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Dental staff fired for mocking cancer patient’s private diary

Shocking video has emerged of two dental staff reading a cancer patient's private diary aloud while laughing and mocking her concerns. The video which captured the American employees at Premier Dental Group (PDG) of Knoxville laughing as they read the private diary entries was captioned: "Found a patients journal and now it's story time lmao." The footage was reportedly filmed by another staff member who could be heard giggling throughout the video, according to the New York Post. A woman in black scrubs was filmed reading passages from the diary to others in the room and describing the radiation treatments the worried patient faces. Another woman was sitting cross-legged on the office floor and listening intently, a male employee was also in the room but he did not intervene or join in with the women. It’s not clear how staff obtained access to the patient’s private journal, or why they decided to read it. The video sparked outrage across social media, with Premier Dental Group of Knoxville having to share an apology on Facebook acknowledging the incident. "Premier Dental Group of Knoxville is aware of a recent incident involving an inappropriate video created and shared by some of our employees that addressed an individual’s medical condition in a disrespectful and unprofessional manner.” “We deeply regret this incident and the hurt [it] has caused,” they wrote in the statement which has now been deleted. A spokesperson for PDG confirmed to the New York Post the female employees involved in the incident were fired “effective immediately”. After an investigation it was determined that the male employee in the video did not participate and kept his job. “We are committed to maintaining a respectful and professional environment for everyone, and we will continue to take necessary actions to uphold these standards,” the practice said. Images: news.com.au

Caring

Paris in spring, Bali in winter. How ‘bucket lists’ help cancer patients handle life and death

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/leah-williams-veazey-1223970">Leah Williams Veazey</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/katherine-kenny-318175">Katherine Kenny</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> In the 2007 film <a href="https://www.imdb.com/title/tt0825232/">The Bucket List</a> Jack Nicholson and Morgan Freeman play two main characters who respond to their terminal cancer diagnoses by rejecting experimental treatment. Instead, they go on a range of energetic, overseas escapades. Since then, the term “bucket list” – a list of experiences or achievements to complete before you “kick the bucket” or die – has become common. You can read articles listing <a href="https://www.cnbc.com/2023/01/11/cities-to-visit-before-you-die-according-to-50-travel-experts-and-only-one-is-in-the-us.html">the seven cities</a> you must visit before you die or <a href="https://www.qantas.com/travelinsider/en/trending/top-100-guide/best-things-to-do-and-see-in-australia-travel-bucket-list.html">the 100</a> Australian bucket-list travel experiences. <figure><iframe src="https://www.youtube.com/embed/UvdTpywTmQg?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> But there is a more serious side to the idea behind bucket lists. One of the key forms of suffering at the end of life <a href="https://onlinelibrary.wiley.com/doi/10.1002/pon.4821">is regret</a> for things left unsaid or undone. So bucket lists can serve as a form of insurance against this potential regret. The bucket-list search for adventure, memories and meaning takes on a life of its own with a diagnosis of life-limiting illness. In a <a href="https://journals.sagepub.com/doi/10.1177/14407833241251496">study</a> published this week, we spoke to 54 people living with cancer, and 28 of their friends and family. For many, a key bucket list item was travel. <h2>Why is travel so important?</h2> There are lots of reasons why travel plays such a central role in our ideas about a “life well-lived”. Travel is often linked to important <a href="https://doi.org/10.1016/j.annals.2003.10.005">life transitions</a>: the youthful gap year, the journey to self-discovery in the 2010 film <a href="https://www.imdb.com/title/tt0879870/">Eat Pray Love</a>, or the popular figure of the “<a href="https://theconversation.com/grey-nomad-lifestyle-provides-a-model-for-living-remotely-106074">grey nomad</a>”. The significance of travel is not merely in the destination, nor even in the journey. For many people, planning the travel is just as important. A cancer diagnosis affects people’s sense of control over their future, throwing into question their ability to write their own life story or plan their travel dreams. Mark, the recently retired husband of a woman with cancer, told us about their stalled travel plans: "We’re just in that part of our lives where we were going to jump in the caravan and do the big trip and all this sort of thing, and now [our plans are] on blocks in the shed." For others, a cancer diagnosis brought an urgent need to “tick things off” their bucket list. Asha, a woman living with breast cancer, told us she’d always been driven to “get things done” but the cancer diagnosis made this worse: "So, I had to do all the travel, I had to empty my bucket list now, which has kind of driven my partner round the bend." People’s travel dreams ranged from whale watching in Queensland to seeing polar bears in the Arctic, and from driving a caravan across the Nullarbor Plain to skiing in Switzerland. Nadia, who was 38 years old when we spoke to her, said travelling with her family had made important memories and given her a sense of vitality, despite her health struggles. She told us how being diagnosed with cancer had given her the chance to live her life at a younger age, rather than waiting for retirement: "In the last three years, I think I’ve lived more than a lot of 80-year-olds." <h2>But travel is expensive</h2> Of course, travel is expensive. It’s not by chance Nicholson’s character in The Bucket List is a billionaire. Some people we spoke to had emptied their savings, assuming they would no longer need to provide for aged care or retirement. Others had used insurance payouts or charity to make their bucket-list dreams come true. But not everyone can do this. Jim, a 60-year-old whose wife had been diagnosed with cancer, told us: "We’ve actually bought a new car and [been] talking about getting a new caravan […] But I’ve got to work. It’d be nice if there was a little money tree out the back but never mind." Not everyone’s bucket list items were expensive. Some chose to spend more time with loved ones, take up a new hobby or get a pet. Our study showed making plans to tick items off a list can give people a sense of self-determination and hope for the future. It was a way of exerting control in the face of an illness that can leave people feeling powerless. Asha said: "This disease is not going to control me. I am not going to sit still and do nothing. I want to go travel." <h2>Something we ‘ought’ to do?</h2> Bucket lists are also a symptom of a broader culture that emphasises conspicuous <a href="https://www.youtube.com/watch?v=JH_Pa1hOEVc">consumption</a> and <a href="https://productiveageinginstitute.org.au/">productivity</a>, even into the end of life. Indeed, people told us travelling could be exhausting, expensive and stressful, especially when they’re also living with the symptoms and side effects of treatment. Nevertheless, they felt travel was something they “<a href="https://doi.org/10.1080/14461242.2021.1918016">ought</a>” to do. Travel can be deeply meaningful, as our study found. But a life well-lived need not be extravagant or adventurous. Finding what is meaningful is a deeply personal journey. <hr /> Names of study participants mentioned in this article are pseudonyms.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225682/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/leah-williams-veazey-1223970">Leah Williams Veazey</a>, ARC DECRA Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, Professor of Sociology & Director, Sydney Centre for Healthy Societies, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/katherine-kenny-318175">Katherine Kenny</a>, ARC DECRA Senior Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/paris-in-spring-bali-in-winter-how-bucket-lists-help-cancer-patients-handle-life-and-death-225682">original article</a>. </div>

