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Neil Patel,1,2 Kathryn Kinmond,1,3 Pauline Jones,1 Pamela Birks,1 Monica A Spiteri1 1Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK; 2Directorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK; 3Department of Health & Social care, Staffordshire University, Stoke-on-Trent, Staffordshire, UKCorrespondence: Neil PatelDirectorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UKTel +44 7852 318157Email neil.patel@heartofengland.nhs.ukBackground: COPDPredict™ is a novel digital application dedicated to providing early warning of imminent COPD (chronic obstructive pulmonary disease) exacerbations for prompt intervention. Exacerbation prediction algorithms are based on a decision tree model constructed from percentage thresholds for disease state changes in patient-reported wellbeing, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP) levels. Our study determined the validity of COPDPredict™ to identify exacerbations and provide timely notifications to patients and clinicians compared to clinician-defined episodes.Methods: In a 6-month prospective observational study, 90 patients with COPD and frequent exacerbations registered wellbeing self-assessments daily using COPDPredict™ App and measured FEV1 using connected spirometers. CRP was measured using finger-prick testing.Results: Wellbeing self-assessment submissions showed 98% compliance. Ten patients did not experience exacerbations and treatment was unchanged. A total of 112 clinician-defined exacerbations were identified in the remaining 80 patients: 52 experienced 1 exacerbation; 28 had 2.2± 0.4 episodes. Sixty-two patients self-managed using prescribed rescue medication. In 14 patients, exacerbations were more severe but responded to timely escalated treatment at home. Four patients attended the emergency room; with 2 hospitalised for < 72 hours. Compared to the 6 months pre-COPDPredict™, hospitalisations were reduced by 98% (90 vs 2, p< 0.001). COPDPredict™ identified COPD-related exacerbations at 7, 3 days (median, IQR) prior to clinician-defined episodes, sending appropriate alerts to patients and clinicians. Cross-tabulation demonstrated sensitivity of 97.9% (95% CI 95.7– 99.2), specificity of 84.0% (95% CI 82.6– 85.3), positive and negative predictive value of 38.4% (95% CI 36.4– 40.4) and 99.8% (95% CI 99.5– 99.9), respectively.Conclusion: High sensitivity indicates that if there is an exacerbation, COPDPredict™ informs patients and clinicians accurately. The high negative predictive value implies that when an exacerbation is not indicated by COPDPredict™, risk of an exacerbation is low. Thus, COPDPredict™ provides safe, personalised, preventative care for patients with COPD.Keywords: COPD acute events, preventative care, digital enabled-healthcare, automated health-status algorithms, diagnostic accuracy, reduced hospitalisations

This is the peer reviewed version of the following article: Oakley, L., Kinmond, K. S., Humprheys, J. & Dioum, M. (2019). Safeguarding children who are exposed to Abuse Linked to Faith or Belief. Child Abuse Review. 10.1002/car.2540, which has been published in final form at https://doi.org/10.1002/car.2540. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

Purpose A previous publication in this journal reported the findings of a 2013 survey into people’s experiences of membership of a Christian church in the UK (author citation removed for the purposes of review). A major finding of this survey was that many people said they had been “harmed” by their experience with some labelling it as “Spiritual Abuse” (SA). Respondents in the 2013 study also stressed the importance of developing safeguarding policy and practice in this area. The purpose of this paper is to explore the findings of a more extensive survey conducted in 2017 which aims to identify people’s understanding of SA some four years after the initial work and within a context of some discussion and uncertainty around the term itself. The study also aims to assess the current status of safeguarding policy and practice in SA perpetrated against individuals in the Christian church in the UK. A secondary aim of the study is to ascertain how far understandings, policy and practice have developed since the initial survey was conducted. It is emphasised that the authors do not assert that SA is perpetrated solely in the Christian church. However, as this is their personal religious background it is the focus of this work. Design/methodology/approach A mixed methods online survey of Christians, Church attendees and members of Christian organisations was conducted in 2017. Data were analysed using descriptive statistics, inductive thematic and content analysis. Findings A clear definition of SA is required. There is an ongoing need to develop policy and practice in the area of SA in order to respond effectively to those who have these harmful experiences. Research limitations/implications This work has been conducted within the Christian faith community and thus, represents only this faith context. Accordingly, it is research with a specific group. The work would usefully be expanded to other faith contexts. Practical implications People are still being harmed by experiences in the Christian church. Safeguarding policy and practice in the area of spiritual abuse needs to be developed in the immediate future. Social implications Those working in statutory agencies, faith and community contexts need to develop an understanding of SA. Originality/value This is the largest survey conducted on the topic of SA in the Christian faith to date in the UK.

