Rare case of autonomic instability of the lower limb presenting as painless Complex Regional Pain Syndrome type I following hip surgery: two case reports

<p>Abstract</p> <p>Introduction</p> <p>According to the International Association for the Study of Pain criteria of 1994, pain is a diagnostic requirement for Complex Regional Pain Syndrome type I. However, other authors have suggested that patients can rarely present with the sensory and vascular symptoms of Complex Regional Pain Syndrome without pain. This entity has not been reported following hip surgery in the English medical literature.</p> <p>Case presentation</p> <p>We present two cases of Complex Regional Pain Syndrome-like symptoms following hip surgery and with the total absence of pain. The first case was a 29-year-old Caucasian woman who had a reattachment of the greater trochanter following non-union of an intertrochanteric osteotomy of the hip. Five weeks later, the patient presented with features of Complex Regional Pain Syndrome but with the absence of pain. The second patient was a 20-year-old Caucasian woman who had undergone an open debridement and repair of a torn acetabular labrum. Ten days later, the patient presented with features suggestive of Complex Regional Pain Syndrome which was again painless. Both patients were non-weight bearing at presentation and the symptoms resolved following recommencement of weight bearing.</p> <p>Conclusions</p> <p>The authors believe these symptoms are manifestations of vascular changes to the lower limb as a result of non-weight bearing status. Painless Complex Regional Pain Syndrome-like symptoms may occur in patients who are kept non-weight bearing following hip surgery. However, vascular insufficiency and deep venous thrombosis must be excluded before this diagnosis is made. If the clinical situation permits, early weight bearing may relieve symptoms. Orthopaedic and vascular surgeons should be aware of this entity when a postoperative patient presents to them with the above clinical picture. This is also relevant to general practitioners who are likely to see the patients in the postoperative period.</p

Developing Health Information Literacy in Disadvantaged and Dependent Circumstances: The Everyday Role of Family Nurses

This paper examines the challenges of developing health information literacy (HIL) amongst disadvantaged and dependent populations from the perspective of non-information professionals occupying everyday support roles. Our participants were a team of UK Family Nurses providing outreach support to vulnerable young mothers from areas of multiple deprivations. Our data collection methods were observation, interviews, and focus groups. Our participants all believe that they have an important role in developing HIL in clients but are unfamiliar with fundamental overarching information literacy (IL) concepts and models. Consequently, their confidence in their own ability to develop HIL skills in clients is limited. We discuss that to extend primary healthcare practices beyond HIL support to HIL education requires not only IL training, but also an appropriate pedagogical approach adaptable to semi-structured problematic situations. We raise important questions regarding approaches to developing HIL in disadvantaged population

The role of cognitive emotion regulation on the vicarious emotional response

Perceiving another in need may provoke two possible emotional responses: empathic concern and personal distress. This research aims to test whether different emotion regulation strategies (i.e., reappraisal and rumination) may lead to different vicarious emotional responses (i.e., empathic concern and personal distress). In this sense, we hypothesized that reappraisal may lead to a greater feeling of empathic concern, whereas rumination may lead to a higher feeling of personal distress. To test the hypotheses we used experimental instructions (Study 1) and a priming procedure (Study 2) to manipulate the emotion regulation strategies. The results supported our hypotheses. Furthermore in the rumination condition the emotional experience was described as being more negative and more highly arousing than in the reappraisal condition. We discuss the effect of these two forms of cognitive emotion regulation on empathic concern and personal distress

Maternal effects on anogenital distance in a wild marmot population

Peer reviewedPublisher PD

Emotions in business-to-business service relationships

Emotion in business-to-business service relationships regarding cargo services is explored. The service relationship is characterised by mutual trust and cooperation. Contact is mainly via telephone or e-mail with some face-to-face interactions and participants providing a complex, multi-skilled seamless service. Experience rather than training plays a vital role with long-term service relationships built up and maintained. Emotional sensitivity is acquired partly by experience and a repeat customer base but mainly through a genuine desire to help and get to know others. In contrast to the view of emotional labour bringing managerial control or adverse affects to service staff, the emotion engendered by this work is authentic expression bringing personal satisfaction

Herbal medicine use by surgery patients in Hungary: a descriptive study

BACKGROUND: The popularity of non-conventional treatments, especially the consumption of herbs is showing an increasing tendency all over the world. The consumption of herbal medicines might cause several complications during perioperative care. METHODS: The survey was conducted at the First Department of Surgery of Semmelweis University and focused on the demographics of patients consuming herbal medicines who had undergone elective surgery between July 1(st) 2014 and February 28(th) 2015. A one-page questionnaire, that the patients filled in individually and anonymously, was used. The response rate was 17.3 %. RESULTS: Out of the 390 patients who filled in the questionnaire, 7.2 % (28 patients) used herbal medicines, 3.6 % (14 patients) of them two weeks prior to their hospitalization. The other 3.6 % (14 patients) took herbal medicines sometime in the past. The majority of those who have ever consumed herbs are women (18/28), have completed secondary or tertiary education (23/28), more than half of them suffer from tumorous diseases and only a quarter of them (7/28) informed their physician about their use of herbal medication of their own accord. CONCLUSIONS: Attention must be paid to the exploration of herb consumption habits of surgery patients during the preoperative examinations in order to avoid potential side effects, complications or drug interactions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12906-015-0890-2) contains supplementary material, which is available to authorized users