Caring

How music is changing the way dementia patients think

New research has proven that music truly is the universal language, with experts discovering how the power of music is helping those suffering with dementia. Music therapists have shown that music brings dementia patients back to the present, with some even finding their voice thanks to the nostalgic memories of the past. According to Registered Music Therapist and Managing Director of music therapy company Music Beat, Dr Vicky Abad, the power of music is not to be overlooked when it comes to degenerative diseases. “Music is a window into people’s pasts,” she said. “It builds on strengths and abilities against a disease that can strip a person of their dignity, abilities and quality of life.” The team at <a href="https://www.tricare.com.au/">TriCare Aged Care and Retirement</a>, who see the devastating impact of dementia each and every day, also experience first-hand the impact music has on residents, with many noticing “unrecognisable” changes in personality when a nostalgic tune is played. Louis Rose, an 80-year-old dementia patient and TriCare resident, was diagnosed with dementia six years ago, and requires assistance with many aspects of day to day life. However, listening to music is one thing he can enjoy on his own. “I grew up in Mauritius and while we didn’t have a lot, we certainly had music. Listening to music has always been an escape for me and a way to relax,” Mr Rose said. “When your brain starts to slow down and you find yourself forgetting things, it can be quite frustrating and confusing. Listening to music has been a way to distract myself from what’s going on in my head, it has helped me so much.” Tamsin Sutherland is a regular live music performer at TriCare facilities across Queensland, and has been able to witness incredible moments with the residents as they come alive as soon as she starts to play. “Watching residents who are often non-verbal sing along to the words is incredible,” she said “It really is like they are coming back to life and reconnecting with who they once were. To be part of that is quite emotional for me.” According to Dr Abad, music can help prevent the restless behaviour that often leads to pacing and wandering, especially in the evenings, which are often difficult times for those battling the disease. “Sundowning usually occurs in the late afternoon as dusk approaches, a time that is also associated with what used to be a busy time period in people’s lives,” she noted. “Personalised music is a simple and effective tool to help residents feel validated in their emotions during this time and provides them an opportunity to experience a calmer state of mind”. Image credits: Getty Images

Mind

What actually is palliative care? And how is it different to end-of-life care?

<a href="https://theconversation.com/profiles/samar-aoun-1437641">Samar Aoun</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> Although it is associated with dying, palliative care is an approach focused on improving <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405258/#:%7E:text=QOL%20can%20also%20be%20defined,QOL%20(2%E2%80%934).">quality of life</a> – or how people feel about and respond to facing a life-threatening illness. Palliative care aims to prevent and relieve physical, social, emotional, spiritual and existential distress. Palliative care also supports family caregivers during the disease journey and bereavement phase. You might have heard it mentioned for cancer, but it is beneficial for the majority of life-limiting conditions. It has been shown to reduce health-care costs by <a href="https://palliativecare.org.au/publication/kpmg-palliativecare-economic-report/">preventing</a> unnecessary hospital admissions. Palliative care is not voluntary assisted dying. It does not aim to hasten or prolong death. It is not just for people who are about to die and seeking palliative care does not mean “giving up”. In fact, it can be a profound and positive form of care that the World Health Organization (WHO) has <a href="https://www.who.int/news-room/fact-sheets/detail/palliative-care">recognised</a> as a basic human right. But what does it involve? <h2>Not just for someone’s final days</h2> Palliative care is often seen as a “last resort” rather than a service that empowers terminally ill people to live as well as possible for as long as possible. The full benefit of this holistic approach can only be realised if people are referred early to <a href="https://palliativecare.org.au/resource/what-is-palliative-care/">palliative care</a> – ideally from the time they are diagnosed with a terminal illness. Unfortunately, this rarely happens and palliative care tends to blur with <a href="https://www.nia.nih.gov/health/providing-comfort-end-life">end-of-life care</a>. The latter is for people who are likely to die within 12 months but is often left to the last few weeks. <figure><iframe src="https://www.youtube.com/embed/qMbq0fP9kr4?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Palliative is not just for the very end of someone’s life.</figcaption></figure> <h2>Palliative care can involve difficult conversations</h2> Palliative care provides a time to ask some usually taboo questions. What kind of death do you want to experience? Who is in your personal network? How will they respond to your life ending? What kind of support can they offer? Palliative care can be provided at home, hospital, hospice or residential aged care facility, depending on the preference and circumstances of patients and their family carers. In general, patients are referred by their treating specialist, health professional or GP. Patient preferences for care and what matters most to them are discussed with their doctor or other health professionals and with their loved ones with <a href="https://www.advancecareplanning.org.au/">advance care planning</a>. These discussions can include information on their preferred place of care, preferred place of death, personal care needs such as dietary preferences and religious and spiritual practices. This helps those caring to make decisions about the patient care when the patient cannot anymore. However, advance care planning can start at any time in life and without a diagnosis. <h2>How palliative care delivery has changed</h2> Once upon a time, we were born at home and we died at home. Death was a social event with a medical component. Now it is close to the opposite. But research indicates a solely clinical model of palliative care (mainly symptom management funded through the health system) is <a href="https://www.mdpi.com/2227-9032/9/12/1615">inadequate</a> to address the complex aspects of death, dying, loss and grief. A <a href="https://www.phpci.org/">public health</a> palliative care approach views the community as an equal partner in the long and complex task of providing quality health care at the end of someone’s life. It promotes conversations about patients’ and families’ goals of care, what matters to them, their needs and wishes, minimising barriers to a “good death”, and supporting the family post-bereavement. These outcomes require the involvement of family carers, friendship networks and not-for-profit organisations, where more detailed conversations about life and death can happen, instead of the “pressure cooker” rushed environment of hospitals and clinics. Investment could develop stronger <a href="https://pubmed.ncbi.nlm.nih.gov/29402101/">death literacy</a> and grief literacy in the community and among health professionals, who may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312518/#:%7E:text=Some%20struggle%20with%20the%20limitations,lead%20in%20opening%20a%20dialogue">reluctant</a> to raise or discuss these topics. This would likely see the take up of advance care planning increase, from the current low levels of <a href="https://www1.racgp.org.au/newsgp/clinical/advance-care-planning-in-an-ageing-population#:%7E:text=A%20paper%20exploring%20the%20cognitive,advance%20health%20directive%20in%20place.">less than 15%</a> of Australians (<a href="https://theconversation.com/only-25-of-older-australians-have-an-advance-care-plan-coronavirus-makes-it-even-more-important-144354">25% of older Australians</a> accessing health and aged-care facilities). One such successful approach is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720808/">Compassionate Communities Connectors Program</a> in Western Australia, using trained <a href="https://comcomnetworksw.com/compassionate-connectors-program/">community volunteers</a> to enhance the social networks of terminally ill people. Our research trial trained 20 community volunteers (“connectors”) and 43 patients participated over 18 months. In sourcing others to help (who we called “caring helpers”), connectors built the capacity of the community and social networks around patients in need. Caring helpers assisted with transport, collecting prescriptions, organising meals and linked clients to community activities (such as choirs, walking groups, men’s shed). And they helped complete advance care planning documentation. About 80% of patients’ needs were social, particularly around reducing feelings of isolation. Patients in the trial had fewer hospital admissions and shorter hospital stays. <h2>Tailored to need</h2> Palliative care should be tailored to each person, rather than a one-size-fits-all clinical model that doesn’t respect autonomy and choice. Many people are dying in a way and a place that is not reflective of their values and their end-of-life is interrupted with preventable and costly admissions to hospital where control and even dignity are surrendered. Palliative care hospitalisations have <a href="https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/summary">increased</a> in recent years compared to all hospitalisations, with 65% of such admissions ending with the patient dying in hospital. It is unrealistic and unaffordable to have a palliative care service in every suburb. There needs to be a shift to a more comprehensive, inclusive and sustainable approach, such as Compassionate Communities, that recognises death, dying, grief and loss are everyone’s business and responsibility.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/205488/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/samar-aoun-1437641">Samar Aoun</a>, Perron Institute Research Chair in Palliative Care, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-actually-is-palliative-care-and-how-is-it-different-to-end-of-life-care-205488">original article</a>.

Caring

Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts

<a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, <a href="http://www.theconversation.com/">The Conversation</a> Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters. A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions. “Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>. By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns. So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts. Brett Montgomery - GP academic Yes, sometimes – but with great care. I agree that weight stigma is damaging, and insensitively raising weight in consultations can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251566" target="_blank" rel="noopener">hurt people's feelings and create barriers</a>to other aspects of health care. I also agree people can sometimes be “overweight” yet <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0287218" target="_blank" rel="noopener">quite healthy</a>, and that common measures and categories of weight are <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">questionable</a>. On the other hand, I know obesity <a href="https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf" target="_blank" rel="noopener">is associated with</a> heart disease, joint problems, diabetes and cancers. GPs should be ready to help people with their weight when they want help. <a href="https://www.bmj.com/content/377/bmj-2021-069719.full?ijkey=FnARkmvxLOMFvlb&keytype=ref">Our assistance somewhat effective</a>, though sadly dietary efforts often have minimal effect on weight in the long term. Meanwhile, treatments causing larger weight changes (<a href="https://insightplus.mja.com.au/2021/10/bariatric-surgery-public-system-access-still-terrible/">surgery</a> and <a href="https://www.nature.com/articles/s41366-022-01176-2">some medicines</a> are often financially inaccessible. I feel safe discussing weight when my patient raises the issue. Fearing hurting people, I often avoid raising it myself. I focus instead on health rather than weight, discussing physical activity and healthy diet – these are good things for people of any size. Emma Beckett - Nutrition scientist No. It’s not likely to succeed. Large systematic reviews bringing together multiple studies of multiple weight-loss diets show weight loss is not generally maintained long term (<a href="https://pubmed.ncbi.nlm.nih.gov/32238384/">12 months</a> to <a href="https://www.nature.com/articles/0802982">four years</a>). The idea that weight is about willpower is outdated. The current body of evidence <a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">suggests</a> we each have a weight set point that our body defends. This is determined by genetics and environment more so than education. There may be associations between weight and health outcomes, but losing weight <a href="https://theconversation.com/just-because-youre-thin-doesnt-mean-youre-healthy-101185">does not necessarily equate</a> with improving health. Fat stigma and fatphobia are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/">harmful too</a> and can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/">compromise access to health care</a>. Instead, consider asking a better question. Healthy eating reduces disease risk <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/">regardless of weight</a>. So maybe ask how many vegetables are your patients eating. Would they like to see a dietitian to discuss strategies for a better-quality diet? Liz Sturgiss - GP/researcher No. A <a href="https://pubmed.ncbi.nlm.nih.gov/33211585/">US study</a> estimates it would take a family doctor 131% of their work hours to implement all preventive health-care recommendations. It's impossible to address every recommendation for preventative care at every consultation. One of the key skills of a GP is balancing the patient and doctor agenda. <a href="https://www.obesityevidencehub.org.au/collections/treatment/weight-bias-and-stigma-in-health-care">Weight stigma</a> can deter people from seeking health care, so raising weight when a patient doesn't have it on their agenda can be harmful. A strong <a href="https://academic.oup.com/fampra/article/38/5/644/6244494?login=false">therapeutic relationship</a> is critical for safe and effective health care to address weight. Weight is always on my agenda when there is unexpected weight loss. If a patient has rapid weight loss, I am concerned about an undetected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283307/">cancer</a> or infection. Additionally, I am increasingly seeing patients who are unable to afford food, who often have <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">poor oral health</a>, who lose weight due to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12580">poverty</a>. Weight loss for the wrong reasons is also a very concerning part of general practice. Nick Fuller - Obesity researcher Yes. GPs should play a role in the early detection of weight issues and direct patients to evidence-based care to slow this progression. <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Research</a> shows many people with obesity are motivated to lose weight (48%). <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Most</a> want their clinician to initiate a conversation about weight management and treatment options. However, this conversation <a href="https://pubmed.ncbi.nlm.nih.gov/32385580/">rarely occurs</a>, resulting in <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">significant delays to treatment</a>. Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it's still <a href="https://pubmed.ncbi.nlm.nih.gov/25752756/">highly stigmatised</a>in our society and even in the <a href="https://pubmed.ncbi.nlm.nih.gov/23144885/">clinical setting</a>. Sensitivity is required and the wording the clinician uses is important to make the patient feel safe and avoid placing blame on them. Patients often <a href="https://pubmed.ncbi.nlm.nih.gov/20823355/">prefer terms</a> such as “weight” and “BMI” (body mass index) over “fatness,” “size” or “obesity”, <a href="https://pubmed.ncbi.nlm.nih.gov/27354290/">particularly women</a>. Measuring weight, height and waist circumference should be <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">considered routine in primary care</a>. But this needs to be done without judgement, and in collaboration with the patient. Helen Truby - Nutrition scientist Yes. A high body weight contributes to many chronic conditions that negatively impact the <a href="https://www.aihw.gov.au/australias-health/summaries">quality of life and mental health</a> of millions of Australians. Not all GPs feel confident having weight conversations, given the sensitive nature of weight and its stigma. GPs' words matter – they are a <a href="https://doi.org/10.1111/nbu.12320">trusted source</a> of health information. It’s critical GPs gain the skills to know when and how to have <a href="https://doi.org/10.1186/s12875-019-1026-4">positive weight conversations</a>. GPs need to offer supportive and affordable solutions. But effective specialist weight management programs are few and far between. More equitable access to programs is essential so GPs have referral pathways after conversations about weight. GPs' time is valuable. Activating this critical workforce is essential to meet the <a href="https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032?language=en">National Obesity Strategy.</a> <a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, Deputy Editor and Senior Health Editor, <a href="http://www.theconversation.com/">The Conversation</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">original article</a>.

Body

Astonishing report identifies Covid’s alleged “patient zero”

