Search

IntroductionAvoiding over-investigation and overtreatment in health care is a challenge for clinicians across the world, prompting the international Choosing Wisely campaign. Lists of recommendations regarding medical overactivity are helpful tools to guide clinicians and quality improvement initiatives. We aimed to identify the most frequent and important clinical challenges related to pediatric medical overactivity in Europe and Japan. Based on the results, we aim to establish a (European) list of Choosing Wisely recommendations.MethodsIn an online survey, clinicians responsible for child health care in Europe and Japan were invited to rate 18 predefined examples of medical overactivity. This list was compiled by a specific strategic advisory group belonging to the European Academy of Paediatrics (EAP). Participants were asked to rate on a Likert scale (5 as the most frequent/important) according to how frequent these examples were in their working environment, and how important they were considered for change in practice.ResultsOf 2,716 physicians who completed the survey, 93% (n = 2,524) came from 17 countries, Japan (n = 549) being the largest contributor. Pediatricians or pediatric residents comprised 89%, and 51% had 10–30 years of clinical experience. Cough and cold medicines, and inhaled drugs in bronchiolitis were ranked as the most frequent (3.18 and 3.07 on the Likert scale, respectively), followed by intravenous antibiotics for a predefined duration (3.01), antibiotics in uncomplicated acute otitis media (2.96) and in well-appearing newborns. Regarding importance, the above-mentioned five topics in addition to two other examples of antibiotic overtreatment were among the top 10. Also, IgE tests for food allergies without relevant medical history and acid blockers for infant GER were ranked high.ConclusionOvertreatment with antibiotics together with cough/cold medicines and inhaled drugs in bronchiolitis were rated as the most frequent and important examples of overtreatment across countries in Europe and Japan.

Introduction in the elderly patient population, where fracture comminution, osteoporotic fractures, and associated arthritis or rotator cuff pathologies dominate, metadiaphyseal proximal humeral fracture is a challenging subset of fractures to treat. This study reports on cementless long-stem reverse total shoulder arthroplasty (RTSA) as primary treatment of metadiaphyseal proximal humeral fractures in elderly patients. Materials & Methods Between January 2018 and October 2021, 22 consecutive patients sustained proximal humerus fractures with metadiaphyseal extension and underwent surgery with cementless long-stem RTSA. Patients older than 60 years with minimum 1 year of clinical and radiographic follow-up were included. Patient demographics, range of motion, and patient reported outcomes [Visual Analog Scale (VAS) pain scale, Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), and American Shoulder Elbow Surgeon (ASES) scores] were retrospectively collected. Postoperative X-rays were evaluated for fracture and tuberosity union. Results There were 14 eligible patients with a median age of 71 years (range 61-91 years) and a median 13 months follow-up. At final follow-up, the median active elevation was 120° (range 80°-150°), external rotation was 40° (range 0°-50°), and internal rotation was 40° (range 0°-80°). Median VAS was 2 (range 0-8), SST was 71% (range 33%-92%), SSV was 78% (range 20-90%), and ASES was 73 (range 17-90). All patients exhibited radiographic union. There were five minor complications in three patients: postoperative neuropathy, tuberosity nonunion, scapula notching, and proximal humeral stress shielding. Conclusion Cementless long-stem RTSA is a viable alternative to primary fracture fixation in the elderly patient population with metadiaphyseal proximal humerus fractures.

BackgroundIt has been estimated that 20% of the tests and therapies currently prescribed in North America are likely unnecessary, add no value, and may even cause harm. The Choosing Wisely (CW) campaign was launched in 2012 in the US and Canada to limit the overuse of medical procedures in adult and pediatric healthcare, to avoid overdiagnosis and overtreatment.MethodsIn this narrative review, we describe the birth and spread of the CW campaign all over the world, with emphasis on CW in pediatric healthcare.ResultsTo date, CW has spread to more than 25 countries and 80 organizations, with 700 recommendations published. The awareness of medication overuse also made its way into pediatrics. One year after the launch of the CW campaign, the American Academy of Pediatrics and the pediatric section of the Society of Hospital Medicine provided the first recommendations specifically aimed at pediatricians. Thereafter, many European pediatric societies also became active in the CW campaign and published specific top-5 recommendations, although there is not yet a common set of CW recommendations in Europe.DiscussionWe reviewed the main pediatric CW recommendations in medical and surgical fields and discussed how the recommendations have been produced, published, and disseminated. We also analyzed whether and how the CW recommendations impacted pediatric medical practice. Furthermore, we highlighted the common obstacles in applying CW recommendations, such as pressure from patients and families, diagnostic uncertainty, and worries about legal problems. Finally, we highlighted the necessity to foster the CW culture, develop an implementation plan, and measure the results in terms of overuse decline.

This article opens a window on the world of chaplains supporting seafarers, which has largely been neglected by the literature. Shipping happens in ports, which are often far away from urban centres. It is thus removed from everyday experience making seafarers an invisible population and, with them, the chaplains who assist them. The article proposes to view chaplains' service to seafarers as a form of 'embodied' hospitality. It is an offer of a relationship as well as of assistance. The angle of hospitality sheds light on the dynamics of the relationships between seafarers and chaplains, the tensions and opportunities for exchange. The ethic of chaplains' hospitality that emerges from the observation and interviews is one of 'compassion' requiring openness to and acceptance of the other. Compassion, here, is the recognition of the dignity of the other based on a shared humanity.

Abstract Background Primary meningococcal arthritis is a rare infectious disease that occurs in less than 3% of meningococcal infections and is characterized by arthritis without meningitis, fever, rash, or hemodynamic instability Barahona [Case Rep Orthop 4696014:2017 ]. There are no validated clinical criteria that can be used for the diagnosis. We present two pediatric cases of atypical presentation of meningococcal disease revealed by molecular tests. Case presentation The clinical presentation of the two children (6- and 9-years-old) was characterized by signs of arthritis. By Real Time Polymerase Chain Reaction (RT-PCR), we identified N. meningitidis serogroup Y in the joint fluid in both cases. After specific antimicrobial treatment, the clinical conditions of the two patients quickly improved during hospitalization. Conclusions. We believe that the incidence of meningococcal arthritis could be underestimated in those settings where the use of RT-PCR is limited. Clearer data on the incidence of meningococcal disease would help to design specific treatments and the best possible national vaccine strategies [Fiji Sci Rep 23:39784, 2016, J Infect 67:385-90, 2013].

Protein-losing enteropathy (PLE) is a rare condition characterized by protein loss through the gastrointestinal tract, leading to hypo-proteinemia. Patients may be asymptomatic or present with variety of complications of hypoproteinemia (e.g., oedema, ascites, pleural, and cardial effusions). We describe a case report of a young girl suffering from behavioral disorder since childhood who presented with generalized oedema, hypoproteinaemia, and microcytic hypochromic anemia. In addition, the girl had an intervention for jejunal atresia and intestinal malrotation in her past medical history. Upper gastrointestinal endoscopy revealed a trichobezoar extending from stomach into the small bowel, thus classified as Rapunzel Syndrome (RS), causing mechanical obstruction of intestinal lumen and intestinal lymphatic drainage resulting in a protein-losing enteropathy (PLE). Trichobezoar was successfully removed by a surgical laparotomy resulting in resolution of symptoms and normalization of biochemical parameters. Possibly, previous surgery might have had an influence on intestinal dysmotility and trichobezoar formation. PLE is a very rare presenting symptom of RS, developing as result of intestinal obstruction caused by large trichobezoars. RS has to be considered in patients, especially adolescents, suffering from behavior disorder as trichotillomania and trichophagia. Surgical removal and nutritional supplementation are the gold treatment of large trichobezoar.

Post-Christian Britain is characterised by a rejection of doctrinal and morally conservative religion. This does not reflect solely the experience of those with ‘no religion’ but can be found in the narratives of ‘new Quakers,’ those who have become members or attenders in the past three years. New Quakers contrast Quaker sense of acceptance, freedom from theological ideas and freedom to be a spiritual seeker with conservative Christian churches, which have often been experienced as judgmental and doctrinal. Quaker liberal morality also affords inclusivity to those who have felt marginalised, such as disabled and LGBT people. The way new Quakers articulate their identity shines a light on the contemporary transformation of religious forms and society. Their emphasis on individual spirituality and rejection of theological doctrine reflect the profound cultural shift towards a post-Christian Britain, which is religiously diverse, more open to individual spiritual seeking and more liberal morally and socially.

Splenectomy and splenic irradiation (SI) are the sole treatment modalities to control drug resistant splenomegaly in patients with myelofibrosis (MF). SI has been used in poor surgical candidates but optimal total dose and fractionation are unclear. We retrospectively reviewed 14 MF patients with symptomatic splenomegaly. Patients received a median of 10 fractions in two weeks. Fraction size ranged from 0.2-1.4 Gy, and total dose varied from 2-10.8 Gy per RT course. Overall results indicate that 81.8% of radiation courses achieved a significant spleen reduction. Splenic pain relief and gastrointestinal symptoms reduction were obtained in 94% and 91% of courses, respectively. Severe cytopenias occurred in 13% of radiation courses. Furthermore patients were divided in three groups according to the radiation dose they received: 6 patients in the low-dose group (LDG) received a normalized dose of 1.67 Gy; 4 patients in the intermediate-dose group (IDG) received a normalized dose 4.37 Gy; the remaining 4 patients in the high-dose group (HDG) received a normalized dose of 9.2 Gy. Subgroup analysis showed that if no differences in terms of treatment’s efficacy were seen among dose groups, hematologic toxicity rates distributed differently. Severe cytopenias occurred in 50% of courses in the HDG, and in the 14.3% and in 0% of the IDG and LDG respectively. Spleen reduction and pain relief lasted for a median of 5.5 months in all groups. Due to the efficacy and tolerability of the low-dose irradiation 4 patients from the LDG and IDG were retreated and received on the whole 12 RT courses. Multiple retreatments did not show decremental trends in terms of rates of response to radiation nor in terms of duration of clinical response. Moreover, retreatment courses did not cause an increased rate of adverse effects and none of the retreated patients experienced severe hematologic toxicities. The average time of clinical benefit in retreated patients was much longer (21 months, range 44-10) than patients who were not retreated (5,75 months, range 3-6).

The article informs about vivid and structured attempts at representing a Christian afterlife. Topics include Purgatory does add complexity to the picture, insofar as it is a post-mortem temporal state towards eternal beatitude; and form of judgement in the sense of condemnation, would be to read it at odds with a fundamental aspect of Christian teaching.

The paper explores the ethical attitude of Christian evangelicals in a church in Britain and how it affects boundary-making of their community. Evangelicals in the case study seek to be accepting of the person and to refrain from being judgemental. The paper distinguishes between the person-centred ‘ethic of compassion’ and the norm-centred ‘ethic of purity’. The ethic of compassion consists in accepting another and recognising the dignity of another based on shared humanity. It is a frame of mind that combines moral intention with the emotions of empathy and sympathy. In contrast, the ethic of purity privileges adherence to the moral order of the group over considerations for the person. The ‘compassionate’ frame of mind weakens boundaries, while the ‘pure’ frame of mind reinforces them. The boundaries of a community result from the interplay of the two ethics. [ABSTRACT FROM AUTHOR]

Introduction: Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).Methods: We retrospectively analysed a case series of 256 children (aged 2 months to 17 years) presenting with AHMD to the pEDs of six Italian tertiary care hospitals over a 2-year period (January 2012 to December 2013).Results: The most common type of AHMD was tics (44.5%), followed by tremors (21.1%), chorea (13.7%), dystonia (10.2%), myoclonus (6.3%) and stereotypies (4.3%). Neuropsychiatric disorders (including tic disorders, psychogenic movement disorders and idiopathic stereotypies) were the most represented cause (51.2%). Inflammatory conditions (infectious and immune-mediated neurological disorders) accounted for 17.6% of the cases whereas non-inflammatory disorders (including drug-induced AHMDs, genetic/metabolic diseases, paroxysmal non-epileptic movements and idiopathic AHMDs) accounted for 31.2%. Neuropsychiatric disorders prevailed among preschoolers and schoolers (51.9% and 25.2%, respectively), non-inflammatory disorders were more frequent in infants and toddlers (63.8%), whereas inflammatory conditions were more often encountered among schoolers (73.3%). In 5 out of 36 Sydenham's chorea (SC) cases, tics were the presentation symptom on admission to emergency department (ED), highlighting the difficulties in early diagnosis of SC. Inflammatory disorders were associated with a longer hospital stay and a greater need of neuroimaging test compared with other disorders.Conclusions: This study provides the first large sample of paediatric patients presenting to the ED for AHMDs, helping to elucidate the epidemiology, aetiology and clinical presentation of these disorders. [ABSTRACT FROM AUTHOR]