Symptoms of Anxiety, Depression, and Aggression in Non-clinical Children: Relationships with Self-report and Performance-based Measures of Attention and Effortful Control

This study investigated the relation between the regulative trait of effortful control, and in particular attention control, and psychopathological symptoms in a sample of 207 non-clinical children aged 8–12 years. For this purpose, children completed self-report scales for measuring regulative traits and various types of psychopathological symptoms (i.e., anxiety, depression, and aggression) and were tested with a neuropsychological battery for measuring attention/effortful control capacity. Results indicated that self-report and performance-based measures of attention/effortful control were at best moderately correlated. Further, it was found that self-report indexes of attention/effortful control were clearly negatively related to psychopathological symptoms, which provides support for the notion that low regulation is associated with higher levels of psychopathology. Finally, the performance-based measure of attention/effortful control was not convincingly related to psychopathological symptoms

Systematic reviews of complementary therapies - an annotated bibliography. Part 1: Acupuncture

Background Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. Results From a total of 48 potentially relevant reviews preselected in a screeening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture. Conclusions A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials

Attitudes towards fibromyalgia: A survey of Canadian chiropractic, naturopathic, physical therapy and occupational therapy students

<p>Abstract</p> <p>Background</p> <p>The frequent use of chiropractic, naturopathic, and physical and occupational therapy by patients with fibromyalgia has been emphasized repeatedly, but little is known about the attitudes of these therapists towards this challenging condition.</p> <p>Methods</p> <p>We administered a cross-sectional survey to 385 senior Canadian chiropractic, naturopathic, physical and occupational therapy students in their final year of studies, that inquired about attitudes towards the diagnosis and management of fibromyalgia.</p> <p>Results</p> <p>336 students completed the survey (response rate 87%). While they disagreed about the etiology (primarily psychological 28%, physiological 23%, psychological and physiological 15%, unsure 34%), the majority (58%) reported that fibromyalgia was difficult to manage. Respondants were also conflicted in whether treatment should prioritize symptom relief (65%) or functional gains (85%), with the majority (58%) wanting to do both. The majority of respondents (57%) agreed that there was effective treatment for fibromyalgia and that they possessed the required clinical skills to manage patients (55%).</p> <p>Chiropractic students were most skeptical in regards to fibromyalgia as a useful diagnostic entity, and most likely to endorse a psychological etiology. In our regression model, only training in naturopathic medicine (unstandardized regression coefficient = 0.33; 95% confidence interval = 0.11 to 0.56) and the belief that effective therapies existed (unstandardized regression coefficient = 0.42; 95% confidence interval = 0.30 to 0.54) were associated with greater confidence in managing patients with fibromyalgia.</p> <p>Conclusion</p> <p>The majority of senior Canadian chiropractic, naturopathic, physical and occupational therapy students, and in particular those with naturopathic training, believe that effective treatment for fibromyalgia exists and that they possess the clinical skillset to effectively manage this disorder. The majority place high priority on both symptom relief and functional gains when treating fibromyalgia.</p

Behavioral Inhibition and Attentional Control in Adolescents: Robust Relationships with Anxiety and Depression

Behavioral inhibition (BI) has been associated with the development of internalizing disorders in children and adolescents. It has further been shown that attentional control (AC) is negatively associated with internalizing problems. The combination of high BI and low AC may particularly lead to elevated symptomatology of internalizing behavior. This study broadens existing knowledge by investigating the additive and interacting effects of BI and AC on the various DSM-IV based internalizing dimensions. A sample of non-clinical adolescents (N = 1806, age M = 13.6 years), completed the Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS), the attentional control subscale of the Adult Temperament Questionnaire (ATQ) and the Revised Child Anxiety and Depression Scale (RCADS). As expected, BI was positively, and AC was negatively related to internalizing dimensions, with stronger associations of BI than of AC with anxiety symptoms, and a stronger association of AC than of BI with depressive symptoms. AC moderated the association between BI and all measured internalizing dimensions (i.e., symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive–compulsive disorder, and major depressive disorder). Since high AC may reduce the impact of high BI on the generation of internalizing symptoms, an intervention focused on changing AC may have potential for prevention and treatment of internalizing disorders