A bombshell report has claimed the infamous Covid-19 "patient zero” was a Wuhan scientist carrying out experiments on souped-up coronaviruses. The scientist in question, Ben Hu, was conducting risky tests at the Wuhan Institute of Virology with two colleagues, Ping You and Yan Zhu, the report states. It is understood that all three suffered Covid-like symptoms and required hospital care weeks before China broke the news of the virus outbreak to the rest of the world. The Sun reported that the name of “patient zero" has never been disclosed until now. Many US government officials have now identified the three scientists in a shocking report by journalists Michael Shellenberger and Matt Taibbi. Writing in the Substack newsletter Public, the pair alleged the scientists were experimenting with coronaviruses when they fell ill in 2019. Several experts and intelligence officials have long suspected scientists at the lab accidentally spread the virus during so-called “gain of function” experiments on bat coronaviruses. The naming of “patient zero” could prove to be the smoking gun, only adding to mounting circumstantial evidence of a lab leak. It is unclear who in the US government had the intelligence about the sick lab workers, how long they had it, and why it was not shared with the public. The Australian journalist and Sky News host Sharri Markson spoke to The Sun about the lab leak theory in 2021 and dubbed it an “explosive development”. Jamie Metzl, a former member of the World Health Organisation advisory committee on human genome editing, described it as a possible “game changer”. “It’s a game changer if it can be proven that Hu got sick with Covid before anyone else,” he said. “That would be the ‘smoking gun’. Hu was the lead hands-on researcher in (virologist Shi Zhengli’s) lab.” DRASTIC, an international team of scientists and sleuths attempting to piece together Covid-19’s origins, researched the three scientists in 2021. The Wuhan Institute of Virology’s website lists Hu’s biography showing he was working as an assistant researcher. He was said to be the “star pupil” of virologist Shi Zhengli — the virologist at the lab who became known as “batwoman” for her research on bat coronaviruses. Markson, the author of What Really Happened in Wuhan, said that Hu was running a state-funded project in 2019 to test if new coronaviruses could infect humans. The study involved souping up the viruses and experimenting with them on humanised mice. However, the results were never published and the study’s existence was erased from the internet as Covid-19 was spreading around the globe, which raised suspicion of a possible lab leak. A source told The Sun that footage from 2017 that was aired by Chinese state-run TV showed Hu working in the lab without protective gear. The same video shows scientists from the Wuhan lab searching for bat viruses with inadequate protective gear. Alina Chan, a molecular biologist at MIT and Harvard, told Public, “Ben Hu is essentially the next Shi Zhengli. “He was her star pupil. He had been making chimeric SARS-like viruses and testing these in humanised mice. “If I had to guess who would be doing this risky virus research and most at risk of getting accidentally infected, it would be him.” She noted, “If this info had been made public in May of 2020, I doubt that many in the scientific community and the media would have spent the last three years raving about a raccoon dog or pangolin in a wet market.” US scientist Dr Steven Quay, “He was always my first choice for one of the infected Wuhan Institute of Virology workers but it seemed too simple.” A bill signed by US President Joe Biden in 2023 called for the release of the names of the sick scientists, their symptoms, and whether they had been involved with or exposed to coronavirus research. The US is currently preparing to release previously classified material, which could include the names of the three Wuhan scientists. Earlier in 2023, FBI director Christopher Wray said, “the FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan”. China has long been accused of attempting to cover up or distort its involvement with Covid-19, but they continue to deny claims. In March 2023, China’s former government scientist confessed the Wuhan lab leak theory shouldn’t be ruled out, sparking uproar in Beijing. Professor George Gao, the former chief of China’s Centre for Disease Control, played a key role in the efforts to trace the origins of Covid-19, insisting scientists should “suspect anything”. Speaking to the BBC Radio 4 podcast Fever: The Hunt for Covid’s Origin, Professor Gao said, “You can always suspect anything. That’s science. “Don’t rule out anything.” Professor Gao retired from the CDC in 2022 after playing a key role in the pandemic response and efforts to find the mysterious origin of the virus. He would have had access to highly classified government information on the outbreak of Covid-19. According to Professor Gao, a formal investigation into the Wuhan Institute of Virology was carried out by a government department. The government scientist claimed the “lab was double-checked by the experts in the field”. Investigators believe scientists were working with the Chinese military to develop a mutant virus and pursue bioweapons just as the pandemic began. The findings followed a team of US investigators who combed through top-secret intercepted communications and research. In 2016, researchers discovered a new fatal type of coronavirus in a mineshaft in Mojiang, Yunnan province. However, they kept it under wraps, with the sample then transported to the Wuhan lab and dubbed as classified work. The virus is the only known immediate relative of Covid-19 known to exist prior to the pandemic. Speaking to The Times, one US investigator said, “The trail of papers starts to go dark. “That’s exactly when the classified program kicked off. “My view is that the reason it was covered up was due to military secrecy related to the army’s pursuit of dual-use capabilities in virological biological weapons and vaccines.” The findings came after a scientist who worked closely with the Wuhan lab claimed the virus was genetically engineered and leaked from the facility. Image credit: Getty

Body

Lucid dying - what some patients experience as they’re going through CPR

A study of people who received cardiopulmonary resuscitation (CPR) in hospital has found that some of them had what’s being dubbed “lucid experiences of death,” accompanied by spikes in brain activity. The research found that roughly one in five CPR survivors described unique experiences, including feeling separated from their bodies, observing the events without pain or distress, and a meaningful evaluation of life. These experiences were different to hallucinations, dreams, or CPR-induced consciousness, according to the researchers, who presented their findings at the American Heart Association’s Scientific Sessions 2022 conference. The international team of researchers collected data on 567 patients whose hearts stopped beating, in UK and US hospitals, between May 2017 and March 2020. While they were all treated immediately, fewer than 10% of these people were ultimately discharged from hospital. In addition to hearing the patients’ experiences, the researchers observed spikes in brain activity – specifically, in so-called gamma, delta, theta, alpha and beta waves. In some cases, these activity spikes were observed when CPR had been going on for up to an hour. “These recalled experiences and brain wave changes may be the first signs of the so-called near-death experience, and we have captured them for the first time in a large study,” says lead investigator Dr Sam Parnia, an intensive care physician and associate professor in the Department of Medicine at New York University Langone Health, US. “Our results offer evidence that while on the brink of death and in a coma, people undergo a unique inner conscious experience, including awareness without distress.” While plenty of people have personal accounts of near-death experiences before, they’re difficult to judge empirically. “These lucid experiences cannot be considered a trick of a disordered or dying brain, but rather a unique human experience that emerges on the brink of death,” says Parnia. It may be linked to disinhibition – the release of barriers in the brain as it shuts down. The researchers are keen to investigate the lucid dying experiences further. This article originally appeared on <a href="https://cosmosmagazine.com/health/lucid-dying-cpr/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Ellen Phiddian. Image: Shutterstock

Mind

Not “your average beanie”: Smart Aussie invention to help stroke and trauma patients

A new ‘smart helmet’ packed with tech is being developed to monitor brains of patients who have suffered a stroke, injury or trauma by a team of Australian scientists and developers thanks to funding from the Victorian government. Patients with these kinds of injuries often experience brain swelling and have parts of their skull removed to prevent the brain from pushing on structures such as the brainstem, the part of the brain that regulates the cardiovascular and respiratory systems, <a href="https://www.urmc.rochester.edu/news/story/brain-drowns-in-its-own-fluid-after-a-stroke" target="_blank" rel="noopener">which can be fatal</a>. The SkullPro, developed by Anatomics Pty Ltd and the CSIRO, is a customised protective helmet that includes sensors that relay data back to the patient’s neurosurgeon to help them determine the best time to repair the skull. With the helmet, the conditions of patients’ brains can be monitored while they recover at home. Neurosurgeons can monitor their brain function in real time thanks to a ‘brain machine interface’ developed using machine learning, advanced sensors and microelectronics. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CDApuNgj68s/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CDApuNgj68s/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Anatomics (@anatomicsrx)</a> </div> </blockquote> Victorian Premier Daniel Andrews announced that Anatomics’ development of the helmet would be among 11 Victorian medical technology products funded through the latest round of MedTech grants. “This isn’t your average beanie. This is a Smart Helmet,” Mr Andrews <a href="https://www.facebook.com/DanielAndrewsMP/posts/pfbid02SJfjW1BcypXz8ubJHtQUTPvG349spbWAch4Eib1nguHedjAH1fFhWg4DaPJ9V5kNl" target="_blank" rel="noopener">wrote</a> on social media. “It helps monitor the brains of patients who've had a stroke or suffered traumatic brain injury. It lets doctors know how the brain is healing and helps surgeons decide on the ideal time to perform operations on the skull to give patients the best possible chance of a full recovery. It's been researched, designed and manufactured right here in Bentleigh East by Anatomics. “It's the kind of technology that doesn't just save lives – it changes lives too.” Mr Andrews added that the series of grants would help support “Victorian innovation” and create jobs. “We're backing Anatomics and 11 other Victorian medical technology manufacturers with a new round of MedTech grants. Creating jobs and supporting Victorian innovation,” the post continued. “That's something we can all get behind.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/B8xqoDDnORs/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/B8xqoDDnORs/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Anatomics (@anatomicsrx)</a> </div> </blockquote> The team developing the SkullPro hope it will lay the foundation for research relating to brain injuries, diagnostics, and treatments in Australia. In a <a href="https://www.anatomics.com/au/news/2020/07/24/smart-skullpro.html" target="_blank" rel="noopener">statement</a>, Professor Paul D’Urso, a neurosurgeon and the founder of Anatomics, said the grant would “greatly benefit brain injured patients throughout the world”. "The recently announced funding through MTPConnect’s BioMedTech Horizons program will allow Anatomics and CSIRO to lay the foundations for advanced diagnostics and therapies for decades to come that will greatly benefit brain injured patients through-out the world,” he said. "We should all be proud of the pioneering R&D (Research & Development) that has already occurred in Australia and the opportunities that this grant will deliver to our future." Image: @anatomicsrx (Instagram)

