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To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low energy hip fracture population compared to a non-anticoagulated comparison group.Multicenter Retrospective Cohort.Three Urban Level I Academic Trauma Centers.Acute, low-energy, native hip fractures in patients 55 years of age or older on chronic warfarin anticoagulation, propensity-score matched 1:2 to non-anticoagulated hip fracture patients meeting all other inclusion criteria.Transfusion and postoperative complication rates.210 anticoagulated hip fracture patients were matched to 420 non-anticoagulated patients. A higher proportion of patients required blood transfusion in the warfarin cohort (52.4% vs. 43.3%, p0.001), attributable mostly to the subgroup of patients undergoing arthroplasty. Warfarin patients had higher incidence of overall 90-day complications (47% vs. 38%, p=0.039) and readmissions (31.4% vs. 8.9%, p0.001). Day of surgery International Normalized Ratio (INR) did not influence transfusions or complications among warfarin patients. Warfarin patients undergoing surgery within 24 hours had no difference in transfusions and had fewer complications compared to those undergoing surgery after 24 hours. On multivariable logistic regression analysis, warfarin use and day of surgery INR were not predictors of transfusion or complications.Patients on warfarin experienced longer time to surgery and higher incidence of overall transfusion and postoperative complications within 90 days of surgery. However, warfarin use and day of surgery INR was not independently associated with transfusions or complications. The reason for poorer outcomes in warfarin patients remains a topic of further investigation.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patients with Parkinson's disease and shoulder osteoarthritis may be indicated for total shoulder arthroplasty. However, short- and long-term outcomes after total shoulder arthroplasty in this population remain poorly characterized.A retrospective matched case-control study was performed using data abstracted from the 2010-2018 PearlDiver Mariner administrative database. Patients undergoing total shoulder arthroplasty were identified, and those with and without the diagnosis of Parkinson's disease were matched (1:10) based on age, gender, Elixhauser comorbidity index, diabetes, chronic kidney disease, obesity, coronary artery disease, and congestive heart failure. Ninety-day incidence of adverse events were compared with multivariate regressions. Implant survival was also assessed for up to 5 years, based on the occurrence of revision surgery. Kaplan-Meier implant survival curves were compared using a log-rank test.In total, 478 patients with Parkinson's disease were matched to 4715 patients without Parkinson's disease. After adjusting for demographic and comorbid factors, patients with Parkinson's disease had significantly higher odds of prosthetic dislocation (odds ratio = 3.07, P = .001), but did not experience increased odds of other 90-day adverse events. Five-year follow-up was available for 428 (89.5%) of those with Parkinson's disease and 3794 (80.5%) of those without Parkinson's disease. There was 97.2% implant survival in the Parkinson's disease cohort and 97.7% implant survival in the matched control cohort (not significantly different, P = .463).Patients with Parkinson's disease undergoing total shoulder arthroplasty, compared with patients without Parkinson's disease, have 3-fold higher odds of periprosthetic dislocation in the 90-day postoperative period, but equivalent rates of other short-term adverse events as well as implant survival at 5 years. Accordingly, surgeons should be mindful of the short-term risk of implant instability but should have confidence in long-term total shoulder implant success in the Parkinson's disease population.

Background: Today, prioritizing the spiritual well-being of medical students holds significant importance in numerous countries worldwide. An educational curriculum serves as a comprehensive written document that delineates educational objectives, content, as well as teaching and assessment methods. Objectives: This study aims to formulate and construct a curriculum for a master's degree program in spiritual health. Methods: The initial phase of this study aims to ascertain the existing state of spiritual health education programs by conducting a thorough literature review. In the subsequent phase, a focus group discussion was conducted with eight experts and scholars to deliberate on the spiritual health curriculum, utilizing Tyler's curriculum development model as a framework. Finally, the nominal group process was employed to reach a consensus among the experts, ensuring the formulation of the final draft. Results: The spiritual health education curriculum was developed following Tyler's curriculum planning framework, encompassing four distinct components. Part one outlines the goals of the spiritual health curriculum, while part two focuses on defining the content of the curriculum. Part three addresses the learning opportunities and strategies for teaching spiritual health within the curriculum. Lastly, part four involves the evaluation process to assess the effectiveness and impact of the spiritual health curriculum. Conclusions: Spiritual health education has been recommended in various references. Recognizing discipline as spiritual health has fostered the growth of spiritual concepts in the healthcare environment, bringing attention to the needs of patients.

Four key themes are explored in this third issue of the Journal of Religion and Health for 2022: (1) the lead topic for this issue considers the work and spiritual care provided by nurses, which is followed by a series of articles on the subject areas of (2) diabetes and (3) hemodialysis. Then, like previous issues, we again consider (4) research exploring the effects of COVID-19. Finally, this issue presents a miscellaneous collection of articles with respect to various faith dynamics and the findings from several national surveys.

