Moral Injury: How It Affects Us and Tools to Combat It.

Introduction: Moral injury comprises feelings of guilt, despair, shame, and/or helplessness from having one's morals transgressed. Those underrepresented in health care are more likely to experience moral injury arising from micro- and macroaggressions. This workshop was designed for interprofessional health care providers ranging from students to program leadership to raise awareness about moral injury and provide tools to combat it. Methods: This 75-minute interactive workshop explored moral injury through a health care lens. It included components of lecture, case-based learning, small-group discussion, and individual reflection. Participants completed anonymous postworkshop evaluations, providing data on satisfaction and intention to change practice. We used descriptive statistics to analyze the quantitative data and applied content analysis to the qualitative data. Results: The workshop was presented at two local academic conferences. Data were collected from 34 out of 60 participants, for a response rate of 57%. Ninety-seven percent of participants felt the workshop helped them define and identify moral injury and was a valuable use of their time, as well as indicating they would apply the information learned in their daily life. One hundred percent would recommend the workshop to a friend or colleague. Almost half felt they could implement strategies to address moral injury after participating in the workshop. Discussion: This workshop proved to be a valuable tool to define and discuss moral injury. The materials can be adapted to a broad audience.

"Now I Feel a Little Bit More Secure": The Impact of SNAP Enrollment on Older Adult SSI Recipients.

In June 2019, California expanded Supplemental Nutrition Assistance Program (SNAP) eligibility to Supplemental Security Income (SSI) beneficiaries for the first time. This research assesses the experience and impact of new SNAP enrollment among older adult SSI recipients, a population characterized by social and economic precarity. We conducted semi-structured, in-depth interviews with 20 SNAP participants to explore their experiences with new SNAP benefits. Following initial coding, member-check groups allowed for participants to provide feedback on preliminary data analysis. Findings demonstrate that SNAP enrollment improved participants' access to nutritious foods of their choice, contributed to overall budgets, eased mental distress resulting from poverty, and reduced labor spent accessing food. For some participants, SNAP benefit amounts were too low to make any noticeable impact. For many participants, SNAP receipt was associated with stigma, which some considered to be a social "cost" of poverty. Increased benefit may be derived from pairing SNAP with other public benefits. Together, the impacts of and barriers to effective use of SNAP benefits gleaned from this study deepen our understanding of individual- and neighborhood-level factors driving health inequities among low-income, disabled people experiencing food insecurity and SNAP recipients.

Acute myopericarditis in an adolescent mimicking acute myocardial infarction.

Acute myopericarditis is primarily a pericarditic syndrome with variable myocardial involvement, as evidenced by elevated cardiac enzymes. It is a rare entity, exclusively seen in male adolescents and accounts for less than 2% of the cases of inpatient admissions for chest pain/pericarditis in the pediatric age group. The electrocardiographic changes of pericarditis include J point/ST segment elevation, which needs to be differentiated from the benign early repolarization pattern that is common in young adolescents and the subtle anterior ST segment elevation myocardial infarction. Differentiating acute myopericarditis from acute coronary syndromes can be challenging because they share the presenting triad of acute chest pain, ST segment changes, and elevated cardiac enzymes. The accurate distinction of myopericarditis from acute myocarditis or acute coronary syndrome is important because of their differences in risk for specific complications, prognosis, and treatment implications. We present a case of acute myopericarditis in an adolescent who presented with atypical precordial chest pain, accompanied by inferolateral focal electrocardiographic changes and significant elevation of cardiac enzymes. The differential diagnosis and management of myopericarditis is reviewed with a focus on electrocardiographic changes and troponin assays.

Severe failure to thrive in infant.

Failure to thrive in an infant has multiple etiologies and at times, is only manifestation of underlying serious disease. Bartter syndrome is a rare disease that manifests as failure to thrive. It can be diagnosed by a careful history, physical examination, and abnormal electrolyte pattern. It can be alleviated by appropriate management, whereas failure to recognize early can be life threatening. A case of severe failure to thrive in an infant due to neonatal form of Bartter syndrome, its manifestations, management, and outcome is presented in this article.