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We compared the effects of a 16-week Cognitive-Behavioral Therapy (CBT) program and a Social Recreational (SR) program on anxiety in children with Autism Spectrum Disorders (ASD). Seventy children (9–16 years old) were randomly assigned to either of the programs ( n CBT  = 36; n SR  = 34). Measures on child’s anxiety using the Spence Child Anxiety Scale—Child (SCAS-C) and the Clinical Global Impression—Severity scale (CGI-S) were administered at pre-, post-treatment, and follow-ups (3- and 6-month). Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as “Normal” and “Borderline” for both programs. Findings from the present study suggest factors such as regular sessions in a structured setting, consistent therapists, social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD.

AimMultidisciplinary trauma teams are routinely activated for patients with serious injuries in the emergency department (ED). We aim to describe the characteristics of patients requiring trauma team activation (TTA) at a level two trauma centre.Materials and MethodsA retrospective review of a single centre’s trauma registry data was performed. Information on demographics, circumstances of trauma, details of injury, and clinical progress was collected and analysed.ResultsAmong 77,132 trauma cases, 496 (0.6%) required TTA. On average, one TTA occurred every three days. The median age was 38 years [interquartile range (IQR), 28-54 years], and 367 (74.0%) were male. The primary reason for TTA was the mechanism of injury (n=418, 84.3%). Blunt injuries occurred in 453 (91.3%) patients and vehicular accidents were the most common mechanism (n=342, 69.0%). The median injury severity score was 1 (IQR: 0-9). Twenty patients (4.0%) required emergency surgery. The overall mortality was 60 (12.1%), with 49 patients (9.9%) dying in the ED. Four hundred and one patients (80.8%) were admitted to the hospital; the median length of stay was 2 days (IQR 1-5 days).ConclusionTTA was an uncommon event; when it occurred, patients generally had low injury severity and low utilisation of healthcare resources. Revision of the activation criteria and a tiered trauma-team or expedited-care approach may help achieve a balance between timely, coordinated care and the justified, optimal deployment of personnel.

Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored. To understand the psychological processes involved in the experiencing of suffering at the end phase of life. Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9. 5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed. The findings may inform the development of mechanism-based interventions in the palliation of suffering.