Therapeutic Use of Self and Fieldwork Experience: An Exploration of the Art and Science of Occupational Therapy

The clinical practice of occupational therapy has been described as a blend of both art and science. For occupational therapy students, Level II fieldwork experiences offer early opportunities to refine both client-centered attitudes and scientific aptitude in relationship-based caregiving. In this retrospective study, researchers examined the ability to predict final Fieldwork Performance Evaluation scores from the following non-cognitive (i.e., art) and cognitive (i.e., science) variables: ranked student responses to the Self-Assessment of Modes Questionnaire (v.II); undergraduate grade point average (GPA; cumulative and science), and Graduate Record Examination (GRE) scores (quantitative, verbal, and analytic). Using a series of simple linear regressions, researchers analyzed data from sixty-nine master’s-level occupational therapy students. For the first Level II fieldwork experience, empathizing and empathizing-revised modes appeared to be a significant predictor with moderate, positive correlation coefficients (p=.008, r=.329; p=.01, r=.296, respectively). For the second Level II fieldwork experience, collaborating and instructing modes appeared to be significant predictors (p=.036, r= -.255; p=.037, r=.254 respectively). GPA and GRE scores were not predictive of fieldwork success. The degree to which art and science shape expectations for relationship-based client interactions during fieldwork experiences requires further investigation. However, calling attention to occupational therapy students’ preferred communication modes highlight how client interactions may be shaped to fit the students’ natural tendencies rather than the needs of the client

Myocarditis and sports in the young: data from a nationwide registry on myocarditis - "MYKKE-Sport"

BACKGROUND: Myocarditis represents one of the most common causes of Sudden Cardiac Death in children. Myocardial involvement during a viral infection is believed to be higher as a consequence of intensive exertion. Recommendations for return to sports are based on cohort and case studies only. This study aims to investigate the relationship between physical activity and myocarditis in the young. PATIENT: Every patient in the MYKKE registry fulfilling criteria for suspicion of myocarditis was sent a questionnaire regarding the physical activity before, during and after the onset of myocarditis. METHOD: This study is a subproject within the MYKKE registry, a multicenter registry for children and adolescents with suspected myocarditis. The observation period for this analysis was 93 months (September 2013–June 2021). Anamnestic, cardiac magnetic resonance images, echocardiography, biopsy and laboratory records from every patient were retrieved from the MYKKE registry database. RESULTS: 58 patients (mean age 14.6 years) were enrolled from 10 centers. Most patients participated in curricular physical activity and 36% in competitive sports before the onset of myocarditis. There was no significant difference of heart function at admission between the physically active and inactive subjects (ejection fraction of 51.8 ± 8.6% for the active group vs. 54.4 ± 7.7% for the inactive group). The recommendations regarding the return to sports varied widely and followed current guidelines in 45%. Most patients did not receive an exercise test before returning to sports. CONCLUSION: Sports before the onset of myocarditis was not associated with a more severe outcome. There is still a discrepancy between current literature and actual recommendations given by health care providers. The fact that most participants did not receive an exercise test before being cleared for sports represents a serious omission

Clinical characteristics and outcome of biopsy-proven myocarditis in children - Results of the German prospective multicentre registry "MYKKE"

BACKGROUND: Heart failure (HF) due to myocarditis might not respond in the same way to standard therapy as HF due to other aetiologies. The aim of this study was to investigate the value of endomyocardial biopsies (EMB) for clinical decision-making and its relation to the outcome of paediatric patients with myocarditis. METHODS: Clinical and EMB data of children with myocarditis collected for the MYKKE-registry between 2013 and 2020 from 23 centres were analysed. EMB studies included histology, immunohistology, and molecular pathology. The occurrence of major adverse cardiac events (MACE) including mechanical circulatory support (MCS), heart transplantation, and/or death was defined as a combined endpoint RESULTS: Myocarditis was diagnosed in 209/260 patients: 64% healing/chronic lymphocytic myocarditis, 23% acute lymphocytic myocarditis (AM), 14% healed myocarditis, no giant cell myocarditis. The median age was 12.8 (1.4–15.9) years. Time from symptom-onset to EMB was 11.0 (4.0–29.0) days. Children with AM and high amounts of mononuclear cell infiltrates were significantly younger with signs of HF compared to those with healing/chronic or healed myocarditis. Myocardial viral DNA/RNA detection had no significant effect on outcome. The worst event-free survival was seen in patients with healing/chronic myocarditis (24%), followed by acute (31%) and healed myocarditis (58%, p = 0.294). A weaning rate of 64% from MCS was found in AM. CONCLUSIONS: EMB provides important information on the type and stage of myocardial inflammation and supports further decision-making. Children with fulminant clinical presentation, high amounts of mononuclear cell infiltrates or healing/chronic inflammation and young age have the highest risk for MACE