Although pediatric cancer often causes significant stress for families, most childhood cancer survivors are resilient and do not exhibit severe or lasting psychopathology. Research demonstrates some survivors may report benefit-finding or positive outcomes following this stressful life event. However, considerably less research has included families of children who are unlikely to survive their illness. Thus, this study investigated benefit-finding among parents and their children with advanced cancer, as well as associated demographic and medical factors.

Families (N = 72) of children with advanced cancer (ages 5–25) were recruited from a large pediatric hospital. Advanced cancer was defined as relapsed or refractory disease, an estimated prognosis of <60%, or referral to end-of-life care. Participants completed a demographic survey and the Benefit Finding Scale at enrollment.

Children, mothers, and fathers reported moderate to high benefit-finding scores. Correlations between family members were weak and non-significant. Children reported significantly higher benefit-finding than fathers. Demographic and medical factors were not associated with benefit-finding in children, mothers, or fathers.

Families of children with advanced cancer reported moderate to high benefit-finding regardless of background or medical factors. Children identified benefits of their cancer experience independent of the experiences of their mothers and fathers. Larger studies should continue to examine factors associated with positive and negative outcomes in the context of childhood cancer to inform interventions.

Older adults often have a heightened awareness of death due to personal losses. In many low- and middle-income countries, including Nigeria, conversation about end-of-life issues and advanced care planning (ACP) among older adults is gradually emerging. Our study explored older adults’ knowledge and perceptions towards advanced directives and end-of-life issues in a geriatric care setting in Nigeria.

A cross-sectional study was conducted among older adults (aged ≥60 years) in a geriatric outpatient clinic. Data were collected using an interviewer-administered, semi-structured questionnaire, tested at a significance level set at alpha 0.05.

The study included 204 participants with a mean age of 71.3 ± 7.2 years, predominantly female (67.2%). Few of the participants have heard about end of life (20.1%), living will (19.1%), power of attorney (19.6%), and ACP (25.9%). About 29.9% of the respondents considered having a living will, of which about 34.4% have written one. Only 23 (11.3%) would consider discussing ACP in the future, 32 (15.7%) would discuss place of care, and 30 (14.7%) place of death. Preparedness for end of life and knowledge of ACP was higher among males, those with formal education, and those with good self-rated health (p < 0.05).

The study highlighted gap in awareness and engagement in ACP among older adults in a country like Nigeria. This lack of knowledge can lead to inadequate end-of-life care and unpreparedness for critical health decisions for older adults in Africa. Thus, improving awareness and understanding of ACP can empower older adults, ensuring their end-of-life preferences are respected, enhancing the quality of care, and reducing the emotional and financial burden on families.

Neonatal intensive care units (NICUs) emerge as one of the areas where palliative care is most needed. This study was conducted to examine the attitudes and compassion fatigue levels of NICUs nurses working in Şanlıurfa, where the fertility rate and infant mortality are highest in Turkey, toward palliative care.

This study was conducted in descriptive type.

The research was carried out with 204 (85%) nurses who agreed to participate in the research between October 2022 and February 2023, out of 240 neonatal intensive care nurses working in the NICU of 2 training and research hospitals and a university hospital in Şanlıurfa. The data of the study were collected using an Introductory Information Form, the Neonatal Palliative Care Attitude Scale, and the Compassion Fatigue Short Scale.

Nurses; compassion fatigue scale mean score was 61.46 ± 26.64, palliative care scale mean score was 3.13 ± 0.74 for organization subdimension, 2.85 ± 0.73 for resources subdimension, and 3.08 ± 0.89 for clinician subdimension. In the results of the study, 8 barriers (parents do not participate in decisions, there is not enough staff, lack of time to spend with the family, lack of policies/rules in institutions for palliative care, lack of education and communication, society’s beliefs, nurses’ personal attitudes toward death, and lack of appreciation of past experiences with palliative care) and 6 facilitators (Nurses’ ability to express their perceptions, views and beliefs about palliative care, to participate and support palliative care, to inform parents, to provide counseling, adequate physical conditions) for palliative care were determined.

While it was determined that nurses had a slightly below moderate level of compassion fatigue and a close attitude toward organization and resources toward palliative care, it was determined that ethical conflict toward palliative care was high in clinical subdimension scores.

