We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

We report a case of a male infant who presented with congenital anomalies and was found to have a de novo deletion in the terminal region of the long arm of chromosome 9. He died at the age of 17 weeks of cardiorespiratory failure owing to RSV positive bronchiolitis. A review of previously published reports documented one previous report of a patient with a deletion of (9) He required tube feeding during the first two days owing to poor feeding. He was discharged home on day 3 feeding satisfactorily. At the age of 19 days he was admitted again because of lethargy, poor feeding, and vomiting, and was found to be in heart failure. He had a holosystolic heart murmur grade 3/6. The following investigations were normal: a septic screen including lumbar puncture, routine serum biochemistry, haematological indices, plasma and urinary amino and organic acid screens, thyroid function tests, brain and renal ultrasound, and skeletal survey. An ECG showed right ventricular hypertrophy. Echocardiography showed a large ventricular septal defect, left to right shunt, right ventricular hypertrophy, and dilatation of the main pulmonary artery consistent with pulmonary hypertension.At the age of 31/2 weeks an extraction of the natal teeth was performed.

Diagnosis of attention deficit-hyperactivity disorder (ADHD) is traditionally based on subjective assessments of behaviour by clinicians and carers in different settings, but this approach is prone to biases. Recent advances in computerised continuous performance task (CPT) tests have greatly improved their clinical utility in ADHD. In this article, the authors review the history of computerised CPT tests and their potential role in the diagnosis and management of children and adolescents with ADHD.

Melatonin is generally effective and safe in children with neurodevelopmental conditions. Increasing above 6 mg/night adds further benefit only in a small percentage of children.