OBJECTIVES: To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with non-anticoagulated patients undergoing hip fracture surgery and, secondarily, to determine if time to surgery or complications differ between these groups. DESIGN: Multicenter retrospective cohort SETTING: Three tertiary care, academic, level I trauma centers PATIENTS: Acute, operatively treated, low-energy hip fracture patients aged 55 and older were included. Anticoagulated patients were matched in a 1:2 ratio to “control” non-anticoagulated hip fracture patients using propensity score matching. MAIN OUTCOME MEASUREMENTS: The primary outcome was incidence of perioperative transfusion. Secondary outcomes include time to surgery, length of stay, 90-day complications, re-admissions, re-operations and mortality. RESULTS: 132 hip fracture patients admitted on DOACs were identified (107 factor Xa inhibitors, 25 dabigatran) and were matched to 262 “control” non-anticoagulated patients. There was no difference in overall transfusion rates between anticoagulation groups (43.2%; n=57 DOAC vs. 39.7%; n=104 control; p=0.517). Median time from admission to surgery was 41.7 hours in the DOAC group and 26.0 hours in the control group (p

Waleed Ahmed Alghamdi,1 Ahmed Hussein Subki,2 Hazim Abdulkarim Khatib,3 Nadeem Shafique Butt,4 Rahaf Ali Alghamdi,1 Mohammed Saad Alsallum,5 Ahmed A Alharbi,1 Mohammad Nasser Almatrafi,1 Abdullah Ahmed Alobisi,1 Faten Al-Zaben,1 Harold G Koenig1,6,7 1Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Internal Medicine, King Faisal Specialist Hospital & Research center, Jeddah, Saudi Arabia; 3Department of Internal Medicine, King Abdulaziz Hospital, Jeddah, Saudi Arabia; 4Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 6School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; 7Duke University Medical Center, Durham, NC, USACorrespondence: Waleed Ahmed Alghamdi; Harold G Koenig, Email wagalghamdi@kau.edu.sa; harold.koenig@duke.eduBackground: The present study examined the prevalence of and risk factors for symptoms of body dysmorphic disorder (BDD) in the general population of Jeddah, a large port city in Saudi Arabia.Methods: This cross-sectional study surveyed a convenience sample of 520 adults. We used a validated self-screening measure to assess BDD, the body dysmorphic disorder questionnaire (BDDQ).Results: The prevalence of significant BDD symptoms among the general Saudi population was 8.8% (ie, those scoring above the cut off for BDD on the BDDQ). Over half (52%) of all respondents reported concerns about the attractiveness of their body parts, and of those expressing such concerns, 66% were preoccupied with these thoughts. Only 3% of all respondents opted for cosmetic surgery because of these concerns, and most of those individuals (69%) had only one surgery. Nearly 9% of all respondents reported that these concerns affected their relationships with family and friends. Almost 15% of all participants spent an hour or more each day thinking about these concerns. Patients who reported a history of depression were 3.8 times more likely to have BDD. Other variables included in the model predicting high BDD scores (eg, age, job status, and marital status) did not achieve statistical significance.Conclusion: Significant symptoms of BDD (based on the BDDQ) are not uncommon among the general population of Jeddah, Saudi Arabia. Risk factors for this condition were female gender, younger age, being unmarried, and in bivariate and multivariate analyses, history of depression and female gender. These findings underscore the need for increased awareness by clinicians of this disorder, particularly when treating patients with depressive disorder, particularly among women.Keywords: body dysmorphic disorder, body image, prevalence, Saudi Arabia

Three topics are explored in this first issue of the Journal of Religion and Health for 2022, namely: (1) mental health and religion, (2) clinical practice issues and the relevance of religion/spirituality, and finally (3) the continuing and expanding public health crisis of COVID-19 and the associated religious/spiritual impact and response.

Detailed simulations show that the relationship between electroenzymatic glutamate (Glut) sensor performance in vitro and that modeled in vivo is complicated by the influence of both resistances to mass transfer and clearance rates of Glut and H2O2 in the brain extracellular space (ECS). Mathematical modeling provides a powerful means to illustrate how these devices are expected to respond to a variety of conditions in vivo in ways that cannot be accomplished readily using existing experimental techniques. Through the use of transient model simulations in one spatial dimension, it is shown that the sensor response in vivo may exhibit much greater dependence on H2O2 mass transfer and clearance in the surrounding tissue than previously thought. This dependence may lead to sensor signals more than double the expected values (based on prior sensor calibration in vitro) for Glut release events within a few microns of the sensor surface. The sensor response in general is greatly affected by the distance between the device and location of Glut release, and apparent concentrations reported by simulated sensors consistently are well below the actual Glut levels for events occurring at distances greater than a few microns. Simulations of transient Glut concentrations, including a physiologically relevant bolus release, indicate that detection of Glut signaling likely is limited to events within 30 μm of the sensor surface based on representative sensor detection limits. It follows that important limitations also exist with respect to interpretation of decays in sensor signals, including relation of such data to actual Glut concentration declines in vivo. Thus, the use of sensor signal data to determine quantitatively the rates of Glut uptake from the brain ECS likely is problematic. The model is designed to represent a broad range of relevant physiological conditions, and although limited to one dimension, provides much needed guidance regarding the interpretation in general of electroenzymatic sensor data gathered in vivo.

