Depressed mood in a theological perspective

The symptoms of depression and those of accidie as described by the Desert Fathers overlap, in that feelings of despair, guilt, poor estimates of self-worth, lack of energy and self-absorption predominate. Tillich adds to these symptoms a sense of meaninglessness and purposelessness. A new model of depressed mood is proposed which incorporates a variety of different aetiological factors, integrating those from the body and the mind which are found in clinical practice, with others which have a spiritual origin. The need for reconciliation with God, the world and the self means that discernment of spiritual problems can be fundamental in finding an answer to disturbed mood. The psychological aspects of guilt and self-hatred and lethargy are explored through the work of Karen Homey, mainly in a discussion of the compulsions caused by an inflated ego-ideal. The work of Carl Jung emphasises the integration of the shadow, stressing the importance of reconciling polarities in the psyche so as to generate a creative tension which can replenish spiritual and mental energy. Many theologians, including Tillich, also emphasise that opposites must come together, so that God can be found at the centre of all things. Hans Urs von Balthasar is " outstanding because of his understanding of Christ's kenosis in balance with His plerosis These polarities point to the way in which Christ, through His Passion and Resurrection redeems us from godforsakermess, and also suggest a helpful way of understanding the Trinity as Love. Nicholas de Cusa and Ignatius of Loyola, from the fifteenth and sixteenth centuries, have a common strand of finding God in the midst of opposite and fragmenting influences. Miguel de Unamuno at the beginning of this century adds a dimension of God's involvement in tragedy and suffering, and Charles Williams stresses our co-inherence vyith God, and the need for forgiveness in bearing each other’s burdens. The convergence of psychological and theological insights concerning polarities is applied to a recovery model for depressed mood through cognitive therapy, art, and prayer - methods which search, respectively, for truth, beauty and goodness. The process of healing is part of redemption, in that the 'Fruits of the Spirit' are the antithesis of some of the symptoms of depression, such as guilt, anger, self-absorption and fear. We may feel helpless and vulnerable because of negative feelings, but in His total self-giving, Christ suffered the helplessness and agony of the Passion in order to transform our disorders and bring us to His Kingdom of service and praise

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

The probability of receiving a kidney transplantation in end-stage kidney disease patients who are treated with haemodiafiltration or haemodialysis : a pooled individual participant data from four randomised controlled trials

UDBELLATERRADue to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D. Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study. After a median follow-up of 2.5 years (Q1 to Q3: 1.9-3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86-1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92-1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes. Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions