Worldviews.

Common human questions include 'Why are we here?' and 'How should we live?' The search for meaning, purpose and values is fundamental to most religions and philosophies. In the UK these views used to be derived from a shared Judaeo-Christian faith. People defined themselves as accepting or rebelling against the faith community. In postmodern times we no longer trust in meta-narrative and there is no consensus on how to deal with existential issues, nor on how to label and map the territory; some would deny that the territory even exists.

Psychiatry for the person.

PURPOSE OF REVIEW: This review considers much recent work focused around the Psychiatry for the Person Programme of the World Psychiatric Association. Yet we have also considered the wider medical context, based on recent publications familiar to us in the fields of ethics, religion, spirituality and person-centred medicine as well as 'medicine of the person' as developed by Tournier. RECENT FINDINGS: There is an urgent need for evaluative outcome studies of person-centred care, including the narratives of service users, rigorous scientific methods and new conceptual models; and for a reformulation of the bio-psychosocial model to incorporate new knowledge in the neurosciences, philosophy, anthropology, ethics and theology. SUMMARY: We suggest that a biosocial/psychospiritual (BSPS) approach to relationship-based healthcare should be more actively considered.

Quantifying tumour-infiltrating lymphocyte subsets: a practical immuno-histochemical method.

BACKGROUND: Efficient histological quantification of tumour-infiltrating T and B lymphocyte (TIL) subsets in archival tissues would greatly facilitate investigations of the role of TIL in human cancer biology. We sought to develop such a method. METHODS: Ten x40 digital images of 4 micro sections of 16 ductal invasive breast carcinomas immunostained for CD3, CD4, CD8, and CD20 were acquired (a total of 640 images). The number of pixels in each image matching a partition of Lab colour space corresponding to immunostained cells were counted using the 'Color range' and 'Histogram' tools in Adobe Photoshop 7. These pixel counts were converted to cell counts per mm(2) using a calibration factor derived from one, two, three or all 10 images of each case/antibody combination. RESULTS: Variations in the number of labelled pixels per immunostained cell made individual calibration for each case/antibody combination necessary. Calibration based on two fields containing the most labelled pixels gave a cell count minimally higher (+5.3%) than the count based on 10-field calibration, with 95% confidence limits -14.7 to +25.3%. As TIL density could vary up to 100-fold between cases, this accuracy and precision are acceptable. CONCLUSION: The methodology described offers sufficient accuracy, precision and efficiency to quantify the density of TIL sub-populations in breast cancer using commonly available software, and could be adapted to batch processing of image files.

Leadership, complexity and the mental health professional. A report on some approaches to leadership training.

BACKGROUND: Psychiatrists commonly take on a range of leadership roles. These responsibilities are complex because of an environment which is ever-changing, lack of training and competition between disciplines. AIMS: This article outlines some of the issues facing the psychiatrist within the multidisciplinary team and describes a leadership programme initiated in the West Midlands. METHOD: A programme of in-house leadership training and increased delegation of leadership roles within one NHS Trust. RESULTS: These initiatives have been favourably received; but it is recognised that the approach can be further developed. CONCLUSION: This basic strategy should be enhanced and delivered more widely.