Family Support Network

The perspective in this study sees “the non-religious” not as people without a religion, but as people with sincerely and seriously held non-religious beliefs. As people who want, and should have, the opportunity to both give and receive like-minded pastoral care. The key elements of good non-religious pastoral care practice are described. While real progress has been made in introducing non-religious pastoral care, huge barriers are preventing its effective development. These include recruitment and communications. Working together to remove these barriers can help to ensure that everyone receives appropriate pastoral, spiritual, and religious care. Forming a care service that is better, fairer, and stronger, one fit for the twenty-first century. A person-centered service, putting patients first; all patients, those with religious beliefs and those with non-religious beliefs.

The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients (N = 158) as part of standard care. For implementation, therapists determined treatment format, number of sessions, and so forth and reported session-by-session fidelity. Patients completed fidelity and outcome assessments. Results showed therapists BBI implementation was done with fidelity, for example, session "dose" (59%), core content coverage (60-70%), and others. Patient reported fidelity was favorable and comparable to the BBI efficacy trial. Effectiveness data show the primary outcome, patients' scores on the Profile of Mood States total mood disturbance, significantly improved (R² = 0.06, β = -0.24, p < .01) as did a secondary outcome, physical activity (R² = 0.02, β = 0.13, p < .05). This first use of a hybrid design in health psychology provided support for a novel strategy that allowed providers implementation flexibility. Still, the EBT was delivered with fidelity and in addition, therapists generated novel procedures to enhance setting-specific usage of BBI and its ultimate effectiveness with patients. This research is an example of translational research spanning theory and efficacy tests to dissemination and implementation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

People with intellectual disabilities (IDs) have very high rates of osteoporosis and fractures, to which their widespread vitamin D deficiency and other factors could contribute. We aimed to assess in people with IDs previously treated for vitamin D deficiency (1) long-term adherence to vitamin D supplementation and (2) bone mineral density (BMD), as an indicator for risk of fractures, according to vitamin D supplementation and other factors. We recorded height, weight, medical, pharmacological, dietary and lifestyle assessment. Blood sample were taken for vitamin D and related analytes. dual-energy X-ray absorptiometry for BMD was performed. Of 51 study participants (mean [standard deviation, SD] age 51.5 [13.6] years, 57% male), 41 (80.4%) were taking vitamin D and 10 were not. Mean [SD] serum vitamin D was 81.3 [21.3] vs. 25.2 [10.2] nmol/L (P<0.0001), respectively. Thirty-six participants underwent a dual-energy X-ray absorptiometry scan, which showed osteoporosis in 23.7% and osteopenia in 52.6%. Participants on vitamin D had higher BMD than those who were not, a statistically significant difference when confounders (lack of mobility and hypogonadism) were removed. BMD was significantly different according to mobility, particularly in wheelchair users, in whom hip BMD was 33% lower (P<0.0001) than in participants with normal mobility. Participants still taking vitamin D showed a 6.1% increase in BMD at the spine (P=0.003) after mean [SD] 7.4 [1.5] years vitamin D treatment. In people with IDs and previous vitamin D deficiency, BMD increases on long-term vitamin D supplementation. However, additional strategies must be considered for osteoporosis and fracture prevention in this population.

David Cameron verbaasde vriend en vijand in aangename zin toen hij in 2010 zijn sociale agenda onder de naam van Big Society bekend maakte. Een actieve inzet om de sociale cohesie te herstellen, benadrukking van civil society waardoor burgers weer een nadrukkelijke plaats in de samenleving krijgen, waar tegelijkertijd meer inzet van die burgers wordt verwacht.

Diverticula of the large intestine constitute a common source of lower gastrointestinal (GI) bleeding both occult and massive and are a particular common cause of right-sided colonic hemorrhage. Bleeding in all cases is due to rupture of the underlying vasa rectum. In all cases, rupture of the artery is not circumferential, but eccentric having occurred toward the lumen of the diverticula. It is rare to see either acute or chronic diverticulitis associated with this situation. Lower GI bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10% to 30% GI bleeds and actually is much less frequent than upper GI bleeding. Diverticular disease actually is uncommon in people under the age of 40. However, by the age of 50 almost one-third of the population has diverticulosis. Ninety percent of the diverticula are in the left colon, but bleeding is from the right colon at least 50% of the time. Diverticular hemorrhage will cease spontaneously in about 90% cases. Most often, there is no inflammatory process around the diverticular bleeding. Hypertension even may be a predisposing factor. Also anticoagulation, diabetes mellitus, and ischemic heart disease are associated with diverticular hemorrhage. As far as treatment is concerned, conservative therapy is usually the best approach. One would like to avoid angiography and surgery if at all possible. There is a significant recurrence of bleeding in those patients who are treated even with angiography and with surgery. Etiology of the bleeding is not really well understood and the diagnosis and treatment is quite difficult in some situations.