It is recommended that all nurses working in the NICU obtain certificates, improvements in resources such as personnel and equipment, improvements in the shift work system and development of policies/rules in institutions for palliative care.

The rising incidence of cancer has led to an increased number of adult children impacted by parental cancer. Previous research primarily focused on younger individuals, leaving a gap in understanding the experiences of adult children aged 20–35.

To examine a model that integrates the interrelationships among the disease’s characteristics (i.e., disease stage), illness representations, coping strategies, and posttraumatic growth (PTG) in young adults with parents diagnosed with cancer. In addition, we examined indirect relationships involving illness representations as independent variables, coping strategies as mediators, and PTG as the outcome variable.

The rising incidence of cancer has led to an increased number of adult children impacted by parental cancer. Previous research primarily focused on younger individuals, leaving a gap in understanding the experiences of adult children aged 20–35. This study examines a model that integrates the interrelationships among the disease’s characteristics (i.e., disease stage), illness representations, coping strategies, and posttraumatic growth (PTG) in young adults with parents diagnosed with cancer. In addition, we examined indirect relationships involving illness representations as independent variables, coping strategies as mediators, and PTG as the outcome variable.

A cross-sectional survey was conducted with 109 adult children (ages 20–35) of cancer patients. Data were collected using the Posttraumatic Growth Inventory, the Brief Illness Perception Questionnaire, and the COPE questionnaire. Path analysis was performed to test the study’s hypotheses.

The findings revealed that illness representations and coping strategies accounted for significant variance in PTG. Higher perceived severity of the parent’s illness was associated with greater use of problem-focused and emotion-focused coping strategies, which were linked to higher PTG. Lower perceived control over the illness was associated with less use of problem-focused coping and subsequently lower PTG.

This study underscores the importance of subjective perceptions and coping strategies in fostering PTG among young adults with parents diagnosed with cancer. The findings highlight the need for tailored psychosocial interventions to enhance adaptive illness representations and effective coping strategies, promoting resilience and growth in this unique demographic.

The coronavirus pandemic has caused concern in the community, especially in patients. Spirituality, hopelessness, and quality of life have an impact on the management of the process in cancer patients during these crisis periods. To investigate COVID-19 anxiety’s mediating role in hopelessness’ relationships with the quality of life and spiritual well-being among cancer patients.

This study used a cross-sectional design to collect data from cancer patients using self-administered questionnaires. The study recruited 176 cancer patients receiving treatment at a university hospital. The participants completed measures of spiritual well-being, COVID-19 anxiety, hopelessness, and quality of life. Following preliminary analyses, a mediation model was analyzed using the PROCESS macro for SPSS, with the bootstrap method applied (model 4).

The results showed that spiritual well-being was negatively associated with COVID-19 anxiety and hopelessness, and positively associated with the quality of life. COVID-19 anxiety was associated positively with hopelessness, and negatively with the quality of life. Moreover, COVID-19 anxiety mediated the relationship between hopelessness, spiritual well-being, and quality of life.

This study provides evidence for COVID-19 anxiety’s mediating role in the relationship between spiritual well-being and quality of life and hopelessness among cancer patients. The findings suggest that interventions aimed at reducing COVID-19 anxiety may be effective in reducing hopelessness among cancer patients, by promoting higher levels of spiritual well-being and improving quality of life.

This study aimed to examine the feasibility and preliminary effectiveness of a behavioral activation (BA) program for the bereaved of cancer patients toward reducing depressive symptoms.

The BA program for the bereaved was a partially modified version for cancer patients. This program encompassed a preinterview and seven 50-minute sessions every 1–2 weeks, using worksheets, with homework assignments each day. To examine feasibility, the completion rates of intervention and 3 months of follow-up were examined. To examine the preliminary effectiveness, psychological symptoms were assessed with the Patient Health Questionnaire (PHQ-9; primary outcome) and Beck Depression Inventory-II (BDI-II) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. These were evaluated 3 times: before, immediately after, and 3-month post-intervention. Non-parametric tests were used for comparison of scores at 3 time points and calculation of effect size.

