Symptom complexes in patients with seropositive arthralgia and in patients newly diagnosed with rheumatoid arthritis: a qualitative exploration of symptom development

Objective: The aim of this study was to explore symptoms and symptom development during the earliest phases of rheumatoid arthritis (RA) in patients with seropositive arthralgia and patients newly diagnosed with RA

Symptom complexes at the earliest phases of rheumatoid arthritis: a synthesis of the qualitative literature

Objective: Understanding the features and patterns of symptoms that characterise the earliest stages of rheumatoid arthritis (RA) is of considerable importance if patients are to be identified and started on treatment early. However, little is known about the characteristics of symptoms at the onset of a disease that eventually progresses to RA

Lack of evidence for central sensitization in idiopathic, non-traumatic neck pain : a systematic review

Background: Chronic neck pain is a common problem with a poorly understood pathophysiology. Often no underlying structural pathology can be found and radiological imaging findings are more related to age than to a patient's symptoms. Besides its common occurrence, chronic idiopathic neck pain is also very disabling with almost 50% of all neck pain patients showing moderate disability at long-term follow-up. Central sensitization (CS) is defined as "an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity," "increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input," or "an augmentation of responsiveness of central neurons to input from unimodal and polymodal receptors." There is increasing evidence for involvement of CS in many chronic pain conditions. Within the area of chronic idiopathic neck pain, there is consistent evidence for the presence and clinical importance of CS in patients with traumatic neck pain, or whiplash-associated disorders. However, the majority of chronic idiopathic neck pain patients are unrelated to a traumatic injury, and hence are termed chronic idiopathic non-traumatic neck pain. When comparing whiplash with idiopathic non-traumatic neck pain, indications for different underlying mechanisms are found. Objective: The goal of this article was to review the existing scientific literature on the role of CS in patients with chronic idiopathic non-traumatic neck pain. Study Design: Systematic review. Setting: All selected studies were case control studies. Methods: A systematic search of existing, relevant literature was performed via the electronic databases Medline, Embase, Web of Science, Cinahl, PubMed, and Google Scholar. All titles and abstracts were checked to identify relevant articles. An article was considered eligible if it met following inclusion criteria: (1) participants had to be human adults (> 18 years) diagnosed with idiopathic non-traumatic chronic (present for at least 3 months) neck pain; (2) papers had to report outcomes related to CS; and (3) articles had to be full-text reports or original research (no abstracts, case-reports, reviews, meta-analysis, letters, or editorials). Results: Six articles were found eligible after screening the title, abstract and - when necessary the full text for in- and exclusion criteria. All selected studies were case-control studies. Overall, results regarding the presence of CS were divergent. While the majority of patients with chronic traumatic neck pain (i.e. whiplash) are characterized by CS, this is not the case for patients with chronic idiopathic neck pain. The available evidence suggests that CS is not a major feature of chronic idiopathic neck pain. Individual cases might have CS pain, but further work should reveal how they can be characterized. Limitations: Very few studies available. Conclusions: Literature about CS in patients with chronic idiopathic non-traumatic neck pain is rare and results from the available studies provide an inconclusive message. CS is not a characteristic feature of chronic idiopathic and non-traumatic neck pain, but can be present in some individuals of the population. In the future a subgroup with CS might be defined, but based on current knowledge it is not possible to characterize this subgroup. Such information is important in order to provide targeted treatment

Health care and patient safety: The failure of traditional approaches – how human factors and ergonomics can and MUST help

Hazard and harm to patients as well as inefficiencies associated with health care have been well described as worldwide problems that result in hundreds of thousands of patient deaths and billions of dollars of waste every year. The underlying causes for these problems have not been nearly so well described; more importantly, generalizable mitigation strategies have not been effectively identified or used. The current state of health care and patient safety will be discussed with particular attention to the essential role that an engineering‐based approach, which is heavily rooted in human factors and ergonomics, must play if real and sustainable progress in the safe and efficient delivery of health care is to be achieved. Specific case studies that illustrate the compelling opportunities for the application of human factors and ergonomics–related knowledge will be discussed. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89498/1/20261_ftp.pd

Pediatric liver diseases: current challenges and future perspectives

Chronic liver diseases in children represent a rising problem with significant effects on public health. In fact, several pediatric liver diseases are precursors of adult chronic hepatopathies, cirrhosis and hepatocellular carcinoma. The prevalence of liver diseases in children is unknown. In the USA, every year, 15,000 children are hospitalized for liver diseases, but these disorders continue to be under-recognized or diagnosed late. The main reason is due to the frequent absence of symptoms in the vast majority of liver diseases, especially in the early stages. In the last few decades several advances have been made in understanding the pathogenesis of liver diseases, permitting the discovery of new therapeutic targets to treat liver diseases, thus improving the natural history of these disorders. In this article we discuss the most recent advances in the understanding of the pathogenesis, diagnosis and treatment of the most frequent pediatric liver diseases

Plantar fasciopathy: revisiting the risk factors

Background Plantar fasciopathy is the most common cause of acquired sub-calcaneal heel pain in adults. To-date, research of this condition has mainly focused on management rather than causal mechanisms. The aetiology of plantar fasciopathy is likely to be multifactorial, as both intrinsic and extrinsic risk factors have been reported. The purpose of this review is to critically reevaluate risk factors for plantar fasciopathy. Methods A detailed literature review was undertaken using English language medical databases. Results No clear consensus exists as to the relative strength of the risk factors reported. Conclusions To-date numerous studies have examined various intrinsic and extrinsic risk factors implicated in the aetiology of plantar fasciopathy. How these factors interact may provide useful data to establish an individuals’ risk profile for plantar fasciopathy and their potential for response to treatment. Further research is indicated to rank the relative significance of these risk factors

Differential Diagnosis for a Vietnam Veteran with Complex Neurological Signs and Symptoms: A Case Report

Background: Neck pain has an annual incidence of 10.4 to 21.3% affected in the United States. Clinical practice guidelines developed by the American Physical Therapy Association have classified neck pain into four categories that guide treatment: neck pain with mobility deficits, neck pain with movement coordination impairments, neck pain with headaches, or neck pain with radicular symptoms. Case Description: A patient presented to an outpatient physical therapy clinic with severe chronic neck pain, dropped head syndrome, and neurological symptoms including bowel incontinence and split hand sign. His chief complaint was neck pain. The patient transported Agent Orange during the Vietnam War and had comorbidities linked to his military history. Differential Diagnosis: Several diagnoses were considered for this patient due to the risk factors and signs and symptoms identified during the evaluation. Agent Orange exposure has been linked to a number of disease states. Dropped head syndrome can be a sign of certain neurological and autoimmune conditions. Epidemiological studies identified a 60% greater risk of ALS in military men during the last 100 years compared to the general population. The purpose of this case report is to describe the clinical decision-making process for the differential diagnosis of a patient with complex neurological signs and symptoms. Discussion: Physical therapists are direct access providers in many states, so it is imperative to screen for underlying conditions that would not be appropriately treated with physical therapy alone. This patient is an example of someone who did not realize the potential implications of his additional neurological signs and symptoms. Several physical therapy interventions were used with this patient including manual therapy, dry needling, and movement coordination training