To review nonmortality outcome measures in clinical trials of therapies to treat sepsis in children. Literature review using the search word terms "sepsis" + "surrogate markers," "sepsis" + "biomarkers," or "sepsis" + "outcomes." Articles were generally categorized as those dealing with review of patient-centered outcomes, characteristics of good surrogate markers, resolution of organ dysfunction, morbidity and functional status, quality-of-life measures, intensive care unit costs, and biomarkers. Information potentially relevant for development of surrogate markers for pediatric sepsis trials was extracted and organized as noted above. Multiple potential surrogate markers are being actively investigated for their potential validity and utility in pediatric clinical trials of sepsis and increasingly for adult sepsis trials. This is important because as mortality decreases, it becomes an impractical primary end point. Surrogate end points that address patient-related morbidity and intensive care unit costs may also be quantified. Treatment of sepsis and corresponding end points for clinical trials should be aimed at both the duration and the quality of survival.

Itis common knowledge among practitioners of pediatric critical care that the frequently cited randomized trials treating septic patients with activated protein C (1), goal-directed therapy (2), and corticosteroids (3) do not include any subjects younger than 18 yrs of age. What is not as well known is that, by and large, these trials also excluded a large proportion of immunocompromised patients, as have most other sepsis trials. The activated protein C study excluded those with a history of bone marrow, lung, liver, pancreas, or small-bowel transplantation and those with human immunodeficiency virus (HIV) and a CD4 count <50 cells/mm3 (although 18% of the subjects did have cancer as an underlying condition) (1). The goal-directed therapy study of Rivers et al. (2) excluded those with “uncured cancer (during chemotherapy)” or “immunosuppression (because of organ transplantation or systemic disease).” The corticosteroid trial of Annane and colleagues (3) excluded patients with “evidence for…advanced forms of cancer or acquired immunodeficiency syndrome (AIDS) infection, and contraindication or formal indication for steroids.” Given the fact that these trials are the underpinnings of several of the key recommendations of the Surviving Sepsis Campaign (4), we are left asking whether we can legitimately apply the results of those trials to immunocompromised patients with sepsis. Also, immunocompromised children and adults make up a substantial proportion of patients with severe sepsis (5, 6). These considerations underscore the critical gaps in knowledge regarding the treatment of sepsis in the immunocompromised host and the importance of seeking that knowledge through clinical trials. The articles presented in the section on the immunocompromised host during the International Sepsis Forum on Sepsis in Infants and Children and included in this supplement are an important step in addressing the need to include immunocompromised patients in sepsis trials. The goals of the session are listed in Table 1. Dr. Upton Allen, a specialist in pediatric infectious diseases from the Hospital for Sick Children in Toronto, presents the broad categories of acquired immunodeficiencies unrelated to HIV infection, including cancer, hematopoietic stem cell and solid organ transplantation, and immunomodulating agents. His article highlights the difficulties encountered when including immunocompromised patients in sepsis trials and will be highly useful for any investigator designing such trials. Dr. Robert Tamburro, a pediatric intensivist formerly at St. Jude Research Hospital for Children (currently at Penn State Children’s Hospital) discusses the published literature involving pediatric cancer patients with sepsis and concludes that pediatric cancer patients account for a relatively high proportion of severe sepsis episodes in children and that outcomes of sepsis in the pediatric oncology population (excluding those who have undergone hematopoietic stem cell transplantation) are not substantially different from that of the general population. He also points out that the generally poor outcomes of pediatric hematopoietic stem cell transplantation patients with sepsis should not preclude their participation in clinical trials but rather should be a call to action for their widespread participation in clinical trials. Dr. Mark Hatherill, a pediatric intensivist at the Red Cross Children’s Hospital in Cape Town, discusses the heterogeneity of pediatric HIV infection in the era of highly active antiretroviral therapy and outlines important clinical aspects that will prove to be invaluable for stratification in sepsis trials. Finally, Dr. Jordan Orange, a pediatric immunologist at Children’s Hospital of Philadelphia, provides a comprehensive, detailed overview of congenital immunodeficiencies, with a focus on bacteremic sepsis as a presenting or characteristic feature. An understanding of these disorders will be important for the design of sepsis trials in children to ensure that proper evaluation for congenital immunodeficiencies in children with sepsis is undertaken.Table 1: Focus questions in the session on the immunocompromised host of the International Sepsis Forum on Sepsis in Infants and Children, Boston, MA, 2004As a whole, the articles presented in this section of the International Sepsis Forum on Sepsis in Infants and Children will allow clinical trials involving immunocompromised children with sepsis to move forward more efficiently and more successfully. This, in turn, will likely lead to important clinical advances for this understudied patient population having very much to gain. Gregory P. Priebe, MD Division of Critical Care Department of Anesthesiology Division of Infectious Diseases Department of Medicine Children’s Hospital Boston Channing Laboratory Department of Medicine Brigham and Women’s Hospital Boston, MA