Four substantial topics are explored in this issue of the Journal of Religion and Health, namely: (1) Christianity, (2) family and faith dynamics, (3) the spiritual and religious experiences of students from Islamic, Christian, Buddhist, Hindu, and Jewish perspectives, and lastly, (4) the lingering effects of COVID-19. This issue also notes the diamond jubilee-60th year-of JORH (2021).

Background Programmatic assessment is increasingly being implemented within competency-based health professions education. In this approach a multitude of low-stakes assessment activities are aggregated into a holistic high-stakes decision on the student’s performance. High-stakes decisions need to be of high quality. Part of this quality is whether an examiner perceives saturation of information when making a holistic decision. The purpose of this study was to explore the influence of narrative information in perceiving saturation of information during the interpretative process of high-stakes decision-making. Methods In this mixed-method intervention study the quality of the recorded narrative information was manipulated within multiple portfolios (i.e., feedback and reflection) to investigate its influence on 1) the perception of saturation of information and 2) the examiner’s interpretative approach in making a high-stakes decision. Data were collected through surveys, screen recordings of the portfolio assessments, and semi-structured interviews. Descriptive statistics and template analysis were applied to analyze the data. Results The examiners perceived less frequently saturation of information in the portfolios with low quality of narrative feedback. Additionally, they mentioned consistency of information as a factor that influenced their perception of saturation of information. Even though in general they had their idiosyncratic approach to assessing a portfolio, variations were present caused by certain triggers, such as noticeable deviations in the student’s performance and quality of narrative feedback. Conclusion The perception of saturation of information seemed to be influenced by the quality of the narrative feedback and, to a lesser extent, by the quality of reflection. These results emphasize the importance of high-quality narrative feedback in making robust decisions within portfolios that are expected to be more difficult to assess. Furthermore, within these “difficult” portfolios, examiners adapted their interpretative process reacting on the intervention and other triggers by means of an iterative and responsive approach.

Military personnel deployed to war zones or assigned to other morally challenging military duties are likely to be exposed to potentially morally injurious events (PMIE) that may inflict a moral injury (MI). This qualitative study formed ‘Phase 1’ of a larger study into PMIEs experienced by Australian veterans and the potential pastoral/spiritual care role of chaplains. Two seminars were conducted that involved 10 veterans being interviewed and audio recorded about their deployment experiences to evaluate whether there was any evidence among Australian veterans of a PMIE. Narrative data analysis indicated that all participants had been exposed to, or were involved in, a PMIE of one kind or another. Seven key themes were identified from the analyzed qualitative data: (i) immoral acts, (ii) death and injury, (iii) betrayal, (iv) ethical dilemmas, (v) disproportionate violence, (vi) retribution and (vii) religious/spiritual issues. Given this preliminary PMIE evidence identified, there is a need for further research, as well as the development of a suitable moral injury assessment scale appropriate for Australian veterans. Furthermore, given the ethical, moral, and spiritual issues involved, the implementation of a rehabilitation program suitable for Australian veterans which can be provided by chaplains is also suggested—namely ‘Pastoral Narrative Disclosure.’ It is argued that moral injury needs to be recognized, not just as an issue affecting individual personnel and their families, but is also a community health, organizational and government responsibility.

Research in the field of “Spirituality and Health” has been growing, with spirituality/religiousness (S/R) being consistently related to both physical and mental health. The objective of this article is to provide an updated review of the current scientific evidence on the relationship between S/R and mental health, highlighting the most important studies. As a secondary objective, the mechanisms that explain this relationship and the interventions that utilize this information in treating mental disorders will be discussed. The findings reveal a large body of evidence across numerous psychiatric disorders. Although solid evidence is now available for depression, suicidality, and substance use, other diagnosis, such as post-traumatic stress disorder, psychosis, and anxiety, have also shown promising results. The effects of S/R on mental health are likely bidirectional, and the manner in which religious beliefs are used to cope with distress (i.e. negative and positive), may affect mental health outcomes. Despite these findings, the mechanisms that explain these associations and the role of S/R interventions need further study. Concerning clinical practice, mental health providers should ask patients about S/R that are important in their lives to provide holistic and patient-centered care.

Four key themes are covered in this issue of JORH, namely: (1) the catastrophic events of 11 September 2001, (2) the syndrome of moral injury, (3) the ongoing calamity of COVID-19, and finally, (4) the validation, translation and use of measurement instruments/scales assessing religion, spirituality and health.