Of the 42 bereaved who were contacted, 21 were eligible and 20 were participated, while 19 and 18 were in the completed intervention and completed 3-month post-intervention categories (intervention completion rate was 95% and follow-up completion rate was 90%). PHQ-9, BDI-II, and GAD-7 showed significant reductions immediately and 3 months after the intervention compared to pre-intervention, and the effect sizes were all large after 3 months, although they were less than immediately after (PHQ-9: 0.89, 0.71; BDI-II: 0.88, 0.67; GAD-7: 0.57, 0.53).

This study indicated that the BA program for the bereaved of cancer patients was feasible and effective vis-à-vis reducing depressive symptoms.

While caring for seriously ill children is a rewarding experience, pediatric healthcare providers may experience sadness and emotional distress when their patient dies. These feelings, particularly when not addressed, can lead to negative health and occupational outcomes. Remembrance practices can provide a safe space for staff to process their grief. This study explored pediatric healthcare providers’ perceptions of an annual Pediatric Remembrance Ceremony (PRC) and a quarterly program, Good Grief and Chocolate at Noon (GGCN), to learn what components of the programs were considered meaningful and the personal impact on those who attended. The programs pivoted to a virtual platform during the COVID-19 pandemic, and the study also assessed providers’ perspectives of attending the programs virtually.

A 19 multiple choice survey instrument was designed, reviewed, piloted, revised, and re-piloted by an interdisciplinary bereavement committee prior to administration. The survey included 2 open-ended questions, inviting additional insights into personal impact and future directions for remembrance programs. The survey was administered on an encrypted online platform.

Components of the PRC respondents most valued included the opportunity for staff to choose a name of a patient they cared for and to light a candle for that patient as their name is read. Those who participated in GGCN found story sharing helpful, along with having a speaker address a topic around loss and grief during the second half of the session. Both programs provided reflection, solidarity, and memorialization. Most respondents prefer having both in-person and virtual options.

Healthcare providers are affected by the death of the children they care for and value opportunities provided to join colleagues in remembering their patients. The findings underscore the value of remembrance programs in supporting bereaved staff.

The primary aims of this multicenter, prospective observational study were to investigate spiritual well-being, resilience, and psychosocial distress in an Italian sample of glioblastoma patients undergoing radiochemotherapy. The secondary aim was to explore the influence of demographic, clinical, and psychological characteristics on survival.

The assessment was conducted only once, within the first week of radiochemotherapy treatment. Spiritual well-being was evaluated by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp-12), and religious/spiritual beliefs and practices were evaluated by the System of Belief Inventory. Resilience was evaluated by the Connor−Davidson Resilience Scale (CD-RISC). Psychosocial distress was evaluated the by Distress Thermometer and Hospital Anxiety Depression Scale. We conducted an univariable analysis of overall survival (OS) using data from the most recent follow-up available, considering demographic and clinical variables that could influence survival. Follow-up was defined as either the time of death or the latest follow-up visit recorded.

We recruited 104 patients, and the median follow-up time was 18.3 months. “Distressed” patients had lower scores than “not distressed” patients on the FACIT-Sp-12 and CD-RISC. While OS was not significant according to the FACIT-Sp-12 threshold, the Kaplan−Meier log-rank test was 0.05 according to the CD-RISC threshold. Among demographic variables, age showed significant associations with OS (p = 0.011). Resilience showed significant associations with OS (p = 0.025).

Data showed that high spiritual well-being was associated with high resilience and an absence of psychosocial distress in our sample of glioblastoma patients undergoing radiochemotherapy. Patients with greater resilience survived longer than those with lesser resilience. Profiling spiritual well-being and resilience in glioblastoma patients undergoing radiochemotherapy can be seen as a resource to identify novel characteristics to improve clinical take-in-charge of glioblastoma patients.

This case highlights the limitations of current prognostication and communication in clinical practice.

We report a case of a 50 year old patient with metastatic melanoma following admission to intensive care unit and later transferred to palliative care unit for end-of-life care.

The patient had clinical improvement despite signs of predictors of death and was later transferred back to care of oncology team.

Physicians frequently overestimate or underestimate survival time which can be distressing to patients and families. There is need for further research to improve the accuracy of these tools for the sake of our patients and their families.

Coping styles can be improved by dyadic palliative care interventions and may alleviate patients’ and family caregivers’ distress. Moreover, family caregivers’ preloss resilience protects against depression after bereavement. This study aimed to determine the types of coping styles can be encouraged to increase resilience.

A self-reported questionnaire survey was administered to family caregivers at the 4 palliative care units, and their resilience was assessed using the Connor–Davidson Resilience Scale (CD-RISC) and their coping styles were assessed using the Brief Coping Orientation to Problem Experienced, as well as their background characteristics.

Among 291 caregivers with a mean CD-RISC score of 56.2 (standard deviation: 16.13), internal locus of control, educational level, and history of psychotropic drug use were associated with resilience. After adjusting for the aforementioned factors, more frequent use of positive coping styles such as active coping (Spearman’s ρ = 0.29), acceptance (ρ = 0.29), positive reframing (ρ = 0.29), planning (ρ = 0.24), and humor (ρ = 0.18), was found to be associated with higher resilience. On the contrary, more frequent use of negative coping styles such as behavioral disengagement (ρ = −0.38), self-blame (ρ = −0.27), and denial (ρ = −0.14) was found to be associated with less resilience.

By assessing internal locus of control, educational level, and history of psychotropic medication use of family caregivers, as factors associated with their respective resilience, may help identify less resilient family caregivers who are at risk for developing major depression after bereavement. In addition, coping skill-based educational interventions targeting patients and their family caregivers that focus on specific coping styles associated with resilience may increase family caregivers’ resilience, resulting in less emotional distress and a lower risk of major depression after bereavement.

Prolonged grief is a chronic and debilitating condition that affects millions of persons worldwide. The aim of this study was to use a qualitative approach to better understand how relatives with prolonged grief disorder perceive what does or not help them and whether they were able to make recommendations.

Participants were all relatives of deceased patients admitted to 26 palliative care units involved in the FamiLife study; relatives were included if diagnosed with prolonged grief symptoms (i.e., Inventory Complicated Grief (ICG) questionnaire with a cut-off >25), and volunteered to participate. Semi-directed telephone interviews were conducted by psychologists between 6 and 12 months after the patient’s death. The interviews were open-ended, without a pre-established grid, then transcribed and analyzed using a thematic approach.

Overall, 199/608 (32.7%) relatives were diagnosed with prolonged grief symptoms, i.e., with an ICG score >25, and 39/199 (20%) agreed to be interviewed. The analysis yielded 4 themes: (1) the experience of mourning: intense sadness and guilt (reported by 35/39 participants, 90%); (2) aggravating factors (38/39, 97%): feeling unprepared for death and loneliness, presence of interpersonal barriers to adjustment, external elements hindering the mourning progress; (3) facilitating factors (39/39, 100%): having inner strength or forcing oneself to get better, availability of social and emotional support; and (4) the suggestions grieving relatives had to alleviate the grief burden (36/39, 92%). The analysis enabled to identify 5 suggestions for relieving the grief burden: improving communication, developing education about death and grief, maintaining contact, offering psychological support, and choosing the right time for the palliative care team to contact the relatives.

This study revealed how bereaved relatives experienced the help provided by the healthcare teams, their representations, and what could be improved. These findings could be used to design intervention studies.

Wishes to hasten death (WTHDs) are common in patients with serious illness. The Schedule of Attitudes Toward Hastened Death (SAHD) is a validated 20-item instrument for measuring WTHD. Two short versions have also been developed based on statistical item selection. However, all existing versions show some limitations with potential for improvement. This study aims to develop and initially validate a theory-driven and statistically sound SAHD short version based on a large multinational sample to advance the WTHD assessment in different countries and with different legislations.

A 3-step procedure was carried out including (1) theory-driven item selection, (2) exploratory, and (3) confirmatory factor analysis. We used a data set collected between 1998 and 2020 across 3 different countries (Germany, Spain, USA). Participants were N = 1156 complete cases (n = 181 German, n = 101 Spanish and n = 874 US) of severely ill adult in- and outpatients. They had to be ≥18 years and give informed consent.

The exploratory factor analysis revealed that 10 of 11 items previously selected theory-driven loaded on either of 2 factors: (1) WTHD and (2) internal locus of control. These factors showed good to excellent reliability according to Cronbach’s α and McDonald’s Ω, as well as an excellent fit of our data as an overall model for the total sample.

The developed SAHD-10 represents a reliable and valid alternative to the SAHD and an efficient means to measure and further investigate a WTHD in cross-cultural clinical and research settings.

Advance care planning (ACP) supports communication and medical decision-making and is best conceptualized as part of the care planning continuum. Black older adults have lower ACP engagement and poorer quality of care in serious illness. Surrogates are essential to effective ACP but are rarely integrated in care planning. Our objective was to describe readiness, barriers, and facilitators of ACP among seriously ill Black older adults and their surrogates.

We used an explanatory sequential mixed methods study design. The setting was 2 ambulatory specialty clinics of an academic medical center and 1 community church in Northern California, USA. Participants included older adults and surrogates. Older adults were aged 60+, self-identified as Black, and had received care at 1 of the 2 clinics or were a member of the church congregation. Surrogates were aged 18+ and could potentially make medical decisions for the older adult. The validated ACP engagement survey was used to assess confidence and readiness for ACP. What “matters most” and barriers and facilitators to ACP employed questions from established ACP materials and trials. Semi-structured interviews were conducted after surveys to further explain survey results.

Older adults (N = 30) and surrogates (N = 12) were confident that they could engage in ACP (4.1 and 4.7 out of 5), but many were not ready for these conversations (3.1 and 3.9 out of 5). A framework with 4 themes – illness experience, social connections, interaction with health providers, burden – supports identification of barriers and facilitators to ACP engagement.

We identified barriers and facilitators and present a framework to support ACP engagement. Future research can assess the impact of this framework on communication and decision-making.

Historically, patients with cancer were referred to palliative care near the end of life. In recent years, the increased integration of palliative care throughout the entire trajectory of illness has helped patients with cancer better manage their symptoms and improve QOL. However, it is unknown how patients think about the presence and role of earlier, integrated palliative care. This study explored how patients and caregivers experience cancer care in the context of palliative care co-management with oncology.

We conducted interviews with 18 patients and 13 caregivers to investigate perspectives, attitudes, and experiences surrounding cancer care, specifically with their experiences of co-management with a palliative care outpatient clinic and oncology. Using grounded theory, we identified a typology of patient and caregiver approaches when discussing the care they received and/or desired.

Our data revealed 3 approaches to thinking about palliative care in cancer care. While some participants embraced the “Cure Centrality” approach, caring only about fighting the disease, others adopted a “Quality-of-Life (QOL) Centrality” approach, desiring their health-care team to prioritize a broader range of concerns. A third approach, The “Dual Centrality” approach, espoused values from both approaches.

While co-management of palliative care and oncology is complementary by design, our data suggest that patients and caregivers take a variety of approaches to their copresence. For some patients, palliative care served as an important legitimizing resource for patients desiring expanded priorities in their care (e.g. higher value on QOL and symptom management) and enabling patient-centered care.

Demoralization isa common psychological problem in cancer patients. The purpose of this study is to systematically evaluate the correlated factors of demoralization among cancer patients. We also summarized the available evidence, effect estimates, and the strength of statistical associations between demoralization and its associated factors.

We systematically searched PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, PsycINFO, and 2 electronic databases to identify studies published up to October 2023 with data on the correlates of demoralization. Two researchers independently reviewed references, extracted data, and assessed data quality. Meta-analysis was performed using R4.1.1 software.

Thirty-eight studies were included in this meta-analysis. For the most studied sociodemographic correlates, demoralization was negatively correlated with income (z = −0.29, 95% CI: −0.51, −0.02), education (z = − 0.11, 95% CI: − 0.16, −0.05), and age (z = −0.45, 95%CI: −0.75, −0.01). For the most studied clinical correlates, demoralization was positively correlated with symptom burden (z = 0.37, 95% CI: 0.22, 0.50) and negatively correlated with quality of life (z = −0.40, 95% CI: −0.54, −0.24). For the most studied psychosocial correlates, demoralization was negatively correlated with social support (z = −0.39, 95% CI: −0.51, −0.26) and positively correlated with anxiety (z = 0.65, 95% CI: 0.56, 0.73), depression (z = 0.61, 95% CI: 0.54, 0.67), and suicidal ideation (z = 0.48, 95% CI: 0.34, 0.60).

Demoralization showed either positive or negative associations with sociodemographic, clinical, and psychological variables. More research is needed to explore the underlying mechanisms to develop effective interventions. This review provides information on the factors associated with demoralization in cancer patients, which can be used to inform strategies for clinical care providers.

This study aims to validate the Palliative and Complex Chronic Pediatric Patients QoL Inventory (PACOPED QL), a new quality-of-life (QoL) assessment tool for pediatric palliative patients with complex chronic conditions. The goal is to create a comprehensive and inclusive instrument tailored to this unique population, addressing the gap in existing tools that do not meet these specific needs.

The validation process included a literature review and consultations with experts. A pilot study refined the items, followed by a cross-sectional study involving pediatric palliative patients and their caregivers. Statistical analyses, such as Cronbach’s alpha for internal consistency and exploratory factor analysis for structural validity, were utilized.

The PACOPED QL, comprising 50 items across 8 domains and 6 subdomains, demonstrated strong reliability with Cronbach’s alpha and Guttman split-half reliability both exceeding .9. Validity assessments confirmed its suitability for children with complex illnesses. The tool was refined through expert consultations and pilot testing, reducing items from an initial 85 to a final 50, ensuring relevance and clarity.

The PACOPED QL shows strong reliability and validity in assessing QoL in pediatric palliative patients. Its comprehensive structure makes it a promising tool for clinical practice and research, addressing a critical need for a tailored assessment in this population. The instrument’s robust psychometric properties indicate its potential utility in improving the QoL assessment and care for children with life-threatening illnesses. Further studies are encouraged to confirm its effectiveness across various settings.

Pain is a frequent symptom in cancer patients (CP), and its multidimensional assessment is essential for a comprehensive approach and to establish clinical prognoses. The Short-Form McGill Pain Questionnaire (SF-MPQ) is an internationally recognized tool for the multidimensional assessment of pain, both in clinical and research settings. However, no studies have been reported in Latin America that determine its psychometric properties in CP and chronic pain.

To determine the psychometric properties of the SF-MPQ in adult Mexican cancer patients with chronic pain.

An instrumental design was used with a non-probabilistic convenience sample of 222 cancer patients treated at the pain clinic of a tertiary care hospital. Analyses were conducted to evaluate factorial structure (exploratory and confirmatory factor analysis [CFA]), reliability (internal consistency), measurement invariance, and criterion validity (concurrent and divergent).

CFA verified a 9-item structure divided into 2 factors: (1) Affective-Nociceptive and (2) Neuropathic. A global Cronbach’s alpha coefficient of .82 and a global McDonald’s Omega index of .82 were identified. Configural, metric, and scalar invariance (ΔCFI ≤ .01; ΔRMSEA ≤ .015) were confirmed regarding the sex variable. Finally, the SF-MPQ showed a positive correlation with the Numerical Rating Scale (rho = .436, p< .01) and a negative correlation with the EORTC-QLQ C30 (rho = −.396, p< .01).

The Mexican version of the SF-MPQ presented adequate psychometric properties and fit indices, making it a valid and reliable instrument for use in clinical and research settings in Mexico. Its use is recommended for the comprehensive assessment of pain in oncology in Mexico, as it allows for the understanding of pain characteristics beyond intensity, guiding the establishment of clinical prognoses.

Wernicke encephalopathy (WE) is an acute neuropsychiatric disorder caused by thiamine deficiency. The classical triad of symptoms for WE include mental status changes, ataxia, and ophthalmoplegia. In contrast, more uncommon symptoms include hallucinations. Known risk factors include alcoholism, malignancies, and chronic kidney disease, particularly hemodialysis. However, WE in nonalcoholic adults is often overlooked.

We report a WE patient with lung cancer undergoing hemodialysis who presented with the uncommon symptom of active hallucinations, which were improved by thiamine replacement therapy, despite a borderline whole blood thiamine concentration.

An 81-year-old woman with lung cancer and undergoing hemodialysis was referred to our psycho-oncology department for active hallucinations that appeared suddenly 24 days earlier. She had been diagnosed with lung cancer 6 months earlier and was undergoing chemotherapy and radiotherapy. She had no alcohol dependence or anorexia before or after admission. Physical examination revealed active visual hallucinations and delirium. On suspicion of WE, intravenous thiamine was administered. One day after administration, the hallucinations and delirium improved. Her whole blood thiamine concentration was borderline (24 ng/ml).

WE might be a cause of active visual hallucinations as they disappeared on thiamine administration alone. We need to be aware of risk factors such as malignancies and hemodialysis, and it is important not to overlook WE.