Mind

You’re less likely to die if you’re treated in your own language

<div> Hospital patients who speak the same language as their physicians end up healthier, according to new research. The study, which was <a href="https://doi.org/10.1503/cmaj.212155" target="_blank" rel="noreferrer noopener">published</a> in the Canadian Medical Association Journal, found that hospital patients had shorter stays and were less likely to die, fall, or catch infections during their treatment if they had a physician speaking their language. The researchers examined medical records for home-care care recipients in Ontario, Canada, between 2010 and 2018. In total, they looked at 189,690 records. A third of Ontario’s population doesn’t speak English as a first language. Among these home-care recipients, 84% were English speakers (Anglophones), 13% spoke French (Francophones) and 2.7% spoke other languages (Allophones). The researchers examined whether these patients were treated by a physician who spoke their first language (language concordant) or didn’t (language discordant). “We found that patients who received language-discordant care had more adverse events (such as falls and infections), longer hospital stays and were more likely die in hospital,” the researchers told Cosmos over email. Francophones treated by a French speaker were 24% less likely to die, while Allophones’ chances of death dropped by 54% when they had language-concordant care. The authors float a few reasons for this disparity. Previous studies have shown that better patient-physician communication leads to faster and more accurate diagnoses, and more patient cooperation – both of which have better health outcomes on average. Language discordance, on the other hand, correlates to cultural differences between patients and healthcare workers, which is typically bad for patients. “These are staggering findings that make a strong case for providing care in the same language for linguistic minorities in hospitals,” says co-author Dr Peter Tanuseputro, a physician scientist in the Department of Medicine of The Ottawa Hospital, Institut du Savoir Montfort and Bruyère Research Institute, Ottawa, Ontario. “It’s clearly easier to convey important information about your health in your primary language. Regardless, the more than doubling in odds of serious harms, including death, for patients receiving care in a different language is eye-opening.” Just 44% of Francophones and under 2% of Allophones received care from physicians who spoke their language. For comparison, 58% of physicians in the study spoke English exclusively. “We expect these disparities to be more pronounced in linguistically diverse populations for the following reason: the odds of receiving care from a physician who speaks your primary language decreases if there are more linguistic groups in the population,” the researchers told Cosmos. “We believe that the results of our study highlight the importance of identifying patients who live in minority language communities so that appropriate strategies can be implemented to increase the provision of language-concordant care to these patients.” This means hospitals should ask patients what languages they speak, establish directories of their staff’s language proficiencies, refer patients to doctors who share their languages, and use professional interpreters. “Furthermore, a healthcare system’s ability to provide language-concordant care depends on the languages spoken by physicians, which should match that of the general population,” say the researchers. “This could be optimised by recruiting physicians with specific language proficiencies, and by dedicating resources to increase opportunities for medical education among minority language communities.” Image credits: Getty Images </div> <div id="contributors"> This article was originally published on <a href="https://cosmosmagazine.com/health/language-hospitals-care/" target="_blank" rel="noopener">cosmosmagazine.com </a>and was written by Ellen Phiddian. </div>

