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IntroductionGeorge Floyd’s death in 2020 galvanised large protests around the country, including the emergence of the Capitol Hill Autonomous Zone (CHAZ) in Seattle, Washington, a non-policed, organised protest region that may have differing injury risks than other regions. We sought to quantitatively describe characteristics of injuries related to protests documented at visits to two nearby major emergency departments, including the only Level 1 trauma centre in the state.MethodsUsing the International Classification of Diseases, 10th Revision code inclusion criteria, we identified 1938 unique patient visits across the two emergency departments from 29 May 2020 and 1 July 2020. We reviewed provider notes to identify keywords to determine if the visit was related to the CHAZ protest. We quantitatively described demographics and injury characteristics.ResultsWe identified 48 injury visits related to the protest, with 25 from assault, 11 from crowd-control weapons and 8 from ground-level falls. Crowd-control weapons consisted of five visits from pepper spray, five from tear gas and a smaller number from flash-bang grenades, rubber bullets or other projectiles or a baton. In terms of body region injuries, 23 involved the head, 13 involved the knee and lower leg and 11 involved the thorax. Five patients required transfer to the operating room for surgery and admission and two died.DiscussionThe demonstrations during the CHAZ in Seattle in 2020 resulted in several violent injuries. Given the high proportion of assault and head injuries, these injury patterns can help prepare healthcare workers and first responders to plan care needs during protests.

Background Concern about burnout has prompted increased attention on fostering physician resilience throughout the educational continuum. Studies indicate that lack of meaning-making and connection (domains of spiritual wellbeing) place physicians at risk for burnout. While evidence support including spiritual care in comprehensive patient care to help patients/families heal from impactful experiences, few studies explore physicians’ spiritual wellbeing as they routinely confront suffering and death in their daily work. Storytelling taps into spiritual aspects of human experience. This study, unique in the literature, examined the stories physicians chose to tell about spirituality and medicine over 20-years, from trainee to practicing physician, to explore how these experiences impact professional development and wellbeing. Methods Design:  Qualitative individual interview study – secondary analysis of a rich dataset of physician interviews, gathered over 20-years beginning in first-year residency, regarding attitudes and approach to spiritual care. For this new study, researchers extracted and analyzed the previously unexplored stories participants spontaneously told during interviews. Setting : Participants completed the same USA residency program and now practice throughout USA and Canada. Participants: In study-year 1, all residents (PGY1,2,3) participated; response rate (RR) 97%, reflected a diversity of personal beliefs (atheist to religious). Researchers followed the PGY1 class for 20-years (2001–2020), interviewing them in study-years 1, 3, 11 and 20 (RR 100%, 100%, 97%, 54%). Data Collection : Researchers extracted stories from interview transcripts. Analysis: 4 researchers analyzed 204 stories from 66 interviews with 34 physicians, using grounded theory. Results Irrespective of personal spiritual beliefs, trainees and practicing physicians told numerous spirituality-related stories. Longitudinal story themes—(1) Dissonance to Integration, (2) Formation and Transformation, and (3) Accidental to Purposeful Healing – reflected physicians’ ongoing spiritual journeys as they grappled with meaning, values, purpose, and connection in their daily work. Spiritually impactful moments, whether distressing or uplifting, occurred throughout physicians’ careers influencing professional/personal development, resilience and clinical approach. Spiritual practices (religious/secular) and reflection fostered healing for patients/families and physicians. Conclusion Physicians’ longitudinal spiritual-care stories provide new insights into their professional/personal development. Reflection on spiritually impactful moments, both distressing and uplifting, may trigger transformative learning towards meaning-making, resilience, burnout prevention and positive physician identity formation.

Background Evidence supports classifying spiritual health as a determinant of health and including spiritual care in comprehensive patient-centered care. Despite delineation of primary versus specialty palliative skills, including spiritual care, and availability of spiritual history/assessment communication tools designed for non-specialist (SH/SAs), medical teams continue to neglect patients’ spiritual needs. A possible contributor is that consolidated evidence regarding uses and/or effectiveness of these SH/SA tools is lacking. Aim To explore interest, applications and evaluations of one of the well-known SH/SA tools - the HOPE spiritual assessment. Methods We conducted a scoping review following Arksey and O’Malley’s protocol and PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched PubMed, Web-of-Science, Google Scholar, PsycInfo, Academic Search Premier, CINAHL, Atla Religion Database, with AtlaSerials and SocIndex, for all sources citing the original 2001 HOPE article (to July 2023); no restrictions on article type, location, language. We used tiered inclusion/exclusion criteria, corresponding to our specific research questions regarding interest, applications and evaluations of HOPE. Results Of 1,047 unique sources, 909 underwent full-text review. 571 explicitly mentioned/cited HOPE, representing 51 countries, 21 languages, and multiple disciplines including: 55% medicine, 15% nursing, 7.5% psychology, 6% chaplaincy, 5% social work. 266 sources offered expert opinions about HOPE. 63 described specific experience using and/or evaluating HOPE; 17 from non-English speaking countries. 59 demonstrated acceptability, 34 feasibility, 30 content validity. Of the 31 formal studies/evaluations, 17 intervention studies of HOPE demonstrated validity as a clinical, educational, or qualitative research tool, and 14 studies analyzed the HOPE model itself, with 10 comparing SH/SA tools. In these comparisons, HOPE rated highly, as did some others. HOPE’s comparative strengths include: acceptability for diverse (secular/religious/multicultural) populations; adaptability across clinical settings; flexibility for use by novice and expert clinicians. Conclusion This first systematically constructed review of any of the well-known SH/SA tools revealed broad, international interest in HOPE and evidence for its acceptability, feasibility, and validity in diverse settings. Next steps for improving patient-centered spiritual care include: disseminating evidence; clarifying spiritual care competencies/boundaries for different disciplines/settings; increasing required primary spiritual care training; increasing availability of spiritual care specialists; and improving clinical systems to support whole-person care.