: Practical Strategies to Enhance High-Quality, Time-Efficient Hospice and Palliative Care Visits.

Therapeutic clinical relationships and skilled communication are foundational elements of high-quality hospice and palliative care. Both require that we draw on the most valuable, yet limited, resource in our practice: clinician time. As the demand for serious illness care continues to outpace the supply of trained palliative care clinicians, we must consider time-efficiency as a key component of clinical effectiveness.

Avoidant Restrictive Food Intake Disorder (ARFID)-Looking beyond the eating disorder lens?

Avoidant Restrictive Food Intake Disorder (ARFID) was first included as a diagnostic category in 2013, and over the past 10 years has been adopted by the international eating disorder community. While greater awareness of these difficulties has increased identification, demand and enabled advocacy for clinical services, the heterogeneous nature of ARFID poses unique challenges for eating disorder clinicians and researchers. This commentary aims to reflect on some of these challenges, focussing specifically on the risk of viewing ARFID through an eating disorder lens.

Defining Key Elements of a Clinical Experience in Hospice and Palliative Medicine for Medical Residents in the United States.

Training in hospice and palliative medicine (HPM) is essential for practicing internists, who routinely care for patients and families facing serious illness. Program directors and medical residents acknowledge the importance of palliative medicine skills, and trainees themselves desire more such training. The ACGME has also recognized the importance of HPM training for medical residents, establishing in its 2022 Common Program Requirements for Internal Medicine a new expectation that all residents have a clinical experience in HPM.

Cell division angle predicts the level of tissue mechanics that tune the amount of cerebellar folding.

Modeling has led to proposals that the amount of neural tissue folding is set by the level of differential expansion between tissue layers and that the wavelength is set by the thickness of the outer layer. Here, we used inbred mouse strains with distinct amounts of cerebellar folding to investigate these predictions. We identified a distinct critical period during which the folding amount diverges between the two strains.

Development of an Actor Rehearsal Guide for Communication Skills Courses.

Background: Established models of serious illness communication training frequently include role play with simulated patient actors. Yet preparing for communication courses can feel challenging, as most faculty have minimal experience directing actors, and no literature exists to guide faculty in how to lead course rehearsals.

Methods: A team of palliative care educators partnered with a seasoned acting teacher to design and implement a faculty guide for directing actors during communication course rehearsals.

Cell division angle regulates the tissue mechanics and tunes the amount of cerebellar folding.

Modeling has proposed that the amount of neural tissue folding is set by the level of differential-expansion between tissue layers and that the wavelength is set by the thickness of the outer layer. Here we used inbred mouse strains with distinct amounts of cerebellar folding to investigate these predictions. We identified a critical period where the folding amount diverges between the strains.

: Navigating the Bedside Teaching Role as a Hospice and Palliative Medicine Educator.

Hospice and palliative medicine (HPM) educators must often give up the satisfaction of working one-on-one with patients, to allow learners the opportunity to practice key communication skills and form their own therapeutic bonds with patients. Though the loss of that primary relationship with patients may feel challenging, educators may find new opportunity for professional impact and satisfaction by investing in their relationship with learners. This case discussion explores the challenges of bedside teaching in HPM, including the educator's looser connection with patients, need to withhold their own communication skills, and decision of when to interject into a trainee-patient conversation.

Topical Review: Teaching Serious News Delivery in Eye Care.

Eye doctors regularly convey serious illness news to their patients. There is an evolving understanding of how medical educators can effectively teach this vital communication skill during real-time patient care. This article proposes teaching strategies to improve clinical optometric education related to serious illness conversations.

The Tween Years: Thriving as a Mid-Career Academic Hospice and Palliative Medicine Clinician.

In the young and rapidly evolving field of hospice and palliative medicine (HPM), the transition from early to mid-career can be a precarious time. The high rates of burnout and low rates of work-life balance and satisfaction found in mid-career jeopardize our field's ability to maintain a healthy workforce. In this series, we present three cases that highlight common issues encountered during the early to mid-career transition in academic HPM and present several strategies for navigating challenges.

Perspectives of internal medicine residents on approaching serious illness conversations.

Background: Navigating serious illness conversations is a critical competency for clinical trainees in any discipline, yet many feel underprepared to engage in such conversations. This study explored the challenges and emotions experienced by residents (junior doctors) when approaching serious illness conversations and how their perceptions might inform the development of effective communication skills curricula.

Methods: Using qualitative methodology, we explored the prior experience of Internal Medicine residents who attended communication skills workshops at Brigham and Women's Hospital between January and May 2020.

Palliative care in dermatology: A clinical primer, review of the literature, and needs assessment.

Palliative care has been shown to improve quality of life, symptoms, and caregiver burden for a range of life-limiting diseases. Palliative care use among patients with severe dermatologic disease remains relatively unexplored, but the limited available data suggest significant unmet care needs and low rates of palliative care use. This review summarizes current palliative care patterns in dermatology, identifying areas for improvement and future investigation.

Usage Patterns of a Web-Based Palliative Care Content Platform (PalliCOVID) During the COVID-19 Pandemic.

Context: The COVID-19 pandemic has highlighted the essential role of palliative care to support the delivery of compassionate, goal-concordant patient care. We created the Web-based application, PalliCOVID (https://pallicovid.app/), in April 2020 to provide all clinicians with convenient access to palliative care resources and support.

Development of a Palliative Care Toolkit for the COVID-19 Pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic has led to high numbers of critically ill and dying patients in need of expert management of dyspnea, delirium, and serious illness communication. The rapid spread of severe acute respiratory syndrome-Coronavirus-2 creates surges of infected patients requiring hospitalization and puts palliative care programs at risk of being overwhelmed by patients, families, and clinicians seeking help. In response to this unprecedented need for palliative care, our program sought to create a collection of palliative care resources for nonpalliative care clinicians.

Post-Craniopharyngioma and Cranial Nerve-VI Palsy Update on a MS Patient with Major Depression and Concurrent Neuroimmune Conditions.

We report the case of a male multiple sclerosis (MS) patient with type 2 diabetes (T2D), asthma, major depression (MD or major depressive disorder, MDD), and other chronic conditions, after his recent difficulties with craniopharyngioma and cranial nerve-VI (CN6) palsy. In addition, we show magnetic resonance image and spectroscopy (MRI, MRS), Humphrey's Visual Field (HVF), and retinal nerve fiber layer thickness (RNFLT) findings to explain the changes in the patient's health, and discuss the methods that helped/help him sustain productivity and euthymia despite long-standing problems and new CNS changes.

Exploring and Managing the Impostor Phenomenon in Palliative Care: A Case Series.

The impostor phenomenon (IP) describes the experience of questioning one's abilities and fearing exposure as an intellectual fraud, despite objective evidence of success. The IP has been identified in high-achieving professionals across a variety of disciplines, including clinical medicine, and can be associated with significant anxiety and psychological distress. In this series, we present three authentic cases that demonstrate how the IP may manifest in palliative care practice.

Organization of Embryonic Morphogenesis via Mechanical Information.

Embryonic organizers establish gradients of diffusible signaling molecules to pattern the surrounding cells. Here, we elucidate an additional mechanism of embryonic organizers that is a secondary consequence of morphogen signaling. Using pharmacological and localized transgenic perturbations, 4D imaging of the zebrafish embryo, systematic analysis of cell motion, and computational modeling, we find that the vertebrate tail organizer orchestrates morphogenesis over distances beyond the range of morphogen signaling.