Scale development, validation, and translation are complicated and often arduous procedures that involve considerable cost, time, personnel, and skills necessary to perform the complex statistical analyses required. The need to follow a standard procedure when developing new scales and translating old scales into new languages is essential in order to ensure that researchers accurately measure what they are claiming to measure. Well-designed scales form the foundation for much of the quantitative research conducted today in the psychological, social, behavioral and physical health sciences. This is also true for studies that examine the relationship between religiosity and/or spirituality (R/S) and health. The relationship between R/S and health is a complex one, requiring the development of measures that comprehensively, sensitively, reliably, and accurately measure R/S. As with many other emerging areas in the health sciences, quantitative measurement using psychometrically sound scales and the translation of existing scales into other languages is essential for advancement of the field of religion and health. In this article, a standard procedure for developing, validating, and translating multi-item scales is described.

Moral injury (MI), originally discussed in relationship to transgressing moral beliefs and values during wartime among military personnel, has expanded beyond this context to include similar emotions experienced by healthcare professionals, first responders, and others experiencing moral emotions resulting from actions taken or observations made during traumatic events or circumstances. In this article, we review the history, definition, measurement, prevalence, distinctiveness, psychological consequences, manifestations (in and outside of military settings), and correlates of MI in different settings. We also review secular psychological treatments, spiritually integrated therapies, and pastoral care approaches (specific for clergy and chaplains) used to treat MI and the evidence documenting their efficacy. Finally, we examine directions for future research needed to fill the many gaps in our knowledge about MI, how it develops, and how to help those suffering from it.

This final issue of JORH for 2022 revisits the topics of (1) cancer, (2) religious philosophy, and (3) uniquely collates a number of papers discussing the theme of death and dying-which seems an appropriate topic given the conclusion and celebration of life for one of the most internationally admired monarchs, Queen Elizabeth II (1926-2022). Lastly a call for papers is issued regarding religion, spirituality, suicide, and its prevention: https://www.springer.com/journal/10943/updates/23471166 .

In this fifth issue of the Journal of Religion and Health for 2022, four key themes are revisited: (1) mental health, (2) Islam, (3) various clinical issues relating to religiosity and/or spirituality and (4) the ongoing concerns of COVID-19.

Moral injury is a complex phenomenon characterized by spiritual, psychological, and moral distress caused by actions or acts of omission inconsistent with an individual’s moral and ethical values. We present two cases from an ongoing randomized controlled trial of a spiritually integrated structured intervention delivered by chaplains for individuals suffering from moral injury. Chaplains met with Veterans for twelve 50-min sessions that each focused on a specific domain of moral injury. Participants were asked to complete validated scales assessing symptoms of moral injury and PTSD, including the PTSD Checklist for DSM-5 (PCL-5), Moral Injury Symptom Scale-Military Version Short Form, and Moral Injury Symptom Scale-Military Version Long Form. We report on two Veterans who completed the intervention and demonstrated significant improvement in moral injury and PTSD symptoms.

Bovine pregnancy diagnosis (PD) by transrectal palpation (TRP) is an important skill for veterinary graduates. Factors influencing students’ PD accuracy were investigated to optimize bovine PD by TRP training without increasing live animal exposure. The objective was to determine whether arm length and strength, proprioception, and exposure to a 6-week exercise training program were significantly associated with students’ PD accuracy. Veterinary students ( n = 128) who had previously received formal theoretical and practical training in bovine TRP and PD (live cows and TRP simulators) were assessed for PD accuracy on live cows. Prior to assessment, arm muscle strength measurement, an exercise program, and additional TRP sessions on Breed’n Betsy® simulators and live cows were offered to the students. Seventy-eight students volunteered to participate in the arm length measurement, muscle strength, and proprioception testing. Of these, 35 randomly allocated students completed a 6-week exercise program, after which muscle strength was reassessed. Each student performed PDs on six cows of which the pregnancy status, ranging from 6 weeks to 9 months pregnant or not pregnant, was predetermined by an experienced veterinarian. PD accuracy was measured as sensitivity and specificity, being defined as the proportion of pregnant or nonpregnant cows, respectively, correctly identified by the student. It is concluded that hand grip strength and participation in an exercise program are significant predictors of veterinary students’ PD accuracy. Implementation of an exercise program aimed at improving grip strength in the veterinary curriculum is a novel approach to improve bovine TRP and PD training.

Religious and spiritual (R/S) issues impact medical decision-making, particularly among highly R/S populations, for whom existing measures have limitations in identifying levels of R/S commitment. The Belief into Action (BIAc) scale was designed for this purpose and was never tested among hospitalized patients. We interviewed 152 patients (51% men) with a mean age of 48.9 years (SD = 15.2), having either cancer (27%), cardiovascular (26%), rheumatic (21%), or other diseases (26%). Cronbach alpha was .82 and a 3-factor structure (subjective, social, and private religious commitment) was the most robust. Results suggest the BIAc has adequate convergent, divergent, and incremental validity compared to other well-established questionnaires and is appropriate for the inpatient setting.