Mind

Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

Healthcare workers in New Zealand already face life-and-death decisions daily. But as multiple winter illnesses add pressure to a system already stretched by COVID, staff now also have to deal with <a href="https://www.stuff.co.nz/national/politics/local-democracy-reporting/300534812/covid19-union-and-frontline-worker-say-staff-at-middlemore-hospital-facing-increasing-abuse" target="_blank" rel="noopener">daily abuse</a>, acute <a href="https://www.newshub.co.nz/home/new-zealand/2022/05/christchurch-hospital-cancels-surgeries-as-it-hits-112-pct-capacity.html" target="_blank" rel="noopener">staff shortages</a> and <a href="https://www.1news.co.nz/2022/06/17/dhb-clashes-with-union-over-stretched-palmerston-north-ed/" target="_blank" rel="noopener">unsafe working conditions</a>. At times, they cannot provide the care they would like for their patients. The impact on health workers is often described as <a href="https://www.nzherald.co.nz/rotorua-daily-post/news/great-minds-health-workers-on-covid-19-frontlines-burnt-and-bled-by-two-years-of-virus/T7JXOXGXEKKCICUNOMUJYT4QWM/" target="_blank" rel="noopener">stress and burnout</a>. The consequences of this prolonged pressure can be seen in the number of <a href="https://www.nzdoctor.co.nz/article/undoctored/acem-welcomes-111b-health-nz-budget-urges-fixes-health-workforce-crisis" target="_blank" rel="noopener">doctors</a>, <a href="https://www.nzherald.co.nz/nz/nursing-shortage-nurses-broken-while-sector-faces-thousands-of-vacancies/L7NUXOPG4AB472OKXOH5QJSUMU/" target="_blank" rel="noopener">nurses</a> and other <a href="https://capsulenz.com/be/therapist-shortage-nz/" target="_blank" rel="noopener">health professionals</a> leaving their jobs for overseas positions and the private sector, or being lost to their professions completely. Many of these healthcare workers may well be suffering from a more serious form of psychological distress than burnout: moral injury. <a href="https://www.phoenixaustralia.org/wp-content/uploads/2020/07/Moral-Stress-Healthcare-Workers-COVID-19-Guide-to-Moral-Injury.pdf" target="_blank" rel="noopener">Moral injury</a> refers to the psychological, social and spiritual impact of events on a person who holds strong values (such as caring for patients) and operates in high-stakes situations (hospital emergency care), but has to act in a way inconsistent with those values. Examples include having to turn patients away despite them being in pain or discomfort; being unable to provide adequate care due to staff shortages; having to care for a dying patient isolated from their loved ones while wearing full protective gear. Symptoms of moral injury can include strong feelings of guilt and shame (about not being able to uphold healthcare values, for example) as well as high levels of anger and contempt towards the system that prevents proper care. High levels of self-criticism, loss of trust in people and organisations and a weakening of personal relationships are further <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00113-9/fulltext" target="_blank" rel="noopener">symptoms</a> of moral injury. It can be viewed as a <a href="https://www.afta.org/wp-content/uploads/2019/07/Physicians-aren%E2%80%99t-%E2%80%98burning-out.%E2%80%99-They%E2%80%99re-suffering-from-moral-injury..pdf" target="_blank" rel="noopener">more severe form of burnout</a>. But while burnout can happen in most workplaces, moral injury requires the three core components listed above. From war to the operating table The term moral injury arose in <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp" target="_blank" rel="noopener">military psychology</a> to refer to situations where, for example, soldiers were unable to intervene to save lives in case they risked breaching the rules of engagement. More recently, the term has been adapted to apply to healthcare. Viewing the experiences of health workers through this lens can help us understand why they may experience a seesawing emotional state and the confusing conflict of simultaneously wanting to be at work while wishing they were anywhere but. For healthcare workers, understanding the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752815/#:%7E:text=Over%20time%2C%20these%20repetitive%20insults,is%20in%20some%20way%20deficient" target="_blank" rel="noopener">concept of moral injury</a> may help reframe it as something that is happening to them rather than because they don’t have the skills to cope. The latter can sometimes be a mistaken implication of the term burnout. <figure class="align-center "><img src="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Exhausted nurse" /><figcaption>Staff shortages can take health workers beyond exhaustion and burnout. Getty Images</figcaption></figure> While healthcare workers are largely at the mercy of the organisations they work for, there are some steps individuals can take to alleviate moral injury. Firstly, simply recognising they may be suffering from this condition can reduce confusion and validate their experiences. Secondly, reconnecting back to an individual’s values and beliefs can help refocus and re-energise, at least temporarily. Reminding themselves why they got into this job in the first place is a useful place to start. Organisational responses Organisations and businesses must play a lead role in preventing and treating moral injury. Many of the factors leading to it (lack of resources or staff, a pandemic or peak flu season) are outside the control of individuals. Most modern businesses will be aware they have a legal responsibility under the 2015 <a href="https://www.legislation.govt.nz/act/public/2015/0070/latest/DLM5976660.html" target="_blank" rel="noopener">Health and Safety at Work Act</a> to look after their employees’ mental and physical well-being. At a high level, organisations can advocate for systemic change and increases in funding and resourcing, where needed. But these higher-level changes take time to achieve. In the meantime, it is important healthcare workers are protected and supported. Broad steps an organisation can take to prevent or reduce moral injury include removing the burden of difficult ethical decisions from frontline workers and instead adopting evidence-based policies to guide an organisation-wide response. Where possible, rotating staff between high and low-stress environments may help. Providing funding for workers to access professional psychological supervision is another practical step businesses can consider. At a team level, it can be helpful to have leaders who are visible, validating and can help make sense of the moral conflict. Leaders can also play a role in keeping alive professional values and modelling their own struggles with the situation. The general public also has a role to play in supporting healthcare workers. Any steps we can take to protect our own health and thereby reduce pressure on the system can have a cumulative effect on the well-being of doctors, nurses and allied health clinicians. The health of our nation rests with those who work in this field and it is in all our interest that their health is protected and prioritised.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/185485/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dougal-sutherland-747623" target="_blank" rel="noopener">Dougal Sutherland</a>, Clinical Psychologist, <a href="https://theconversation.com/institutions/te-herenga-waka-victoria-university-of-wellington-1200" target="_blank" rel="noopener">Te Herenga Waka — Victoria University of Wellington</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/moral-injury-what-happens-when-exhausted-health-workers-can-no-longer-provide-the-care-they-want-for-their-patients-185485" target="_blank" rel="noopener">original article</a>. Image: Getty Images

Caring

Cancer patients go untreated due to hospital debts

A cancer centre in Palestine is turning away patients for the first time in its history, with some 500 patients turned away since September last year for one reason - it’s owed $96 million ($NZ 105 million). The cancer unit in the Augusta Victoria Hospital in eastern Jerusalem is owed the funds from the Palestinian Authority (PA) and is unable to buy the chemotherapy drugs needed to treat patients, according to the <a href="https://www.bbc.com/news/world-middle-east-60829319" target="_blank" rel="noopener">BBC</a>. “It’s the first time in our history that we’ve been forced to take the decision not to accept new patients,” Dr Fadi al-Atrash, the hospital’s deputy CEO, told the BBC. “We’re facing a very critical situation where we might be forced to close some departments in future. We might have to stop the treatment of patients already in our care. “It means that more people might die of cancer because they’re not receiving their treatment on time, or according to the right schedule.” A lack of funds for healthcare isn’t the only problem for the PA, which says it’s facing the worst financial crisis since it began 30 years ago, due to a combination of the pandemic, inflation and the Palestinian conflict with Israel. Salem al-Nawati, a 16-year-old with leukaemia from Gaza, collapsed outside the PA Health Ministry in Ramallah earlier in the year and was declared dead soon after. His uncle, Jamal al-Nawati, was fighting to secure a hospital bed for Salem, and detailed the barriers his nephew faced in accessing treatment. Since hospitals in Gaza are ill-equipped to treat many serious cases of cancer, Salem was given a medical referral and PA financial guarantee for treatment in a private hospital in Nablus. However, after being initially refused a travel permit by Israel, Salem arrived for treatment a month later and was turned away from the Nablus hospital because its bills hadn’t been paid by the PA. “I was wondering what we’d done wrong, what had this poor patient ever done?” Mr al-Nawati said. “Salem’s condition was deteriorating hour-by-hour, day-by-day. He was so sad, asking me why he was being refused treatment, and I was doing my best to reassure him.” Though an influential family friend intervened, resulting in the PA offering to send Salem to an Israeli hospital, his permit didn’t allow him to travel there. Image: Getty Images

Caring

Some Covid patients develop resistance to Sotrovimab treatment

As treatments continue to be developed for patients with COVID-19, some scientists have found that one in particular may cause the virus to mutate so that it becomes harder to treat. A team of Australian researchers analysed samples from the first 100 people to be treated with Sotrovimab - an increasingly popular treatment that targets the Omicron variant and prevents severe COVID-19 symptoms - only to make some interesting findings. They took samples from the patients before and after they were treated with Sotrovimab and sequenced the genome of the virus in each sample. In four of the patients, the team found that the virus had mutated in ways that made it more resistant to treatment within 13 days of treatment. “We discovered that the virus that causes COVID-19 can develop mutations within the patient several days after Sotrovimab treatment, which reduces the effectiveness of this treatment by greater than 100-fold,” Dr Rebecca Rockett, a Sydney researcher in infectious disease and co-author of the study, <a href="https://www.scimex.org/newsfeed/covid-19-patients-can-develop-resistance-to-treatment-with-sotrovimab" target="_blank" rel="noopener">said</a>. This research, published in the <a href="https://www.nejm.org/doi/10.1056/NEJMc2120219" target="_blank" rel="noopener">New England Journal of Medicine</a>, is the first to show the mutations in clinical models, with previous research finding the mutations developed in animal models and when growing the virus in a lab setting. With this finding, the researchers are calling for the use of Sotrovimab to be monitored to prevent treatment-resistant versions of the virus from spreading in the community. “Resistant virus samples could be readily grown in the laboratory, a marker that individuals who develop resistance may transmit the resistance virus to others,” said Professor Vitali Sintchenko, the study’s senior author and a fellow researcher in infectious disease. “(Sotrovimab) is the only one (treatment) we have evidence against so far, but we need to be more on the front foot in terms of efficacy,” Dr Rockett told <a href="https://7news.com.au/news/coronavirus/australian-covid-19-patients-developed-resistance-to-antiviral-drug-as-virus-mutates-within-days-of-first-treatment-study-finds--c-6001171" target="_blank" rel="noopener">7News</a>. “I don’t think the infrastructure is in place to capture the resistance. We need better surveillance.” Since the research was published, GSK, the manufacturer of Sotrovimab, has confirmed that the study’s findings were consistent with the company’s large clinical studies. “Resistance is also seen in studies for other COVID-19 monoclonal antibodies and oral treatments, and relates to how the immune system interacts with the virus,” a spokesperson said, per 7News.com.au. “This report does not change the positive benefit-risk of sotrovimab for use in the treatment of mild to moderate COVID-19 in patients at high risk of progression.” Image: Getty Images

Body

“We can’t leave”: Russians accused of holding hospital staff and patients “hostage”

Officials of Ukraine’s besieged city Mariupol <a href="https://www.news.com.au/world/russia-ukraine-war-updates-mariupol-hospital-staff-patients-taken-hostage/news-story/290f75e5198aed84789d7d8d27c3bc67" target="_blank" rel="noopener">have claimed</a> that 400 hospital staff and patients have been taken as “hostages” by Russian forces. “We received information that the Russian army captured our biggest hospital,” Sergei Orlov, Mariupol’s deputy mayor, <a href="https://www.bbc.com/news/world-europe-60757133" target="_blank" rel="noopener">told the BBC</a>. Pavlo Kirilenko, the head of the Donetsk Regional Military Administration, took to Facebook to share an account from a hospital employee who managed to communicate with authorities. “Russian occupiers in Mariupol took doctors and patients hostage,” Mr Kirilenko <a href="https://www.facebook.com/pavlokyrylenko.donoda/posts/506102444405648" target="_blank" rel="noopener">wrote</a>. “One of the hospital employees had time to pass this news. “‘It is impossible to get out of the hospital. There is heavy shooting, we sit in the basement. Vehicles have not been able to drive to the hospital for two days. “‘The Russians forced 400 people from neighbouring houses to come to our hospital. We can’t leave’.” Mr Kirilenko added that the hospital had been “practically destroyed” by the Russian forces, but that staff have continued to work and treat patients in the basement. “I appeal to international human rights organisations to respond to these vicious violations of the norms and customs of war, to these blatant crimes against humanity,” he said. “Russia and every citizen involved in crimes in Ukraine must be punished!” Mr Kirilenko said the hospital holding the “hostages” was the same one that was damaged by a strike last week, as Mariupol continued to suffer constant shelling. Russian troops have surrounded the city for nearly two weeks, with gas, running water and electricity cut off to the estimated 350,000 residents trapped there. The local council said about 2,000 cars left the city on Tuesday, with 2,000 others waiting to leave. However, as food and medical supplies dwindle, no aid has been allowed in. Image: Getty Images

Legal

Doctor makes international headlines for unusual note on patient's chart

A Canadian doctor who cited climate change on a patient’s medical chart and attracted worldwide attention has now clarified what he meant by doing so. During a heatwave in Nelson, British Columbia, in late June, a 70-year-old woman’s health deteriorated, and GP Dr Kyle Merritt believed that extreme weather conditions during the North American summer were a contributing factor. The woman was already suffering from diabetes and heart failure, and lived in a caravan with no air conditioning, during a heatwave that would come to be known as the <a rel="noopener" href="https://www.timescolonist.com/bc-news/bcs-chief-coroner-reveals-city-death-tolls-due-to-heat-wave-4710606" target="_blank">hottest and deadliest</a> in Canadian history. Speaking to <a rel="noopener" href="https://au.news.yahoo.com/doctor-reveals-why-he-wrote-climate-change-on-patients-medical-chart-023010837.html?guccounter=1" target="_blank">Yahoo News</a>, Dr Merritt said, “Oftentimes it's vulnerable patients that are the most affected. It’s people who don't have air conditioning in their homes in the case of the heat dome, or live in places where they can’t get away from the wildfire smoke. ‘ “To see a patient affected that way and being forced to come in and get admitted to hospital because where they're living is not really safe for them anymore, I found it upsetting. “ wanted to think about the the underlying factors that were driving (her deterioration), so that's why I wrote it down.” Dr Merritt clarified that he only mentioned climate change on one patient’s chart, as he believed it “had to be part of the reason” his 70-year-old patient was admitted to the emergency room. He said he “wasn’t trying to make a big deal out of it”, but felt that it was important for both him and his colleagues to “recognise the truth” and acknowledge the contributing factor of climate change on people’s ill health. While some headlines have claimed he diagnosed a patient with ‘climate change’, Dr Merritt confirmed that this was not the case, as "climate change is not a medical condition”, but merely a contributing factor which can worsen existing illnesses, much like exposure to any extreme temperatures or weather conditions can worsen people’s health. He explained, “The diagnosis has to be a specific medical condition that's recognised as a medical condition. As physicians, we can’t just start making things up, of course we work within a medical framework." The links between climate change and people’s health are already well documented, with the <a rel="noopener" href="https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health" target="_blank">World Health Organisation</a> describing climate change as the “biggest health threat facing humanity”. The WHO predicts that between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, primarily from malnutrition, diarrhoea, and heat stress. This is because climate change severely impacts the social and environmental determinants of health - clean air, safe drinking water, sufficient food and secure shelter. Without these basic necessities, it becomes incredibly difficult for people to maintain good health. Dr Merritt told Yahoo that he hopes that in the coming years, GPs will seek to recognise the impact of climate change on the health of their patients. He said, “In a lot of places, and certainly in my corner of the world, we're starting to see the direct impacts of climate change on human health. “It’s always difficult to make the link, but it's got a lot more clear as time has gone on.”

Caring

Patient zero of Black Death found

New evidence has suggested a man who died 5300 years ago in Latvia was infected with the earliest-known strain of the plague that caused the Black Death. Waves of the plague swept through Europe for several centuries from the 1300s, causing millions of deaths. “Up to now this is the oldest-identified plague victim we have,” Dr Ben Krause-Kyora of the University of Kiel in Germany said of the remains. The man was buried with three others at a Neolithic burial site in Latvia near the River Salac, which connects to the Baltic Sea. The research, published in Cell Reports, involved the sequencing of the DNA from the bones and teeth of the four individuals. <img style="width: 500px; height:375px;" src="https://oversixtydev.blob.core.windows.net/media/7842261/60da287e1477f300188c82ae.jpg" alt="Dominik Göldner / BGAEU" data-udi="umb://media/1f7ae3fb0a0c41a49c6b87ea085cbef8" /> When the bodies were tested for bacteria and viruses, the researchers were surprised to find one hunter-gatherer - a man in his twenties - was infected with an ancient strain of the plague, caused by the Yersinia pestis bacterium. “He was most likely bitten by a rodent, got the primary infection of Yersinia pestis and died a couple of days [later] - maybe a week later - from the septic shock,” said Dr Krause-Kyora. The researchers suggest that this strain appeared about 7000 years ago at the same time that agriculture started to appear in central Europe. They also believe the bacterium may have sporadically jumped from animals to humans and that it became better at infecting humans over time, evolving into the form known as the bubonic plague. The research has been welcomed by other experts, though it doesn’t rule out the hypothesis that the disease was spreading throughout Europe at the time. Though the disease is still around today, it is treatable with antibiotics if caught early. Images: Dominik Göldner / BGAEU

Body

Nurse swipes credit card from dead patient and USES it in vending machine

UK healthcare worker, Ayesha Basharat, has been slammed as she stole a dead patient's card and used it at the hospital's vending machine. She had taken an 83-year-old woman's card from her room in the heartlands Hospital's COVID-19 ward and used the card six times at the vending machine, making contactless payments. Basharat had stolen the card from the woman just moments after she died on January 24th, according to <a rel="noopener" href="https://west-midlands.police.uk/news/hospital-worker-used-dead-patients-bank-card-buy-sweets-and-fizzy-pop?fbclid=IwAR0zaC47A9DaQWcq_aaGVGjmJOOV9ccbobeGBpAjHpu-SHpTsADEfOmeqso" target="_blank">West Midlands Police</a>. Police caught up to her after she continued to use the credit card despite the family of the woman cancelling it. Basharat has been given two concurrent jail terms of five months each, both of which were suspended for 18 months. Detective Constable Andrew Snowdon said the act was an "abhorrent breach of trust". “This was an abhorrent breach of trust and distressing for the victim’s family," he said. “They were having to come to terms with the death of a loved one from Covid when they found the bank card missing – and then of course the realisation that the card was taken by someone who should have been caring for her. “I wish the family all the best for the future and with this conviction hope they can move on from this upsetting episode.”

Legal

Doctor's incredible $800,000 gesture to cancer patients

A doctor from the US has helped out 200 of his former patients by forgiving their medical debts, as he plans to close his practice this year. Oncologist Dr Omar Atiq plans to shut his practice, The Arkansas Cancer Clinic, down in March this year, after serving the community for close to 29 years. After closing up shop, Dr Atiq tried to collect payments from some of his former patients but didn't get very far. Speaking to Good Morning America, he revealed some people were unable to cover their debts, so after a discussion with his wife, they decided to forgive the debts of some 200 of his former clients. "We saw that we could do it and then just went ahead and did it," he said. Dr Atiq's patients received a greeting card the week of Christmas, explaining their debt had been paid for and that the Arkansas Cancer Clinic "was proud to serve you as a patient". “Although various health insurances pay most of the bills for majority of patients, even the deductibles and co-pays can be burdensome,” the card said. “Unfortunately, that is the way our health care system currently works. Arkansas Cancer Clinic is closing its practice after over 29 years of dedicated service to the community. “The clinic has decided to forego all balances owed to the clinic by its patients.” In the end, Dr Atiq ended up erasing US$650,000, or roughly AU$842,000, of his patient's debt and explained ever since he opened up his practice, the thought of his sick patients worrying about money made him uneasy. "I saw patients over the years who just didn’t have anything or who went bankrupt trying to pay for their treatment," he told Good Morning America. "In many ways it seems like a totally unfair situation." Good Morning America reported Dr Atiq is now working at the University of Arkansas for Medical Sciences in Little Rock.

Money & Banking

“Major breakthrough”: Scientists find new drug to save COVID-19 patients’ lives

A cheap and widely accessible steroid called dexamethasone has become the first drug that has been shown to save lives among COVID-19 patients. Scientists have hailed it as a “major breakthrough” after trials showed that the drug reduced death rates by around a third of the most severely ill COVID-19 patients admitted to hospital. Dexamethasone is used to reduce inflammation in other diseases and the success of the drug suggest that it should immediately become standard care in patients with severe cases of the pandemic disease. “This is a result that shows that if patients who have COVID-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost,” said Martin Landray, an Oxford University professor co-leading the trial. “It’s going to be very hard for any drug really to replace this, given that for less than STG50 ($A90) you can treat eight patients and save a life,” he told reporters in an online briefing. Co-lead investigator Peter Horby said that dexamethasone was “the only drug that’s so far shown to reduce mortality and it reduces it significantly”. “It is a major breakthrough,” he said. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.” There are currently no approved treatments or vaccines for COVID-19, a disease that has killed more than 431,000 globally. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” Horby said.

Caring

"Save it for younger patients. I already had a good life”

A 90-year-old coronavirus patient has died in Belgium after selflessly refusing a ventilator and instructing doctors to “keep this for the younger” patients. Suzanne Hoylaerts from Binkim, near Lubbeek, was admitted to hospital on March 20 when her condition began rapidly deteriorating due to contracting COVID-19. Currently, there is a global shortage of ventilators as the number of coronavirus cases increase. The equipment is key to help fight the battle against the respiratory disease. Hoylaerts sought medical attention after suffering from a lack of appetite and shortness of breath. She was admitted to hospital where she tested positive for the virus and was placed in isolation, meaning her daughter was unable to visit. She reportedly told doctors at the hospital: “I don’t want to use artificial respiration. Save it for younger patients. I already had a good life.” Hoylaerts passed away two days later, on March 22. Speaking to Dutch newspaper Het Laatste Nieuws, her distraught daughter Judith said: “I can’t say goodbye to her, and I don’t even have a chance to attend her funeral.” Judith said her family were baffled as to how their mother could have contracted the virus as she had stayed at home and was complying carefully with lockdown measures. Belgium has now recorded 705 deaths according to the latest official toll.

Caring

A real princess: Duchess Kate’s special tea party for cancer patients melts hearts everywhere

It was a scene many young children have imagined- a princess tea party with a real life princess. Duchess Catherine attended an important tea party set up for her at the Shaukat Khanum Memorial Cancer Hospital during the Duke and Duchess of Cambridge’s Royal Tour in Pakistan. The mother of three happily obliged to wear a toy tiara when she visited 7-year-old Wafia Rehmani, while Prince William playfully sipped out of a tiny pink cup “brimming” with hot tea. The young patient, from over the border in Afghanistan, is battling a kidney tumour but hopes to be a doctor when she grows up. Wafia showed the Duke and Duchess her own toy medical kit. Princess Diana visited the same hospital over 20 years ago in 1996 and 1997. <blockquote style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" class="instagram-media" data-instgrm-permalink="https://www.instagram.com/p/B3tCIhCFRfS/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="12"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"></div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"></div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"></div> </div> </div> <div style="padding: 19% 0;"></div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"></div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" rel="noopener" href="https://www.instagram.com/p/B3tCIhCFRfS/?utm_source=ig_embed&utm_campaign=loading" target="_blank">A post shared by Kensington Palace (@kensingtonroyal)</a> on Oct 16, 2019 at 8:07pm PDT </div> </blockquote> Earlier in the day, the Duke and Duchess of Cambridge visited the Badshahi Mosque inside the Walled City for an interfaith meeting to talk about promoting harmony and community. The royal couple also stopped by the National Cricket Academy in Lahore and both stepped up to the pitch. Prince William even managed to hit the ball for a six. The Duchess of Cambridge also gave her first speech of the tour at SOS Children's Village in Lahore, speaking parts of it in Urdu.

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Dental staff fired for mocking cancer patient’s private diary

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You’re less likely to die if you’re treated in your own language

Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

Cancer patients go untreated due to hospital debts

Some Covid patients develop resistance to Sotrovimab treatment

“We can’t leave”: Russians accused of holding hospital staff and patients “hostage”

Doctor makes international headlines for unusual note on patient's chart

Patient zero of Black Death found

Nurse swipes credit card from dead patient and USES it in vending machine

Doctor's incredible $800,000 gesture to cancer patients

“Major breakthrough”: Scientists find new drug to save COVID-19 patients’ lives

"Save it for younger patients. I already had a good life”

A real princess: Duchess Kate’s special tea party for cancer patients melts hearts everywhere