Tumor-associated macrophages are present in early carcinogenesis and may play a critical role in the transition from SCCis to SCC, before invasion of the basement membrane by tumor cells. The intratumoral macrophage density in early stages of tumor development is significantly affected in SOTR.

The percentage of documented ADs in adults seen in the HF and Transplant Clinic at a quaternary children's hospital improved through a QI initiative. Over 50% of patients who were engaged in an ACP discussion completed an AD, suggesting this population is receptive to ACP and AD completion.

Figure 2: Immunohistochemistry demonstrates abundant perivascular and parenchymal CD8 lymphocytes (Panel A) and very few CD4 lymphocytes (Panel B). CD8 and CD4 immunohistochemistry with hematoxylin counterstain 200x.

Patient death is a formative and emotional experience for physicians. Medical trainees are particularly susceptible to the emotional impact of patient death. However, few studies have examined how trainees process patient death. This study describes annual patient memorials organized at a large multisite academic graduate medical education program. Peer-led, 1-hour patient memorial services were organized for internal medicine residents, including large and small group reflection, a moment of silence, and collective art projects. At the conclusion of each memorial, participants completed a 10-question survey regarding their experience during the memorial and their prior experiences with patient death. Ninety-nine surveys were analyzed over 2 years. Of resident respondents, 84% reported feeling comfortable or very comfortable participating in the memorials, and 93% rated reflection on patient death as important or very important. When asked how they reflect on patient death, 67% of residents reported processing patient death independently, while only 23% reported processing patient death with their medical teams. Patient memorials with small and large group discussions are easily adopted and replicated. Residents reflect on patient death frequently but often independently rather than with their medical teams. Patient memorials provide a venue for collective mourning and group reflection to support trainees.

No abstract