Scientific research on religion, spirituality and health is fundamental, or our health care systems will become spuriously tokenistic rather than being truly holistic. Likewise, training in scientific research with respect to the interconnection between religion/spirituality and health, is also essential so as to ensure the future inclusion and development of religion and spirituality across the disciplines of medicine, nursing, psychology, social work, pastoral/spiritual care, and other allied health disciplines. This paper describes research training programs now available to obtain the skills and knowledge to develop, fund, manage, and publish research in this area, and disseminate it to clinicians and the general public. First, a model research program is described, and then, three examples of training programs at Duke, Emory, and Yale University are presented. Such training programs seek to develop the next generation of researchers who will dedicate their lives and careers to conducting research on religion and health, teaching it to students, and integrating the findings into clinical practice both in the USA and around the world. Scholarships are now available for health professionals to obtain such training, particularly for academic scholars early in their careers (e.g., graduate students, junior faculty) and for more senior researchers wishing to conduct studies in this area. Nearly 80% of the world’s population have religious or spiritual beliefs that influence their health and well-being in one way or another. Learning to carry out and publish systematic research will help fill the many gaps in knowledge concerning how religion affects health and health affects religion.

Various approaches have been developed to comprehensively assess multiple dimensions of religiosity. The Belief into Action (BIAC) Scale was developed for this purpose and to evaluate the degree of translation of personal beliefs into real-life actions. The goal of the present study was to assess the validity and reliability of the Moroccan Arabic version of the Muslim BIAC, designed to assess the religiosity of Muslims. This study was conducted in two stages. First, the original version of Muslim BIAC was translated from English to Arabic using a standard forward–backward translation procedure. Second, the Moroccan Arabic version of the Muslim BIAC was administered to a sample of 132 students at Ibn Zohr University, Agadir, Morocco (mean age 22.2 years). The average score on the BIAC was 46.1 (SD = 17.2). The Cronbach’s alpha for internal reliability was 0.81, with alphas for removed items ranging from 0.77 to 0.82. Test–retest reliability by intraclass correlation coefficient (ICC) was 0.87 (95% CI = 0.83–0.91). Discriminant validity indicated relatively weak correlations with depressive symptoms (r = − 0.06) and perceived stress (r = 0.08). The Moroccan Arabic version of the Muslim BIAC is a reliable and valid measure of religious involvement that can be used to assess the relationship between religiosity and health in Moroccan Arabic populations.

This study aimed to analyze the moderating effect of religion between sociodemographic variables, lifestyle, and self-referred physical and mental health. Cross-sectional study with non-randomized sample of 392 participants. The Eight Natural Remedies Questionnaire was used to assess lifestyle. Religion was found to be positive predictor between age, education and lifestyle, better physical and mental health. Being an Adventist positively influenced the lifestyle (r = 0.680; p

This cross-sectional pilot study evaluated associations between religion/spirituality, forgiveness, sleep, and health, which were all highly correlated for adult women living in a homeless mission. While causation cannot be determined, these findings help to provide a theoretical framework for studies with stronger designs, prospective measurements, and larger sample sizes.

Four key topics are explored in this second issue of the Journal of Religion and Health for 2022. Following a condemnation of the Russian invasion of Ukraine, (1) the lead topic for this issue forms a special section regarding contemporary chaplaincy, which is followed by (2) ongoing research concerning cancer, (3) aged care and finally (4) the continuing response to COVID-19. Previous issues of JORH have presented various articles related to these topics before; however, this particular collation provides a resourceful anthology.

This systematic review aimed to summarize the literature on the relationship between religiosity or spirituality (R/S) and medication adherence among patients with cardiovascular diseases (CVDs) and to describe the nature and extent of the studies evaluating this relationship. Seven electronic databases (PubMed, MEDLINE, EMBASE, Scopus, the Cochrane Central Library, ProQuest Theses and Dissertations, and Google Scholar) were searched with no restriction on the year of publication. The Crowe Critical Appraisal Tool was used to evaluate the methodological quality of the eligible studies. Due to the heterogeneity observed across the included studies, data synthesis was performed using a narrative approach. Nine original studies published between 2006 and 2018 were included in the review. Only a few quantitative studies have examined the relationship between R/S and medication adherence among patients with CVDs. Most studies were conducted in the USA (n = 7) and involved patients with hypertension (n = 6). Five studies showed a significant correlation between R/S (higher organizational religiousness, prayer, spirituality) and medication adherence and revealed that medication adherence improved with high R/S. The other four studies reported a negative or null association between R/S and medication adherence. Some of these studies have found relationships between R/S and medication adherence in hypertension and heart failure patients. This review showed a paucity of literature exploring the relationship between R/S and medication adherence among patients with other CVDs, such as coronary artery diseases, arrhythmia, angina and myocardial infarction. Therefore, the findings suggest that future studies are needed to explore the relationship between R/S and medication adherence among patients with other types of CVDs. Moreover, there is a need to develop interventions to improve patients' medication-taking behaviors that are tailored to their cultural beliefs and R/S. 2022, The Author(s). Open Access funding provided by the Qatar National Library. We would like to thank American Journal of Experts and Springer Nature Author Services for editing the language of the article. Scopus

In this fourth issue of the Journal of Religion and Health for 2022, four key themes are explored: (1) religious and spiritual issues in China, (2) gender-related issues affecting communities, couples, women and men, (3) a multitude of philosophical perspectives regarding medicine, science, health and religion, (4) and an array of new or adapted religion/spirituality measurements and scales. Finally, we also recall and celebrate the life of former JORH Editorial Board member, Professor John S. Peale.

The transition from being a veterinary student to becoming a member of the veterinary profession is known to be challenging. Despite being licensed directly after graduation, many veterinarians do not feel fully equipped to practice unsupervised when they graduate. The increasing rate of attrition from veterinary practice, and a relatively high percentage of burnout during the first years in practice, has been suggested to be related to a lack of early career support. Over the past decade, medical education has adopted the concept of entrustable professional activities (EPAs). Recently, EPAs have been proposed to restructure veterinary education to help support the transition from veterinary student to practicing veterinarian. Implementing an EPA-based approach could help to bridge the gap between school and clinical practice, potentially preventing veterinary graduates from dropping out early on from what could have been a promising and exciting professional career.

The unusual and tiring physical activity of bovine transrectal palpation (TRP) requires a novel approach to improve students’ TRP and pregnancy diagnosis (PD) skills. It has been shown that students who participated in an exercise program and students who had a grip strength (GS) of more than 30 kilograms performed better in bovine PDs. Participation in the exercise program increased students’ sensitivity (ability to identify pregnant cows) but did not increase total arm muscle strength. To identify which muscles are used during TRPs and to improve the exercise program, an electromyographic (EMG) analysis was used to identify muscle activation patterns and muscle activity levels during bovine TRPs. Eight subject matter experts (SMEs) each palpated two live cows and one Breed’n Betsy® rectal examination simulator while an EMG Triggered Stimulator recorded muscle activity. Muscle activation was higher for forearm muscles compared with all other examined muscle groups ( p < .001); was higher during retraction of the uterus and palpation of left and right uterine horn, compared with palpation of cervix, uterine body, left ovary, and right ovary ( p < .001); and showed an endurance pattern. Findings have been used to modify the previously developed exercise program in effort to improve students’ TRP and PD skills. The Bovine PD Improvement Exercise Program is available to students through an online application (http://icarus.up.ac.za/vetmlp/) and aims to not only improve GS and TRP accuracy but also stamina and well-being while adding fun to busy study schedules.

COPD is characterized by irreversible lung tissue damage. We hypothesized that lung-derived mesenchymal stromal cells (LMSCs) reduce alveolar epithelial damage via paracrine processes, and may thus be suitable for cell-based strategies in COPD. We aimed to assess whether COPD-derived LMSCs display abnormalities. LMSCs were isolated from lung tissue of severe COPD patients and non-COPD controls. Effects of LMSC conditioned-medium (CM) on H2O2-induced, electric field- and scratch-injury were studied in A549 and NCI-H441 epithelial cells. In organoid models, LMSCs were co-cultured with NCI-H441 or primary lung cells. Organoid number, size and expression of alveolar type II markers were assessed. Pre-treatment with LMSC-CM significantly attenuated oxidative stress-induced necrosis and accelerated wound repair in A549. Co-culture with LMSCs supported organoid formation in NCI-H441 and primary epithelial cells, resulting in significantly larger organoids with lower type II-marker positivity in the presence of COPD-derived versus control LMSCs. Similar abnormalities developed in organoids from COPD compared to control-derived lung cells, with significantly larger organoids. Collectively, this indicates that LMSCs’ secretome attenuates alveolar epithelial injury and supports epithelial repair. Additionally, LMSCs promote generation of alveolar organoids, with abnormalities in the supportive effects of COPD-derived LMCS, reflective of impaired regenerative responses of COPD distal lung cells.

