Mental illness, personhood, and transcendence: Spiritual and religious assistance in Catholic psychiatric contexts

In recent decades, there have been many calls for the inclusion of spirituality and religion (S/R) in therapeutic contexts. In some contexts, this has been an institutionalized form of spiritual and religious assistance (SRA). This article examines the concepts and practices involved in SRA services at three psychiatric institutions in Portugal, a country with strong Catholic roots but increasing efforts at secularity and recognition of religious diversity. The case of a user who contacted the SRA service allows us to better grasp this new practice in action. Although some SRA practices have similarities with mindfulness, a systematic comparison allows us to explore the links between SRA and the global dynamics related to S/R in mental health and the particularities of Catholic spirituality. In the contexts observed, the transition from the Catholic hospital chaplaincy system to the SRA model is developing through the integration of features of the Catholic spiritual tradition with concepts and practices drawn from the psychology of religious experience. The accompaniment of the ‘whole person’ emerges as the central concept of this form of SRA. Spirituality gains significance as an integrative approach to the subjectivity fragmented by the illness and the fragmentation of care across multiple clinical specialties. Furthermore, the prioritization of the spiritual needs expressed by users suggests that SRA combines well with the individualistic rationales and the technification of care in the field of mental health.

POCUS for Nephrologists - Basic Principles and a General Approach

Point of care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multi-organ POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. While the need for further imaging studies is obviated in selected cases, POCUS is not meant to serve as an alternative to consultative imaging. In addition, utility of POCUS depends on the skills and experience of the operator, which in turn depends on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss case examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.

Transnationalizing Families: Canadian Immigration Policy and the Spatial Fragmentation of Care-giving among Latin American Newcomers

Transnationalizing Families: Canadian Immigration Policy and the Spatial Fragmentation of Care-giving among Latin American Newcomers

Transnationalizing Families: Canadian Immigration Policy and the Spatial Fragmentation of Care-giving among Latin American Newcomers

Transnationalizing Families: Canadian Immigration Policy and the Spatial Fragmentation of Care-giving among Latin American Newcomers

Role of Dermatologists in Advanced Cutaneous Melanoma Treatment: A Call for Action (Preprint)

UNSTRUCTURED Advanced cutaneous melanoma has always been a dreaded diagnosis, but with the introduction of a number of practice-changing agents, namely targeted therapy and immunotherapy, considerable strides have been achieved in terms of survival rates. However, the introduction of these agents was associated with a variety of dermatological adverse event, some of which have shown a detrimental effect on the continuity of treatment. This holds especially true in the light of the current fragmentation of care provided by the managing health care professionals. This article sheds light on the impact of the scarcity of dermatology specialist input in the management of dermatological adverse events associated with advanced melanoma treatment. Furthermore, it looks into the potential avenues where dermatological input can bridge the gap in the care provided by oncologists, hence standardising the care provided to melanoma patients with dermatological adverse events.

Fragmentation of care: a major challenge for older people living with multimorbidity

As the world’s aging population is rising, so too is the prevalence of multimorbidity increasing among older adults. Multimorbidity is therefore a growing public health challenge among the older population. Researchers have reported fragmentation of care to be one of the major problems facing this population. The leading factors responsible for this issue are use of disease-centered approaches and specialism to manage people living with multimorbidity; poor communication between professionals and people with multimorbidity; and poor communication among the professionals caring for these people. Failure to address this problem leads to increased treatment burden, including polypharmacy. There is therefore a need for all healthcare professionals caring for older people living with multimorbidity to address this problem by providing continuous, coordinated person-centered care. For the person-centered care approach to be well-coordinated and continuous, there is a need for effective means of sharing information among healthcare providers, to facilitate inter-professional collaboration; extension of consultation time to better enable healthcare providers to understand the patient's needs; review of organizational frameworks and policies where necessary; and development of new guidelines for the management of multimorbidity.