What Should Physicians and Chaplains Do When a Patient Believes God Wants Him to Suffer?

When physicians encounter a patient who gives religious reasons for wanting to suffer, physicians should maintain their commitment to the patient's health while making room for religiously informed understandings of suffering and respecting the patient's authority to refuse medically indicated interventions. Respecting the patient can include challenging the patient's reasoning, and physicians can decline to participate in interventions that they believe contradict their professional commitments. Chaplains likewise should both support and possibly respectfully challenge a patient in instances that involve desire to suffer for religious reasons, and physicians should draw on chaplains' expertise in these situations to attend to the patient's spiritual concerns.

Ectopic Fetal Hepatic Tissue in the Placenta.

When an unusual intraplacental lesion is identified during pathologic examination, it becomes of substantial import to determine whether it represents a normal structure, metastasis from the mother, or a primary benign tumor, including those secondary to abnormal embryologic development versus a primary malignant placental tumor. In this case report, we identified an incidental nest of intraplacental cells with nondiagnostic morphology and negative initial Glypican-3 stain in a healthy 35-wk gestation. This negative result prompted a broadening of the differential before ultimately determining this lesion was indeed ectopic liver with positive Arginase-1 and HepPar-1 staining.

Gun Violence Research and the Profession of Trauma Surgery.

The effects of violence are clearly a central component of any trauma surgeon's job. The role trauma surgeons should play in its prevention and advocacy, however, is not clearly defined. In this article, we discuss the statistics and lack of research on gun violence and survey some of the moral frameworks that define a trauma surgeon's professional responsibilities in violence prevention at a practice and a policy level.

How Should Complex Communication Responsibilities Be Distributed in Surgical Education Settings?

Part of any trauma surgeon's job is communicating effectively in difficult, often time-limited, situations. The ability to effectively discuss topics like goals of care in these settings has a direct effect on patient care. Many factors contribute to the complexity of these conversations, including patient, physician, surrogate, and system-specific factors.

Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients.

Background: Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame.

Objective: To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability.

Design: Prospective cohort study.

How Should Trainee Autonomy and Oversight Be Managed in the Setting of Overlapping Surgery?

This case highlights an attending surgeon's conflicts between duty to care for individual patients, train independent surgeons, and serve a patient population in an efficient manner. Although oversight of surgical residents and multiple operating room scenarios can be conducted in an ethical manner, patients might not understand the realities of surgical training and clinical logistics without explicit disclosure. Central to the ethical concerns of the case are the attending surgeon's obfuscation of resident involvement and her insufficient oversight of two concurrent procedures.

Palmitic Acid Induces Müller Cell Inflammation that is Potentiated by Co-treatment with Glucose.

Chronic hyperglycemia is thought to be the major stimulator of retinal dysfunction in diabetic retinopathy (DR). Thus, many diabetes-related systemic factors have been overlooked as inducers of DR pathology. Cell culture models of retinal cell types are frequently used to mechanistically study DR, but appropriate stimulators of DR-like factors are difficult to identify.

The Evolving Moral Landscape Of Palliative Care.

Deactivating a patient's medical device provides a "good" death, which reflects how perspectives on hastening death have changed.

Obesity: Risk Factor for Increased Resource Utilization at Bidirectional Glenn.

Background: Underweight infants with single-ventricle cardiac physiology have been shown to have increased morbidity, mortality, and resource utilization. The purpose of this study was to determine whether patients who were overweight, as defined by weight-for-length z score >90th percentile, were similarly at risk for increased resource utilization, as defined by mechanical ventilation hours (VHs) and intensive care unit length of stay (ICU LOS).

Methods: We evaluated resource utilization for 109 patients from our institution who underwent bidirectional Glenn surgery from January 2010 to June 2015 and met prespecified inclusion criteria.

Balanced Crystalloids versus Saline in Critically Ill Adults.

Background: Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes.

Methods: In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted.

Protein Intake and Long-term Change in Glomerular Filtration Rate in the Jackson Heart Study.

Objective: Dietary protein intake could have deleterious renal effects in populations at risk for chronic kidney disease. Here, we examined whether higher protein intake (≥80th percentile of energy from protein) is associated with decline in kidney function and whether this decline varies by diabetes status.

Design: Observational cohort study.