Patient: Male, 34-year-old Final Diagnosis: Infective endocarditis of the tricuspid valve Symptoms: Lethargy • weakness Medication: — Clinical Procedure: Tricuspid valve repair • tricuspid valve replacement Specialty: Anesthesiology • Cardiac Surgery • Infectious Diseases • Psychiatry Objective: Unusual clinical course Background: Intravenous drug use is an epidemic in the United States. One of the complications of intravenous drug use can be infective endocarditis. The treatment for this disease is a combination of intravenous antibiotics, cardiac surgery consultation, and multidisciplinary psychiatric care. Despite surgical intervention, recurrence of disease is common. In the setting of recurrent infective endocarditis in the setting of intravenous drug use, the ethics of redo cardiac surgery has not been well-established. Case Report: A 34-year-old man with history of intravenous drug use presented on 3 separate occasions with infective endocarditis resulting in 3 tricuspid valve surgeries within fewer than 7 months. He said he had not injected drugs since before his first operation, he was considered to have a strong social support system, and he completed his postoperative antibiotic regimens each time. However, prior to his last operation, the patient had a urine drug screen positive for opiates without recorded prescribed opioids. Pathology reports from the 3 intraoperative specimens showed different pathogens each time. An extensive interprofessional discussion ensued. Conclusions: Infective endocarditis in the setting of intravenous drug use and its treatments continue to be a point of ethical and medical discussion for all professionals involved with the care of these patients. This case could be used as an example of individualized decision-making, with rigorous ethical and medical discussion factoring into each decision for cardiac surgery. The ongoing treatment for patients with recurrent endocarditis in the setting of intravenous drug use requires more research and guidelines to help medical professionals better care for this patient population.

Spirituality, an established resource within rural America, serves as an important coping mechanism for crises of chronic illness. We examined the effects of spirituality on chronic kidney disease (CKD) maintenance in the rural community of Robeson County, North Carolina. We conducted nine focus group discussions and 16 interviews involving 80 diverse key informants impacted by CKD. As disenfranchised patients, they locally engaged in spirituality which mobilized personal and social resources and elicited support from a transcendent authority. Our participants developed a heuristic and aesthetic understanding of disease, built resilience and self-care skills, and improved overall coping and survival.

Objective: To identify the relationship between religiosity and self-rated health among older adults in Colombia. Methods: Data are drawn from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional survey conducted in 2015 involving 18,871 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Religiosity was assessed by self-rated religiosity (how religious are you: not at all, somewhat or very). Self-rated health during previous 30 days was assessed as very good, good, fair, poor or very poor, analyzed as an ordinal variable (1-5) using weighted logistic regression, adjusting for confounders. Results: Those who were more religious were older, female, had lower socioeconomic status, and were more likely to be married. Multivariate analyses demonstrated that older adults who were more religious had better self-rated health (OR: 0.92, 95% CI: 0.86-0.99, p= 0.038); however, there was a significant interaction effect between gender and religiosity on self-rated health (p= 0.002), such that the relationship between religiosity and health was stronger in men (OR: 0.86, 95% CI: 0.79-0.94, p= 0.001) but not significant in women. Conclusion: Older adults in Colombia who consider themselves more religious, especially men, are less likely to perceive their physical health as poor compared to those who are less religious. Resumen Objetivo: Identificar la relación entre religiosidad y el auto reporte de salud entre adultos mayores en Colombia. Métodos: Los datos provienen del estudio SABE (Salud, Bienestar y Envejecimiento) Colombia, una encuesta transversal realizada en 2015 en la que participaron 18,871 adultos de 60 años o más que viven en la comunidad y provienen de zonas urbanas y rurales en Colombia. La religiosidad fue autoevaluada (qué tan religiosa eres: nada, algo o muy). La autoevaluación de la salud durante los 30 días previos se evaluó como muy buena, buena, regular, mala o muy mala, analizada como variable ordinal (1-5) usando la regresión logística ponderada, ajustando por factores de confusión. Resultados: La edad avanzada, el sexo femenino, estar casado, y tener bajo nivel socioeconómico se asociaron con ser más religiosos. Los análisis multivariados demostraron que ser más religioso se asociaba con mejor salud autoevaluada (OR= 0.92; IC 95%= 0.86-0.99; p= 0.038). Sin embargo hubo una interacción significativa entre género y religiosidad sobre la salud autoevaluada (p= 0.002), tal que la relación entre religiosidad y salud fue mas fuerte en los hombres (OR= 0.86; IC 95%= 0.79-0.94; p= 0.001), pero no fue significativa en mujeres. Conclusión: Los adultos mayores en Colombia que se consideran a sí mismos más religiosos, especialmente los hombres, tienen menos probabilidades de percibir su salud como pobre en comparación con aquellos que son menos religiosos.

There is a growing body of evidence on the positive effects of religion and spirituality on recovery from cancer and the ability to cope with it. Most spiritual interventions carried out in Iranian research are based on care and support models that have been developed in the West. With the unique cultural and religious features of the Iranian context, a more refined look at spiritual care in the hospital care system of Iran is called for. This paper examines how to implement the spiritual care of cancer patients in hospitals and oncology wards in Iran. A consensus panel of experts was used to develop guidelines for spiritually integrated care consisting of 18 primary areas, which are described in detail in this report. Health care policy makers and managers of health care in Iran and possibly other areas of the Middle East should consider implementing these guidelines. Using indigenous models and programs specific to the religion and the cultural of a region should be considered when providing spiritual care for cancer patients.

