It emphasizes effective communication tailored to the individual needs of PALS and their families, empathy, sensitivity, and support for PALS' emotional well-being and autonomy. The aim of A-L S-PIKES is to both enhance skills and confidence in delivering difficult news and to improve the QoL of PALS and their families. Future studies should systematically evaluate the feasibility and effectiveness of A-L S-PIKES to establish its utility in clinical practice.

Rational design of ROS scavenging and fluorescent gold nanoparticles to deliver siRNA to improve plant resistance to Pseudomonas syringae.

Bacterial diseases are one of the most common issues that result in crop loss worldwide, and the increasing usage of chemical pesticides has caused the occurrence of resistance in pathogenic bacteria and environmental pollution problems. Nanomaterial mediated gene silencing is starting to display powerful efficiency and environmental friendliness for improving plant disease resistance. However, the internalization of nanomaterials and the physiological mechanisms behind nano-improved plant disease resistance are still rarely understood. We engineered the polyethyleneimine (PEI) functionalized gold nanoparticles (PEI-AuNPs) with fluorescent properties and ROS scavenging activity to act as siRNA delivery platforms. Besides the loading, protection, and delivery of nucleic acid molecules in plant mature leaf cells by PEI-AuNPs, its fluorescent property further enables the traceability of the distribution of the loaded nucleic acid molecules in cells. Additionally, the PEI-AuNPs-based RNAi delivery system successfully mediated the silencing of defense-regulated gene AtWRKY1. Compared to control plants, the silenced plants performed better resistance to Pseudomonas syringae, showing a reduced bacterial number, decreased ROS content, increased antioxidant enzyme activities, and improved chlorophyll fluorescence performance. Our results showed the advantages of AuNP-based RNAi technology in improving plant disease resistance, as well as the potential of plant nanobiotechnology to protect agricultural production.

Novel Gene Therapy Approaches for Targeting Neurodegenerative Disorders: Focusing on Delivering Neurotrophic Genes.

Neurodegenerative illnesses (NDDs) like Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, spinal muscular atrophy, and Huntington's disease have demonstrated considerable potential for gene therapy as a viable therapeutic intervention. NDDs are marked by the decline of neurons, resulting in changes in both behavior and pathology within the body. Strikingly, only symptomatic management is available without a cure for the NDDs. There is an unmet need for a permanent therapeutic approach. Many studies have been going on to target the newer therapeutic molecular targets for NDDs including gene-based therapy. Gene therapy has the potential to provide therapeutic benefits to a large number of patients with NDDs by offering mechanisms including neuroprotection, neuro-restoration, and rectification of pathogenic pathways. Gene therapy is a medical approach that aims to modify the biological characteristics of living cells by controlling the expression of specific genes in certain neurological disorders. Despite being the most complex and well-protected organ in the human body, there is clinical evidence to show that it is possible to specifically target the central nervous system (CNS). This provides hope for the prospective application of gene therapy in treating NDDs in the future. There are several advanced techniques available for using viral or non-viral vectors to deliver the therapeutic gene to the afflicted region. Neurotrophic factors (NTF) in the brain are crucial for the development, differentiation, and survival of neurons in the CNS, making them important in the context of various neurological illnesses. Gene delivery of NTF has the potential to be used as a therapeutic approach for the treatment of neurological problems in the brain. This review primarily focuses on the methodologies employed for delivering the genes of different NTFs to treat neurological disorders. These techniques are currently being explored as a viable therapeutic approach for neurodegenerative diseases. The article exclusively addresses gene delivery approaches and does not cover additional therapy strategies for NDDs. Gene therapy offers a promising alternative treatment for NDDs by stimulating neuronal growth instead of solely relying on symptom relief from drugs and their associated adverse effects. It can serve as a long-lasting and advantageous treatment choice for the management of NDDs. The likelihood of developing NDDs increases with age as a result of neuronal degradation in the brain. Gene therapy is an optimal approach for promoting neuronal growth through the introduction of nerve growth factor genes.

Delivering Serious News in Pediatric Cardiology-A Pilot Program.

