Functional Cognition: An Opportunity to Highlight the Role of Occupational Therapy in Post-Concussion Care

As concern surrounding concussion and the associated long-term effects grow, a continued need for comprehensive, holistic concussion care emerges. Occupational therapists are well-equipped to address the wide variety of symptoms and deficits that clients may experience post-concussion. Functional cognition is one area in which occupational therapists can demonstrate their unique value on the interdisciplinary treatment team. In this Opinions in the Profession paper, we describe how occupational therapists are poised to further establish their role in post-concussion care by becoming the primary discipline for assessing and treating functional cognition. The aim of this paper is to outline the role of occupational therapy in post-concussion care in regard to becoming the primary discipline for assessing and treating functional cognition and distinguishing occupational therapists as experts in functional cognition. Implications for practice, education, and research are discussed

Survey of Pain Curriculum Among Entry-Level Occupational Therapy Programs in the United States

Occupational therapy practitioners address pain management across settings, populations, and the lifespan. Occupational therapy practitioners offer unique contributions to pain management through biopsychosocial approaches, targeting supported self-management and occupational engagement. Comprehensive pain education is necessary to prepare entry-level occupational therapy practitioners to address pain in practice, yet no standards exist in entry-level occupational therapy education. This survey describes the status of pain-related education in entry-level occupational therapy programs across the United States. A total of 41 entry-level occupational therapy programs completed the survey. Total instructional time for pain content was reported to be an average of 9.68 hours, ranging from 1 to 30 hours, indicating significant variability. Average lecture (4.88 hours) and lab-based (5.05 hours) time devoted to pain content were similar. More time was devoted to teaching pain interventions (4.91 hours) than pain assessments (2.82 hours). Most programs integrated pain content throughout the curriculum (73%). One program utilized a standardized pain curriculum (International Association for the Study of Pain Occupational Therapy Curriculum). Open-ended questions revealed a breadth of evidence-based resources, pain assessments, and interventions covering all domains of the biopsychosocial model of pain. The majority of faculty (61%) felt their current amount of pain education was insufficient, citing the need for increased time and educational activities for pain education across all program years. Given the essential and unique role of occupational therapy practitioners in pain management, improving pain education and practitioner competence is an important consideration across entry-level occupational therapy education. Further discussion is needed regarding educational standards and entry-level occupational therapy curricula relating to pain management

Increasing Occupational Engagement by Addressing Psychosocial and Occupational Factors of Chronic Pain: A Case Report

Background: Chronic pain can significantly disrupt occupational engagement through physical, psychological, and social domains. Because pain is a subjective experience influenced by numerous factors, it has the capacity to become increasingly complex. Evidence supports addressing chronic pain through a biopsychosocial approach and promoting health and well-being through occupational engagement. Method: This case report describes the implementation of psychosocial and occupation-focused assessments and interventions for a 68-year-old client with chronic pain and increased symptoms of depression, anxiety, and pain catastrophizing. The use of an occupation-focused time-use assessment (Occupational Experience Profile), psychosocial assessments, and pain assessments guided intervention development. Occupational therapy intervention consisted of evidence-based approaches to address well-being and the pain experience through motivational interviewing, acceptance and commitment therapy, therapeutic exercises, pain neuroscience education, and graded exposure to occupational engagement. Results: The client demonstrated significant progress, and although pain was still present at discharge, he had met all client-directed goals. Outcome measures at discharge indicated improvements in depression, anxiety, catastrophizing thoughts about pain, and occupational engagement. Conclusion: Using a biopsychosocial approach, occupational therapists can incorporate psychosocial and occupation-focused assessments and interventions to increase quality of life and occupational engagement, improve overall well-being, and support clients in living well with chronic pain

Zebrafish mesonephric renin cells are functionally conserved and comprise of two distinct morphological populations

Zebrafish provide an excellent model in which to assess the role of the renin-angiotensin system in renal development, injury and repair. In contrast to mammals, zebrafish kidney organogenesis terminates with the mesonephros. Despite this, the basic functional structure of the nephron is conserved across vertebrates. The relevance of teleosts for studies relating to the regulation of the renin-angiotensin system was established by assessing the phenotype and functional regulation of renin-expressing cells in zebrafish. Transgenic fluorescent reporters for renin (ren), smooth muscle actin (acta2), and platelet derived growth factor receptor beta (pdgfrb) were studied to determine the phenotype and secretory ultrastructure of perivascular renin-expressing cells. Whole-kidney ren transcription responded to altered salinity, pharmacological renin-angiotensin system inhibition, and renal injury. Mesonephric ren-expressing cells occupied niches at the pre-glomerular arteries and afferent arterioles, forming intermittent epithelioid-like multi-cellular clusters exhibiting a granular secretory ultrastructure. In contrast, renin cells of the efferent arterioles were thin-bodied and lacked secretory granules. Renin cells expressed the perivascular cell markers acta2 and pdgfrb. Transcriptional responses of ren to physiological challenge support the presence of a functional renin-angiotensin system and are consistent with the production of active renin. The reparative capability of the zebrafish kidney was harnessed to demonstrate that ren transcription is a marker for renal injury and repair. Our studies demonstrate substantive conservation of renin regulation across vertebrates and ultrastructural studies of renin cells reveal at least two distinct morphologies of mesonephric perivascular ren-expressing cells

Methods for specifying the target difference in a randomised controlled trial : the Difference ELicitation in TriAls (DELTA) systematic review

Peer reviewedPublisher PD

Impact of Diabetes on Postinfarction Heart Failure and Left Ventricular Remodeling

Diabetes mellitus, the metabolic syndrome, and the underlying insulin resistance are increasingly associated with diastolic dysfunction and reduced stress tolerance. The poor prognosis associated with heart failure in patients with diabetes after myocardial infarction is likely attributable to many factors, important among which is the metabolic impact from insulin resistance and hyperglycemia on the regulation of microvascular perfusion and energy generation in the cardiac myocyte. This review summarizes epidemiologic, pathophysiologic, diagnostic, and therapeutic data related to diabetes and heart failure in acute myocardial infarction and discusses novel perceptions and strategies that hold promise for the future and deserve further investigation

GA4GH: International policies and standards for data sharing across genomic research and healthcare.

The Global Alliance for Genomics and Health (GA4GH) aims to accelerate biomedical advances by enabling the responsible sharing of clinical and genomic data through both harmonized data aggregation and federated approaches. The decreasing cost of genomic sequencing (along with other genome-wide molecular assays) and increasing evidence of its clinical utility will soon drive the generation of sequence data from tens of millions of humans, with increasing levels of diversity. In this perspective, we present the GA4GH strategies for addressing the major challenges of this data revolution. We describe the GA4GH organization, which is fueled by the development efforts of eight Work Streams and informed by the needs of 24 Driver Projects and other key stakeholders. We present the GA4GH suite of secure, interoperable technical standards and policy frameworks and review the current status of standards, their relevance to key domains of research and clinical care, and future plans of GA4GH. Broad international participation in building, adopting, and deploying GA4GH standards and frameworks will catalyze an unprecedented effort in data sharing that will be critical to advancing genomic medicine and ensuring that all populations can access its benefits