Child abuse linked to faith or belief (CALFB) is not a recent phenomenon; nor specific to any given culture or faith. This paper presents current work which articulates counsellors’ understanding, experience and training needs around CALFB. An online survey collected data from participants, seventy nine of whom identified themselves as counsellors. Seventy-nine per cent of the counsellors stated that they had heard of the term CALFB. Sixty-six per cent were confident that they understood the term. However, only 46% were confident they could identify indicators with 54% being ‘confident’ to respond. Just 34% of the counsellors had received specific training on CALFB. It is argued here that awareness raising and training around the issues of CALFB are important to include in counsellor training courses and also as Continuous Professional Development.

Chronic obstructive pulmonary disease (COPD) is debilitating and costly. Self-management is championed to empower individuals to better manage their condition and also to efficiently utilize health resources. As a multi-disciplinary team, we conducted focus group research with individuals living with COPD who were participating in a longitudinal study to use an electronic “diary” to monitor, record, and transmit their own health status, plus receiving regular nurse visits. The main aims of the focus groups were to investigate how far individuals embraced the electronic diary and experienced it as an aid to the self-management of their condition. We also looked at the importance of the nurse visits to the process. Thematic analysis revealed that patients responded positively to the use of technology (the electronic diary), including psychological benefits of perceived support offered by the remote symptom surveillance. Findings also showed patients’ increased awareness and monitoring of personal symptoms together with an improved understanding of disease self-management. Nurse support emerged as an important “human” factor in the process. In addition, a reduction in hospital admission was observed, thus reducing costs to the health service.

Purpose – The purpose of this paper is to report the findings of a ground-breaking survey into people's experiences of church and Spiritual Abuse (SA), in a context of issues of safeguarding and policy. Design/methodology/approach – The survey was delivered online between April 2011 and December 2012. Findings – The findings showed many people had encountered negative church experiences. Most respondents had very limited knowledge and understanding of SA and related support and intervention. Research limitations/implications – This survey represents the views of a small percentage of those who attend, or have attended, church and further more extensive research is required to provide a more comprehensive understanding. Additionally research is required within other faiths and cultural contexts. Practical implications – It is evident that there is clearly a need to strengthen current safeguarding policy and practice with regards to SA. Originality/value – This paper offers an initial insight into the challenges for safeguarding together with some suggested intervention strategies.

This paper reports the results of an online survey which aimed to explore practitioners' and faith community groups' awareness and understanding of child abuse linked to faith or belief (CALFB) and to identify their further training needs in this area. The survey was founded in the work of the National working group for CALFB; a multi-agency response group committed to raising knowledge and awareness of this form of child abuse. Despite the relatively small number of recorded cases, CALFB continues to be a matter of concern to professionals and faith communities in the UK and beyond. One thousand three hundred and sixty two respondents comprising of frontline practitioners, faith and community group members completed the survey. A mixed-method analysis of the survey data illustrates a wide-ranging understanding of the term CALFB and disagreement about whether this is a specific form of child abuse. The results also indicate a relationship between confidence levels in identifying and responding to CALFB and specific training in this area. There is a call for specialised training to be more readily available. Further work is needed to develop a toolkit, which identifies indicators of CALFB and effective response pathways together with research across communities. The current research is timely and important in providing a foundation on which to build more effective identification of cases, policy and intervention.