Pediatric cardiology fellows receive limited training on delivering serious news. This is a teachable skill through simulation-based communication. While studies have shown the use of communication courses in pediatrics, there have been none in pediatric cardiology. Pediatric cardiologists recognize the importance of good communication and desire further development of these skills. Based on an internal needs assessment, three cases were developed; fetal hypoplastic left heart syndrome, teenager with new hypertrophic cardiomyopathy, and young-adult with Fontan failure. A 4-h simulation course using evidence-based methods to teach delivering serious news was designed, consisting of a didactic session, case demonstration and small group case-based encounters with simulated patients. Trainees completed standardized pre/post-course surveys to assess perception of skill and preparedness. Paired survey responses were compared. Six pediatric cardiology fellows participated. Only 33% had received formal training in delivering serious news and 17% in techniques of responding to patient's emotions. The proportion of participants who felt good about their ability to deliver serious news and deal with a family's emotions increased from 0 to 83%. The proportion of participants who felt prepared to provide serious news about a patient's illness increased from 17 to 67%. Given the small number of participants, results were not statistically significant. All participants felt that the course was valuable in improving communication skills. A formal communication course increased perception of skill and preparedness among trainees. We provide an evidence-based framework and clinical cases for delivering serious news in pediatric cardiology, which is generalizable to other training programs.

Fluid Balance in Continuous Renal Replacement Therapy: Prescribing, Delivering, and Review.

BACKGROUND: Historically IV and enteral fluids given during acute kidney injury (AKI) were restricted before the introduction of continuous renal replacement therapies (CRRTs) when more liberal fluids improved nutrition for the critically ill. However, fluid accumulation can occur when higher volumes each day are not considered in the fluid balance prescribing and the NET ultrafiltration (NUF) volume target. KEY MESSAGES: The delivered hours of CRRT each day are vital for achievement of fluid balance and time off therapy makes the task more challenging. Clinicians inexperienced with CRRT make this aspect of AKI management a focus of rounding with senior oversight, clear communication, and "precision" a clinical target. Sepsis-associated AKI can be a complex patient where resuscitation and admission days are with a positive fluid load and replacement mind set. Subsequent days in ICU requires fluid regulation, removal, with a comprehensive multilayered assessment before prescribing the daily fluid balance target and the required hourly NET plasma water removal rate (NUF rate). Future machines may include advanced software, new alarms - display metrics, messages and association with machine learning and "AKI models" for setting, monitoring, and guaranteeing fluid removal. This could also link to current hardware such as on-line blood volume assessment with continuous haematocrit measurement. SUMMARY: Fluid balance in the acutely ill is a challenge where forecasting and prediction are necessary. NUF rate and volume each hour should be tracked and adjusted to achieve the daily target. This requires human and machine connections.

Study of the self-assembly, drug encapsulating and delivering characteristics of short chain amylose-based type 3 resistant starch nanoparticles from Canna edulis.

In developing type 3 resistant starch (RS3) from Canna edulis for use as functional food ingredients, we investigated the synthesis of C. edulis RS3 nanoparticles. Simultaneously, we explored the potential of C. edulis short-chain amylose (SCA)-based RS3 nanoparticles (RS3N) as a targeted delivery system, with a specific focus on colon targeting, yielding promising insights. Our study revealed that the degree of polymerization (DP) of C. edulis SCA, particularly the chains of DP 36- 100, exhibited a robust correlation with the particle size and physicochemical characteristics of C. edulis SCA-based RS3N. Additionally, recrystallization temperature variation (4, 25, and 45 °C) significantly influenced the self-assembly behavior of C. edulis SCA, with the preparation at 4 °C resulting in more uniform particle size distributions. In further expanding the scope of applications for C. edulis SCA-based RS3N, we harnessed the potential of Fe3O4 and curcumin (CUR) as guest molecules to assess drug encapsulation and colon-targeting capabilities. Incorporating Fe3O4 into the self-assembly system led to the production of magnetic RS3N, confirming the successful encapsulation of Fe3O4 within C. edulis SCA-based RS3N. Furthermore, in vitro experiments have demonstrated that CUR-RS3N was stable in the gastrointestinal tract and gradually released curcumin with fermentation in the colonic environment. Collectively, these findings provide invaluable insights into the intricate self-assembly behavior of C. edulis SCA with varying fine structures and recrystallization temperatures during RS3N formation. Moreover, they underscore the colon-targeted properties of C. edulis SCA-based RS3N, opening promising avenues for its application within the food industry, particularly in advanced controlled drug delivery systems.

The Need for Protocol-Based Training in Delivering Bad News in Dentistry: A Cross-Sectional Survey Among Dental Professionals in Jeddah, Saudi Arabia.

AIM:  This study aimed to explore the awareness and utilization of protocols (e.g., the SPIKES protocol) for delivering bad news among dental professionals and the perceived need for such training. METHODS:  This study employed a cross-sectional design. A web-based self-administered questionnaire was distributed among dental students, general dentists, and dental specialists/consultants in Jeddah City through social media groups. The questionnaire included questions regarding the knowledge, attitudes, and practices of delivering bad news in dentistry and the use of the SPIKES protocol. Descriptive statistics and bivariate and multivariate analyses were performed to determine the research objectives. RESULTS:  Two hundred and twelve participants responded to the questionnaire, with an almost equal distribution between genders. Specialists/consultants and dental students comprised 87.8% of the respondents. Most respondents (70%) were unaware of any protocols for delivering bad news, and approximately 89% were unaware of the SPIKES protocol. Only 7% reported using the SPIKES protocol to deliver bad news. The bivariate analysis revealed two significant associations. The first association indicated a variation in awareness based on professional status, and the second suggested that experience in delivering bad news affected perceptions of the importance of protocol-based training. Logistic regression models revealed that specialist/consultant status was significantly associated with decreased awareness of protocols (OR = 0.287, 95% CI 0.091-0.903) as compared to general dentists and that other variables, including sex and experience in delivering bad news, did not indicate a statistically significant effect. CONCLUSION:  Most dentists in Jeddah reported the need to be familiar with and practice delivering bad news in dentistry. They agreed that it would improve patients' acceptance of bad news if it were performed in a systematic and organized manner (e.g., the SPIKES protocol).

Interpreting Laboratory Results with Complementary Health Information: A Human Factors Perspective.

The desire to access personal and high-quality health information electronically is increasing, not only in Canada, but globally. With the advent of the COVID - 19 pandemic the desire and demand for telemedicine and timely access to personal health data such as online laboratory (lab) results has increased substantially. This study examines citizens' perspectives of being provided with high-quality information about a specific lab test (i.e., potassium) in the same display as a trend graph. Therefore, the objective of this study is to test how participants managed this additional information about the context of the test, understood, and applied it. The researchers analyzed the responses of semi-structured interviews with Canadian participants (N=24) using conventional content analysis. This paper examined four themes related to providing complementary information concurrently with lab results in the same display: 1) Benefits of Collocated Information, 2) Information Overload, 3) Misinterpretation, 4) Confusion. This study provided examples of some of the difficulties that the participants faced accessing their lab values online, while navigating and discerning complimentary high-quality health information available in their patient portal.

Breaking Bad News in Breast Imaging: Keys to Success.

The radiologist's ability to effectively communicate with patients is crucial in breast imaging. Having to tell a patient that she or he requires a biopsy procedure or has a new diagnosis of breast cancer is both a challenging task and a daily reality for many practicing breast radiologists. Despite this, communication in breast imaging is often not formally taught in most training programs, leading many breast radiologists to obtain their skills through on-the-job experience. We discuss the importance of effective communication with patients and a breast imaging-specific method for delivering bad news, adapted from approaches used in medical oncology. A conversation "script" or guide is provided along with the rationale for how to best handle these difficult conversations. Lastly, we review how to teach effective communication to those in training using our breast imaging fellowship program and recent survey results as an example.

A PD-L1-targeting Regulator for Metabolic Reprogramming to Enhance Glutamine Inhibition-Mediated Synergistic Antitumor Metabolic and Immune Therapy.

Inhibition of glutamine metabolism in tumor cells can cause metabolic compensation-mediated glycolysis enhancement and PD-L1 upregulation-induced immune evasion, significantly limiting the therapeutic efficacy of glutamine inhibitors. Here, inspired by the specific binding of receptor and ligand, a PD-L1-targeting metabolism and immune regulator (PMIR) are constructed by decorating the glutaminase inhibitor (BPTES)-loading zeolitic imidazolate framework (ZIF) with PD-L1-targeting peptides for regulating the metabolism within the tumor microenvironment (TME) to improve immunotherapy. At tumor sites, PMIR inhibits glutamine metabolism of tumor cells for elevating glutamine levels within the TME to improve the function of immune cells. Ingeniously, the accompanying PD-L1 upregulation on tumor cells causes self-amplifying accumulation of PMIR through PD-L1 targeting, while also blocking PD-L1, which has the effects of converting enemies into friends. Meanwhile, PMIR exactly offsets the compensatory glycolysis, while disrupting the redox homeostasis in tumor cells via the cooperation of components of the ZIF and BPTES. These together cause immunogenic cell death of tumor cells and relieve PD-L1-mediated immune evasion, further reshaping the immunosuppressive TME and evoking robust immune responses to effectively suppress bilateral tumor progression and metastasis. This work proposes a rational strategy to surmount the obstacles in glutamine inhibition for boosting existing clinical treatments.