Georg Simmel's writings on religion have too often been overlooked, notwithstanding his undisputed status as one of the founders of sociology. Simmel's metaphysical inclination may give the impression that his thoughts on religion are closer to theology than sociology. This article proposes an interpretation of Simmel's notion of religiosity (Die Religiosität) in conjunction with the notion of self-transcendence, part of the philosophy of life (Lebensphilosophie) he espoused towards the end of his life. The article does not pursue a filologically accurate position, but a development drawing on Simmel's notions. Accordingly, it is proposed to interpret religiosity as a sensitivity to selftranscendence, the awareness of social conditioning, or "facticity", and the striving towards going beyond it. The tension between facticity and self-transcendence reflects - what Simmel called - the 'conflict of culture', the 'malaise' of the fragmentation of the self resulting from the social differentiation of modern society. Religiosity, as a sensitivity to selftranscendence, is expressed in the pursuit of authenticity thus countering the conflict of culture. This interpretation allows us to see religion as a path, albeit not the only one, to authenticity, understood as challenging facticity, which echoes in later existentialist philosophy and contemporary empirical studies. [ABSTRACT FROM AUTHOR]

Based on ethnographic data in a Christian Evangelical church in the UK, the article shows how Evangelical Christians construct their individual and group identity through appeals to authenticity. Authenticity, as it emerges from the local narratives, shares much with philosophical and sociological understandings of it, yet it is articulated within the framework of tradition. By grounding authenticity in Christian tradition, Evangelicals construct an identity which they understand as distinctive rather than morally superior to other moral traditions. Christian authenticity is a moral pursuit that requires obedience—the acceptance of God’s will. This is contrasted with the celebration of individual self-authority that is at the core of Western society. The tension between individuality and obedience to God is the motif that makes Christianity distinctive in the eyes of the informants in this study. It is also the basis for the formation of the Christian self. [ABSTRACT FROM AUTHOR]

Religion has been conceptualised as personal belief in the transcendent. Anthropologists of religion have critiqued such a construct for decades for being based on a Christian Protestant model and one that reflected subsequently modern rationalist Western culture. This construct has increasingly been shown to fail to account for the religiosity of contemporary Christians. Drawing on the sociology of Georg Simmel and based on ethnographic research in a Christian evangelical church, the article proposes a reconceptualisation of religious belief that is experiential and relational. Evangelicals in this case study show that propositional belief plays increasingly a secondary role to belief intended as trust in God and forming a relationship with God and others. Relationships mediate personal religious experience and are shown to be essential to the conversion process, the life of faith, and Christian identity. The study thus bridges the separation between theoretical and empirical works by operationalising Simmel’s sociology. [ABSTRACT FROM PUBLISHER]

THE THINKING SPACE: THE CAFÉ AS A CULTURAL INSTITUTION IN PARIS, ITALY AND VIENNA, LEONA RITTNER, W. SCOTT HAINE AND JEFFREY H. JACKSON (EDS) (2013) Farnham, Ashgate, xiv + 238 pp., ISBN: 9781409438793, h/bk, £65.00 THE VIENNESE CAFÉ AND FIN-DE-SIÈCLE CULTURE, CHARLOTTE ASHBY, TAG GRONBERG AND SIMON SHAW-MILLER (EDS) (2013) Oxford, Berghahn, xii + 244 pp., ISBN: 9780857457646, h/bk, $95.00 ALCOHOL: SOCIAL DRINKING IN CULTURAL CONTEXT, JANET CHRZAN (2013) Abingdon: Routledge, xii + 188 pp., ISBN: 9780415892506, p/bk, £20.99 CAFÉ SOCIETY, AKSEL TJORA AND GRAHAM SCAMBLER (EDS) (2013) New York, NY: Palgrave Macmillan, xi + 208 pp., ISBN: 9781137275929, h/bk, £60 A HOSPITABLE WORLD? ORGANISING WORK AND WORKERS IN HOTELS AND TOURIST RESORTS, DAVID JORDHUS-LIER AND ANDERS UNDERTHUN (EDS) (2015) Abingdon Oxon: Routledge, xviii + 234 pp., ISBN: 9780415747790, h/bk, £85 THE ROUTLEDGE HANDBOOK OF SUSTAINABLE FOOD AND GASTRONOMY, PHILIP SLOAN, WILLY LEGRAND AND CLARE HINDLEY (EDS) (2015) Abingdon: Routledge, xxxi + 426 pp., ISBN: 9780415702553, h/bk, £140.00 FACTIONS, FRIENDS AND FEASTS: ANTHROPOLOGICAL PERSPECTIVES ON THE MEDITERRANEAN, JEREMY BOISSEVAIN (2013) New York: Berghahn, x + 310 pp., ISBN: 978-0-85745-844-5, h/bk, $95.00 HOSPITALITY AND ISLAM: WELCOMING IN GOD'S NAME, MONA SIDDIQUI (2015) London: Yale University Press, xi + 274 pp., ISBN: 9780300211863, h/bk, £20.00 [ABSTRACT FROM AUTHOR]