Delirium Assessment Tools for Use in Critically Ill Adults: A Psychometric Analysis and Systematic Review.

Background: Delirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial.

Objective: To analyze the development and psychometric properties of delirium assessment tools for critically ill adults.

Training the next generation of physician researchers - Vanderbilt Medical Scholars Program.

Background: As highlighted in recent reports published by the Physician-Scientist Workforce Working Group at the National Institutes of Health, the percentage of physicians conducting research has declined over the past decade. Various programs have been put in place to support and develop current medical student interest in research to alleviate this shortage, including The Vanderbilt University School of Medicine Medical Scholars Program (MSP). This report outlines the long-term program goals and short-term outcomes on career development of MSP alumni, to shed light on the effectiveness of research training programs during undergraduate medical training to inform similar programs in the United States.

Isoxazole compound ML327 blocks MYC expression and tumor formation in neuroblastoma.

Neuroblastomas are the most common extracranial solid tumors in children and arise from the embryonic neural crest. -amplification is a feature of ∼30% of neuroblastoma tumors and portends a poor prognosis. Neural crest precursors undergo epithelial-to-mesenchymal transition (EMT) to gain migratory potential and populate the sympathoadrenal axis.

HPV awareness and vaccination rates in college-aged male athletes.

College-aged males are at high risk for human papillomavirus (HPV); however, vaccination rates remain low, suggesting minimal HPV knowledge. Therefore, an educational intervention was developed and implemented to determine if an increase in HPV knowledge, perceived HPV risk, intention and perceived self-efficacy to obtain the vaccine, and vaccination rates were observed.

Molecular Breast Imaging using Synthetic Projections from High-Purity Germanium Detectors: A Simulation Study.

High-Purity Germanium (HPGe) gamma cameras are an emerging technology for Molecular Breast Imaging (MBI) due to their 2D lateral spatial resolution, depth-of-interaction (DOI) estimation, and superb energy resolution. In this simulation study, we investigate the potential imaging performance of an opposing view dual-head HPGe breast imaging system using a synthetic-projection technique, which utilizes DOI data with varying degrees of overlap in an iterative OSEM reconstruction algorithm to create 3D images from which new 2D projections are then created. The radiation transport simulator Monte Carlo N-Particle was employed to generate projections from 10-mm thick HPGe detectors using tungsten parallel-hole collimators with short and wide holes.

An Overview of Achalasia and Its Subtypes.

Achalasia is one of the most studied esophageal motility disorders. However, the pathophysiology and reasons that patients develop achalasia are still unclear. Patients often present with dysphagia to solids and liquids, regurgitation, and varying degrees of weight loss.

Percutaneous Removal of Intravascular Pellet Following Penetrating Cardiac Trauma.

There is controversy regarding the management of projectile embolization, a rare complication of penetrating trauma. We present the case of a 5-year-old, 20 kg male with retrograde venous projectile embolization following traumatic injury with a pellet gun. The projectile was successfully removed utilizing a novel, percutaneous approach.

How Should Resident Physicians Respond to Patients' Discomfort and Students' Moral Distress When Learning Procedures in Academic Medical Settings?

In this scenario, a medical student, Lauren, experiences moral distress because she feels that learning to perform a procedure on a patient who requested not to be used for "practice" puts her own interests above the patient's. Lauren might also worry that the resident physician is misrepresenting her abilities. The resident physician could help alleviate Lauren's distress and align her interests with the patient's by more clearly explaining the training situation to the patient and seeking the patient's approval.

Ganglion Cells Are Frequently Present in Pediatric Mucosal Colorectal Biopsies: H&E Sections and Calretinin Immunohistochemistry in the Evaluation of Children With Chronic Constipation.

Hirschsprung disease (HD) rarely presents as chronic constipation after the newborn period. At our institution, calretinin immunohistochemistry (CAL) is frequently requested by clinicians on rectal mucosal biopsies (RMBs) taken during colonoscopy in older children in whom suspicion for HD is low. We hypothesized that review of these biopsies would frequently reveal ganglion cells (GCs).

Managing herpes zoster in older adults: Prescribing considerations.

NPs must be aware of special prescribing considerations for medication safety when managing the care of older adults with herpes zoster. Age-related physiologic changes of the body impact the pharmacokinetics and pharmacodynamics of antiviral and pain medications and can lead to potential adverse events.