Capstone Simulation: A Multipatient Simulation for Senior Emergency Medicine Residents.

Introduction: Emergency medicine (EM) trainees must learn to manage multiple patients simultaneously using task-switching. While prior work has demonstrated that multipatient scenarios can be an effective teaching tool for task-switching, few studies have shown how simulation can be used to assess residents' ability to manage multiple patients effectively. The goal of this curriculum was to provide a formative assessment of core EM skills by employing a series of simulations designed to require frequent task-switching. Methods: This exercise consisted of three simulation scenarios running in sequence. The first scenario involved medical resuscitation and advanced cardiac life support, the second required learners to manage two patients involved in a trauma using advanced trauma life support, and the final scenario tested learners' ability to communicate bad news. Faculty observers used scenario-specific checklists to identify gaps in content knowledge, communication skills, and task-switching abilities during reflective debriefs. These checklists were analyzed to identify trends. All participants were sent a postsession evaluation. Items omitted by >50% of participants were flagged for review. Results: Flagged items included asking for finger-stick glucose, verbalizing a backup intubation plan, specifying type of blood products, and asking for team input. Nine of 12 participants completed the postsession evaluation, noting that they agreed or strongly agreed the simulation was relevant and promoted reflection on task-switching skills. Discussion: This simulation provides educators with a tool to facilitate reflective feedback with senior EM learners regarding their core resuscitation, leadership, and task-switching skills and could be further adapted to promote deliberate practice.

Exploring the impact of virtual SPIKES training on genetic counselors' confidence to deliver difficult news.

Delivering difficult news is a common occurrence in genetic counseling. This is evidenced by widespread instruction among genetic counseling programs. There is a disconnect in the confidence level of being able to deliver difficult news (DDN) following educational training across healthcare disciplines. Other healthcare professions have addressed this issue with simulation-based training based on the SPIKES protocol, a stepwise process for delivering difficult news. To our knowledge, there is limited research that investigates the impact of simulation-based training in delivering difficult news for genetic counselors. Our aim was to develop simulation-based training in how to deliver difficult news for genetic counselors and analyze the extent to which it increased their confidence to deliver difficult news. Board-certified genetic counselors from all specialties were recruited to participate in a 2-h training session which included the opportunity to practice delivering difficult news. We collected self-reported confidence scores in each of the SPIKES steps from 16 genetic counselors pre- and post-intervention. Participants answered open-ended evaluations about the program's strengths, weaknesses, and gaps in delivering difficult news content. Almost all participants (N = 15) stated that they had gained confidence in delivering difficult news following training completion. Confidence significantly improved in four of seven SPIKES steps. Participants found strengths of the training program to be in their ability to practice with a simulated patient, to reference concrete examples, and to follow the program easily. The results of this study suggest that post-graduate training in how to deliver difficult news using the SPIKES protocol may strengthen genetic counselors' confidence in performing this important skill.

Self-assessment of residents in breaking bad news; skills and barriers.

INTRODUCTION: Breaking bad news (BBN) is inevitable in medicine and is one of the most important and difficult professional tasks of physicians. The main aims of this study are to evaluate residents' practice of BBN and identify perceived barriers to its implementation. METHODS: In this cross-sectional study in 2021, 240 residents from medical, surgical, and emergency medicine departments completed the demographic questionnaire, the Persian SPIKES questionnaire (P-SPIKES), and the researchers-made questionnaire of Barriers to Breaking Bad News (BBBN). In addition, they were asked about their previous experience, previous training, and their perceived level of competence in BBN. RESULTS: 46.5% and 36.84% of residents rated their perceived competence in BBN and managing the patient's emotions during BBN as good or very good, respectively. The most difficult aspects of BBN for residents were expressing upsetting information (78.1%) and not disappointing the patient while being honest (58.3%). The mean and standard deviation of the score of the P- SPIKES was 55.92 ± 6.84. The most common SPIKES item was not giving bad news by phone (98.9%). The SPIKES total score was only related to age (positive relationship). The most commonly reported barriers to BBN were concerns about controlling the patient's emotions (61%) and the aggressiveness of the patient or companions (52.6%). A significant proportion of participants identified lack of training (28%) and insufficient skills (21.9%) as significant barriers to BBN. CONCLUSIONS: The skill of residents in BBN is insufficient in some aspects and points to the need for BBN training courses during residency. BBN is difficult for residents in some aspects and residents may perceive barriers. To overcome the existing barriers and increase residents' confidence in BBN, strategies such as incorporating BBN training into residency educational curricula and communication skills are recommended.

Localization of the ibuprofen molecule in model lipid membranes revealed by spin-label-enhanced NMR relaxation.

Non-steroidal anti-inflammatory drugs (NSAIDs) have antipyretic, anti-inflammatory and analgesic effects, and can be used in the treatment of various diseases. These drugs have also a number of side effects, which may be related to their interaction with lipid membranes. In this study, we use the spin-labeled NSAID ibuprofen (ibuprofen-SL) as a relaxation enhancer to study its interaction with model lipid membranes employing liquid-state 1H NMR at 500 MHz. The high magnetic moment of unpaired electron in the spin label made it possible to reduce the concentration of the studied drug in the membrane to tenths of a mole percent. As model membranes, unilamellar POPC liposomes and bicelles consisting of a 2:1 mixture of DHPC:DMPC or DHPC:POPC lipids were used. An increase in the rate of proton spin-lattice relaxation, T1-1, selectively detected for protons at different positions in the lipid molecule, showed that ibuprofen-SL is localized in the hydrophobic part of the lipid bilayer. As the concentration of ibuprofen-SL increases to 0.5 mol%, the distribution of positions of ibuprofen-SL across the bilayer becomes wider. In the presence of 20 mol% of cholesterol, ibuprofen-SL is displaced from the core of the membrane to a region closer to the head group of the bilayer. This displacement was also confirmed by the NMR NOESY experiment conducted with unlabeled ibuprofen. For bilayers containing unsaturated POPC lipids, the distribution of ibuprofen positions across the bilayer becomes narrower compared to the presence of saturated DMPC lipids.

Strategies for managing group caregiving following hip-fracture surgery among family members: A grounded theory study.

BACKGROUND: Family members in many countries often share caregiving responsibilities for an older relative recovering from an injury. However, few studies have examined strategies employed when multiple family members provide care for an older relative recovering from hip-fracture surgery. OBJECTIVE: This study aimed to understand family group caregiving strategies when two or more family members provide caregiving for an older relative recovering from hip-fracture surgery. METHODS: This study used a grounded theory design. Semistructured interviews were conducted over 1 year with 13 Taiwanese family caregivers from five families. Caregivers shared caregiving responsibilities for an older relative (62-92 years of age) recovering from hip-fracture surgery. Transcribed interviews were analysed using open, axial and selective coding. RESULTS: The core category describing caregiving among family members was 'Preventive Group Management: strategies for family group caregiving'. Three strategies were employed: explicit division of labour (two stem/patriarchal families and one older two-generation/democratic family); disconnected caregiving (one nuclear/noncommunicative family) and patriarchal caregiving (one extended/traditional Chinese family). Strategies reflected family type, structure, cultural values, communication patterns and available outside support. Components of family group caregiving involved family type's division of labour, approaches to caregiving and implementation challenges and allowed family caregivers to maximise safety and stability and prevent harmful events during their relative's recovery from surgery. CONCLUSIONS: There was no one-size-fits-all approach for the strategies of family group caregiving. Components of Preventive Group Management varied with family type, cultural values, communication patterns and available outside support. Healthcare professionals should be sensitive to the dynamics of family caregivers. IMPLICATIONS FOR PRACTICE: Enhance group management for family caregivers by developing interventions to optimize collaboration, thereby better addressing the needs of older adults recovering from hip fracture surgery.

The hidden curriculum of breaking bad news: Identification of three dimensions and four communication patterns.

OBJECTIVES: To explore students' observations in the hidden curriculum of physicians' breaking bad news interactions and identify dimensions and patterns within them. METHODS: We qualitatively analyzed 156 written narrative descriptions of bad news encounters in the clinics written by senior medical students. RESULTS: The analysis identified three dimensions within the encounters: providing information, dealing with emotions, and discussing treatment plans. These dimensions were observed in different proportions, identifying four communication patterns. Half of the encounters focused solely on presenting a treatment plan. Within them, the news was communicated abruptly while neglecting to share information or address emotions. CONCLUSIONS: Compared to the main literature on breaking bad news that focuses on two dimensions-the present study identified a third, prominent dimension-discussing the treatment plan. Half of the hidden curriculum experiences contradict the taught protocol, paying little/no attention to emotion and information. PRACTICE IMPLICATIONS: When teaching breaking bad news, it is essential to address the day-to-day practices students' observe. Students exposed to these encounters might misinterpret the physician's reliance on a single dimension as best practice. To mitigate this and help recognize their and others' tendency to focus primarily or solely on one dimension, we suggest a simple reflective prompt.

Primary postpartum hemorrhage and associated factors among delivering women in Gedeo Zone, Southern Ethiopia.

Introduction: Primary postpartum hemorrhage is still the main cause of maternal death worldwide, especially in low-resource nations like Ethiopia where there are insufficient healthcare facilities and a shortage of skilled medical personnel. Data on the prevalence of primary postpartum hemorrhage in the study population are scarce or non-existent. Objective: The aim of this study was to assess the prevalence of primary postpartum hemorrhage and its associated factors among delivering women in Gedeo Zone, Southern Ethiopia, in 2021. Methods: A facility-based cross-sectional study was carried out from January 1 to March 30, 2021, in public health facilities in the Gedeo Zone. A randomly selected 577 participants were involved in the study. Data were gathered using an interview-administered, pre-tested, structured questionnaire. The gathered information was imported into Epi Info 3.5.1 and analyzed with SPSS 23. Descriptive data was presented using tables and graphs. A logistic regression model was fitted. A bivariable and multivariable logistic regression model was computed to identify the presence and strength of association. To run multivariable logistic regression analyses, variables with P-values of <0.2 were used. The odds ratio, a 95% confidence interval (CI), and a P-value of <0.05 were used to identify variables that were associated with primary postpartum hemorrhage. Results: The magnitude of primary postpartum hemorrhage was 4.2% (95% CI: 2.4-6.0). Postpartum hemorrhage was significantly associated with current antepartum hemorrhage (AOR = 11.67; 95%CI: 7.17-16.17), twin delivery (AOR = 6.59, 95%CI: 1.48-11.70), uterine atony (AOR = 8.45, 95%CI: 4.35-12.55), and prolonged labor (AOR = 5.6, 95%CI: 2.9-8.50). Conclusions: The prevalence of primary postpartum hemorrhages in the Gedeo Zone, Southern Ethiopia was 4.2%. Current ante partum hemorrhage, twin delivery, uterine atony, and prolonged labor were predictors of primary postpartum hemorrhage. The results back up the necessity for care in the early postpartum period so that clinicians may quickly identify any issues, prevent and start treating excessive blood loss early, and, taking into account the aforementioned factors, possibly reduce the frequency of primary postpartum hemorrhage.

Prenatal patient perceptions of receiving difficult news over the telephone.

Difficult news has been described as any news that adversely and seriously affects an individual's view of their future. Research in oncology genetic counseling demonstrated that individuals do not prefer in-person or telephone delivery of their genetic test results. However, in the prenatal setting, there is limited research examining how patients prefer news related to their pregnancies be disclosed. This study aimed to assess the experiences and preferences of prenatal patients who received difficult news by telephone. A semi-structured interview guide was developed to assess patients' personal definitions of difficult news and their experiences receiving the news by telephone. Fifteen patients seen prenatally by a genetic counselor were interviewed. Interviews were transcribed and consensus-coded, using inductive content analysis to identify several themes. The most common definition of difficult news included unexpected, life-changing, or devastating information. Participants described aspects of their experience and strategies employed by their genetic counselor that was helpful when receiving the news, which was found to align with the SPIKES protocol, a six-step process of delivering difficult news to patients. Additional techniques that participants identified as beneficial and satisfactory included the genetic counselor's use of empathy, non-directiveness, and continuity and coordination of care. Participants also provided recommendations for improvement, including a discussion of the mode of result disclosure during pretest counseling, an option to follow up with their genetic counselor, personalized resources, and a summary of the results call. The findings of this study demonstrate that a patient-centered approach is preferred by patients who receive difficult news by telephone in the prenatal setting. Patients' identification of beneficial communication techniques and suggestions for improvement can be implemented by any healthcare provider responsible for delivering difficult news to prenatal patients.