The article makes a contribution to the study of religion by developing the analytical concept of sacralisation as the process whereby individual religious actors and groups construct religious tradition by attributing value to single ideas and practices. The concept of sacralisation helps us understand how religious actors engage with their religious tradition and participate in constructing it by legitimising its single elements. The sacred is thus understood as constructed by religious actors as that which is of value for them and distinctive of their specific tradition. This concept has been developed from a three-year long ethnographic research in a Christian evangelical church and is illustrated through an analysis of the research data. [ABSTRACT FROM PUBLISHER]

The aim of this afterword is - interrogatively - to complement and compliment the preceding papers by raising some general questions concerning the relationship between poetry and forgiveness, and to do so through reflection on the work of two authors who wrote well before the period explored by the essays in the collection, yet whose influence extends significantly into it. The paper will reflect, in particular, on the way in which Dante's Purgatorio and Shakespeare's The Tempest foreground the question of forgiveness by calling for the prayers of their audience in ways that coincide with these texts' self-conscious presentation of themselves as literary artifacts. By focusing specifically on the opening of Purgatorio XI and the Epilogue of The Tempest and by suggesting an inextricable connection in these texts between meaning and the recognition of one's shortcomings, I aim to point to the value that certain perspectives on the relationship between poetry and forgiveness might have for our understanding of the meaning of poetry and of the nature of our relationship with it. [ABSTRACT FROM AUTHOR]

In this article I reflect on the importance of creation ex nihilo for our understanding of Dante's Commedia. I do so, in particular, by reflecting on the inextricable relationship existing in Dante's poem between creation ex nihilo, contemplation and charity. More specifically, I attempt to outline an understanding of how Dante's idea of the relationship between these three can be seen to underlie the very structure and narrative form of the Commedia. Through reflection on the relationship between contemplation, charity, and creation ex nihilo, I suggest, form and content might be seen, from a theological point of view, to be perfectly at one. Underlying these reflections are also some broader questions. What is the Commedia ultimately about? What is Dante's final end in writing his poem? What bearing does this have on our understanding of the form of Dante's text as a narrative poem? And what, in turn, are the broader theological implications of all this? [ABSTRACT FROM AUTHOR]

Spiritual capital has gained prominence in the past decade as the social capital of faith based organizations (FBOs). In a previous issue of Implicit Religion, Chris Baker and Jonathan Miles-Watson, of the William Temple Foundation (WTF), presented an exhaustive review of the relevant literature on social capital and spiritual capital, and proposed a notion of spiritual capital that includes religious culture motivating social action (Baker and Miles-Watson 2010). This interpretation has transformed the original notion of spiritual capital into a normative concept that seeks to celebrate spirituality rather than understand it. This paper presents a critical reflection on the implications of such an approach and argues for the differentiation and analysis of religious phenomena. [ABSTRACT FROM AUTHOR]

In the past decade, UK government policy and academic research have inserted faith based organisations (FBOs) within the discourse of community cohesion and regeneration. This has been articulated primarily within a social capital framework which understands FBOs as 'repositories' of resources to tap into (Home Office 2004). The present paper outlines a critique of social capital as framework for the understanding of FBOs, and of the emerging concept of spiritual capital as the 'social capital of faith organisations' (Stark and Finke 2000). The paper will also sketch an alternative theoretical framework inspired by the work of Georg Simmel on religion. Robert Putnam's version of social capital has been spectacularly successful; yet it has been shown to be utopian and fraught with inconsistencies. This paper argues that social capital has become a highly moralised notion and, as such, it cannot be applied productively. Further, I shall maintain that the economic analogy, made by the terminology of capital, is particularly ill-suited to faith organisations, and that the resulting concept of 'spiritual capital' leads to a fundamental misunderstanding of what is distinctive of faith. Drawing on Georg Simmel's sociology of religion, the paper will provide an initial sketch of an alternative conceptualisation of faith for a deeper understanding of individual religiosity and the relationship between the individual and the community. Simmel's insights on the relational nature of religiosity shed light onto the distinctiveness of religiosity offering better grounding for researching faith communities. [ABSTRACT FROM AUTHOR]

The article presents a case study of a young girl presented with fever and abdominal pain, who demonstrated a peri-appendicular effusion. Clinical intervention resulted to the diagnosis of Kawasaki disease (KD) with normal epi-pericardial effusion and electrocardiography. KD is an acute systemic vasculitis of undetermined etiology and can leading to acquired heart disease in childhood.