Whilst there has been some exploration of experiences of domestic violence and abuse within faith communities, understandings of spiritual abuse and how these phenomena interconnect are not yet widely understood. This chapter serves to provide a definition and understanding of spiritual abuse and how it may manifest across all faiths. Lisa Oakley and Kathryn Kinmond highlight the role and responsibility of the faith leader in shaping a positive, constructive faith discourse that condones abusive behaviour, including that which occurs in the domestic sphere. They also call for a more receptive response from mainstream domestic violence and abuse support services, with greater openness to recognising the importance of faith identity and spirituality as a tool of recovery for many victims/survivors.

Background and Purpose: Stroke rehabilitation coordinated by specialist teams and oriented toward functional activities is now common. However, the potential remains for improved outcome, and new methods for improving rehabilitation are being developed. Observation of functional, meaningful activities, via DVD, has been suggested as a technique that may be effective. This case study aimed to investigate the effect of an individualized program of observation for functional status after stroke. Case Description: The case study participant was a 44-year-old man, 12 months after a right intracerebral hemorrhage, with a Scandinavian Stroke Scale (SSS) score of 42. He was independently mobile using a cane. He viewed, with the instructions to understand and imitate, four DVDs of meaningful daily activities filmed from first- and third-person visual perspectives. Pre- and postintervention measures administered in the participant's home were the SSS, Postural Assessment Scale (PASS), Timed Up and Go test (TUG) with manual and cognitive components, a fluidity scale, and the Stroke-Specific Quality of Life Scale. Outcomes: Improvements were observed in the TUG and the fluidity scale. Small but clinically insignificant changes were observed in the PASS. The patient also felt confident to progress to walking without his cane. Discussion: The findings suggest that, for this relatively young and motivated individual, observation of meaningful activities was an important part of his stroke rehabilitation. (C) 2008 Neurology Section, APTA

As noted in previous chapters SA changes people. It changes their experience of their ‘self, their understanding of who they are as a person, their relationship with others — and often with God — their ability to trust and even their sense of ontological security. SA is abuse of a person’s spirituality, their core beliefs and values, the essence of what makes them the person they are and gives meaning to their life. All this makes it particularly pernicious. As Bent-Goodley and Fowler (2006) comment, SA affects a person’s fundamental values and alters their view not only of their self but, also, of the world. Further, Jenkins warns, ‘Precisely because spirituality is at the heart of how people understand themselves in the world, an attack on someone’s spirituality… is an attack on the heart of the person, on their integrity, their wholeness’ (2011:29). ‘It attacks right at the heart and spirit of a person.’ Thus, the consequences of SA are that people become ‘deeply scarred, emotionally, psychologically and spiritually’ (Parish-West, 2009). ‘The wounds the church gives you never wash away.’

The previous chapter discussed issues therapists may encounter when working with someone who has been spiritually abused in order to raise awareness and best prepare them for effective practice. This chapter continues this theme, exploring professional and personal issues for therapists working with SA. It looks at the impact on therapists, acknowledging that whilst such work can be deeply rewarding, it can also be hugely challenging and emotionally exhausting. Effective therapy is an intense personal relationship as therapists engage empathically in the pain of the person they are working with. Further, as therapists walk alongside someone exploring experiences of trauma it can have a major impact upon them too.

At present, recognition of the importance of psychosocial factors in the care of individuals with diabetes is still in its infancy. Understanding of the specific psychosocial factors relating to diabetic foot ulceration is embryonic. The study reported in this paper begins to raise awareness of psychosocial quality of life issues for patients living with diabetic foot ulceration, as narrated by the patients themselves. Findings revealed a range of restrictions on daily life that profoundly affected the individual's sense of self. These findings have implications for patients' adherence to treatment. Implications of these findings for health promotion are also reported.