OBJECTIVE : To compare the quality of life (QOL) and frequency of hospital admission (FHA) in the past 4 months between congestive heart failure (CHF) patients involved in a structured heart failure program (HFP) compared with waitlisted controls. METHODS : This study, employing an ex-post-facto comparative cross-sectional design, involved 80 patients with CHF (40 in the HFP and 40 controls). Those in the HFP had been enrolled for at least 4 months. Controls were waiting to be enrolled in the program. Participants completed a questionnaire assessing demographic, social/cultural, psychological, and CHF-related physical health characteristics, along with the primary dependent variables, QOL and FHA. Bivariate and multivariate analyses assessed differences between those in the HFP and controls. RESULTS : Congestive heart failure patients in the HFP were significantly less likely than the control group to score below the median on heart failure-specific QOL, controlling for other variables (OR=0.83, 95% CI: 0.82-0.95, p=0.007). Those in the HFP were also significantly less likely than controls to be hospitalized within the past 4 months (OR=0.78, 95% CI: 0.69-0.88, p less than 0.001). Multivariate analyses indicated that CHF patients in the HFP were 95% less likely than controls to be admitted to the hospital during that period, independent of other risk factors for hospital admission. CONCLUSIONS : Involvement by patients with CHF in a structured HFP at King Abdulaziz University in Jeddah, Kingdom of Saudi Arabia, is associated with significantly higher quality of life and lower likelihood of being hospitalized compared to CHF patients not involved. Saudi Med J 2019; Vol. 40 (6): 582-589 doi: 10.15537/smj.2019.6.24211 How to cite this article: Alghalayini KW, Al-Zaben Fn, Sehlo MG, Koenig HG. Effects of a structured heart failure program on quality of life and frequency of hospital admission in Saudi Arabia. Saudi Med J 2019; 40 (6): 582-589. doi: 10.15537/smj.2019.6.24211.

We examined multiple dimensions of religiosity and their relationship to the four DSM-5 PTSD symptom clusters among US Veterans and Active Duty Military (ADM), hypothesizing that religiosity would be most strongly inversely related to negative cognitions/emotions (Criterion D symptoms) and less strongly to neurobiologically based symptom clusters (B, C, and E). This cross-sectional multisite study involved 591 Veterans and ADM from across the southern USA. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms. Measures of religious beliefs/practices, social involvement, and PTSD symptoms were administered, and bivariate and multivariate analyses were conducted in the overall sample, and in exploratory analyses, in the sample stratified by race (White, Black, and Hispanic). In the overall sample, multivariate analyses revealed that the only PTSD symptom cluster inversely related to religiosity was Criterion D, and only to organizational (b = - 0.08, P = 0.028) and cognitive/intrinsic religiosity (b = - 0.06, P = 0.049), relationships that were fully explained by social factors. Religious struggles, in contrast, were positively related to all four symptom clusters. Inverse relationships with Criterion D symptoms were particularly strong in Blacks, in whom inverse relationships were also present with Criterion E symptoms. In contrast, only positive relationships with PTSD symptom clusters were found in Hispanics, and no relationships (except for religious struggles) were present in Whites. As hypothesized, the inverse relationship between religious involvement and PTSD symptoms in Veterans and ADM was strongest (though modest) for Criterion D negative cognitions/emotions, especially in Blacks.

Flexible neural probes have been pursued previously to minimize the mechanical mismatch between soft neural tissues and implants and thereby improve long-term performance. However, difficulties with insertion of such probes deep into the brain severely restricts their utility. We describe a solution to this problem using gallium (Ga) in probe construction, taking advantage of the solid-to-liquid phase change of the metal at body temperature and probe shape deformation to provide temperature-dependent control of stiffness over 5 orders of magnitude. Probes in the stiff state were successfully inserted 2 cm-deep into agarose gel “brain phantoms” and into rat brains under cooled conditions where, upon Ga melting, they became ultra soft, flexible, and stretchable in all directions. The current 30 μm-thick probes incorporated multilayer, deformable microfluidic channels for chemical agent delivery, electrical interconnects through Ga wires, and high-performance electrochemical glutamate sensing. These PDMS-based microprobes of ultra-large tunable stiffness (ULTS) should serve as an attractive platform for multifunctional chronic neural implants.

Spirituality is considered a universal phenomenon, but research addressing the spiritual needs of adolescents in the context of health and illness is limited. The aim of this article is to provide a description of how the spiritual development framework (SDF) was used in conducting research with adolescents. An exemplar of a qualitative descriptive study is provided to demonstrate applicability of the SDF. The SDF was used as a guiding theoretical framework in conducting research with adolescents living with sickle cell disease. The SDF is culturally applicable and methodologically appropriate. Additional research applying the SDF is warranted.