An investigation of depression and fatigue post West Nile virus infection.

INTRODUCTION: The purpose of this study was to examine depression and fatigue in individuals with a seropositive confirmed history of West Nile virus (WNV) infection. METHODS: The South Dakota State Epidemiologist sent 218 letters inviting residents with a diagnosis of WNV to participate in the study. Forty-five subjects were tested. An occupational therapist and a physical therapist met with each participant to assess performance parameters, including depression and fatigue levels. Subjects (n=42) completed the Revised Center for Epidemiologic Studies Depression Scale (CES-D) during the assessment. The Modified Fatigue Impact Scale (MFIS) was sent to participants as a follow-up questionnaire, and 29 were returned. Subjects were placed within one of three diagnosis groups: West Nile Fever (WNF), West Nile Neuroinvasive Disease (WNND) and WNV without fever or neuroinvasive disease (clinical/unspecified). RESULTS: Frequency of those reporting low risk of depression was similar between diagnosis groups (each approximating 75 percent). Depression severity differences were noted, with subjects diagnosed with WNND more likely to report severe risk for depression. Low correlations between depression and overall fatigue, depression and cognitive fatigue, and depression and psychosocial fatigue indicators were found. There was little if any correlation between depression and physical fatigue indicators. Mean CES-D scores for subjects between 13 to 18 months post infection fell within the mild-moderate risk for depression category. CONCLUSIONS: Identifying depression risk is useful for patient referral purposes and may help minimize symptoms of depression correlated with fatigue, especially following hospitalization for WNV infection

Relationship between Occupational and Physical Therapist Students’ Belongingness and Perceived Competence in the Clinic using the Ascent to Competence Scale

Clinical education experiences (CEEs) serve an essential role in physical therapist (PT) and occupational therapist (OT) student development. The Ascent to Competence Scale (ACS) measures valuable attributes of belongingness, competence, and welcoming associated with CEE placement. The purpose of this study was to examine the relationship between PT and OT students’ belongingness and perceived competence during CEE using the ACS. A survey consisting of 35 questions from the ACS measuring students’ feelings of belongingness and perceived competence in the clinic was administered to PT and OT students from 7 Midwest universities. Respondents rated statements using a 5-point Likert-type scale (“never true” to “always true”). Ascent to Competence items were aggregated to develop belongingness and perceived competence constructs. One hundred nineteen (67.2% PT, 32.8% OT) of 509 (23.4% response) eligible students completed the survey. Results of a linear regression analysis showed belongingness in the clinical environment significantly predicted perceived competence measures, F(1, 117) = 182.389; P = r2 = .609, y(comp) = .721(Xbel) + 1.249. Cumulative weeks in CEE and practice environment did not contribute to the predictive model. The analysis lends further support to the role that belongingness plays in advancing perceived competence during the CEE. The results suggest that supportive clinical education environments can positively impact student learning by promoting a sense of belongingness among student therapists

Using the SNAPPS model to develop student physical therapist decision-making skills during new patient encounters in the outpatient clinic: a pilot study

Rationale: The SNAPPS (summarize, narrow, analyze, probe, plan, select) model is a six-step teaching tool that facilitates decision-making in clinic environments. The tool promotes active communication between students and clinical instructors (CIs) and positions the student as lead in the learning scenario. The current study employed the SNAPPS model for use with student physical therapists. The purpose of the study was to gauge changes in perceptions of verbal ability, decision-making, and confidence levels following new patient evaluations where the SNAPPS model was utilized. Methods: Participating student and CI partners received training to learn the SNAPPS model with fidelity. Log worksheets guided students through the SNAPPS steps. After new patient encounters, student and CI partners rated student verbal skills, decision-making, and confidence levels using mirrored statements. Representative early, middle, and late week ratings were compared for change. Results: Six of forty-eight (12.5%) eligible students participated. Student and CI assessments were not significantly different, indicating reliable student self-assessment. Improvements were noted in students’ (1) skill in providing a verbal rationale, (2) ability to generate thoughtful and relevant learning prompts, (3) confidence in diagnosing pathology and impairment, and (4) confidence in selecting an appropriate intervention. Clinical relevance: The SNAPPS model is a clinical education tool that shows promise toward improving thought process verbalization and confidence levels for the student seeing new patients in an outpatient setting. This active learning experience can promote accountability for learning and enhance student verbal and analytical skills

Health status in non-dystrophic myotonias: close relation with pain and fatigue

To determine self-reported health status in non-dystrophic myotonias (NDM) and its relationship to painful myotonia and fatigue. In a cross-sectional study, 32 NDM patients with chloride and 30 with sodium channelopathies, all off treatment, completed a standardised interview, the fatigue assessment scale (FAS), and the 36-item Short-Form Health Survey (SF-36). Beside formal assessment of pain, assessment of painful or painless myotonia was determined. The domain scores of the SF-36 were compared with Dutch community scores. Apart from the relationship among SF-36 scores and (1) painful myotonia and (2) fatigue, regression analyses in both NDM groups were conducted to determine the strongest determinants of the SF-36 domains general health perception, physical component (PCS) and mental component summary (MCS). All physically oriented SF-36 domains in both NDM groups (P ≤ 0.01) and social functioning in the patients with sodium channelopathies (P = 0.048) were substantially lower relative to the Dutch community scores. The patients with painful myotonia (41.9%) scored substantially (P < 0.05) lower on most SF-36 domains than the patients without painful myotonia (58.1%). Fatigued patients (53.2%) scored substantially lower (P ≤ 0.01) on all SF-36 domains than their non-fatigued counterparts (46.8%). The regression analysis showed that fatigue was the strongest predictor for the general-health perception and painful myotonia for the physical-component summary. None of the patients showed below-norm scores on the domain mental-component summary. The impact of NDM on the physical domains of patients’ health status is substantial, and particularly painful myotonia and fatigue tend to impede their physical functioning

Insulin signalling and the regulation of glucose and lipid metabolism

The epidemic of type 2 diabetes and impaired glucose tolerance is one of the main causes of morbidity and mortality worldwide. In both disorders, tissues such as muscle, fat and liver become less responsive or resistant to insulin. This state is also linked to other common health problems, such as obesity, polycystic ovarian disease, hyperlipidaemia, hypertension and atherosclerosis. The pathophysiology of insulin resistance involves a complex network of signalling pathways, activated by the insulin receptor, which regulates intermediary metabolism and its organization in cells. But recent studies have shown that numerous other hormones and signalling events attenuate insulin action, and are important in type 2 diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62568/1/414799a.pd

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme