Integrated Health Care Collaboration and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections: A Working Model for Case Consultation

Historically, integrated health care, often referred to as interdisciplinary health care, has been an approach characterized by a high degree of collaboration and communication among health care professionals. While numerous researchers have explored the benefits of including clinical psychologists as team members, a limited body of research has explored the partnership between school psychologists and physicians, even though school health services can be an effective venue for integrating psychosocial care and education with medical care. As more chronically ill children are reintegrated into school, school psychologists must be prepared to work with these children at school. Childrendiagnosed with complex medical disorders, such as Pediatric AutoimmuneNeuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS), require strong intersystemic relationships from various disciplines to assist in diagnosing, assessing, and treating the disorder; however, barriers to effective interdisciplinary healthcare collaboration can be numerous. The primary purpose of this study was to survey medical students at Philadelphia College of Osteopathic Medicine (PCOM) in order to explore PCOM medical students’ awareness of PANDAS, to explore their selfreported level of agreement in the value of providing integrated health care collaboration to school psychologists on associated medical and psychological impairments, and to determine important considerations for the pediatric school psychologist to consider in order to maximize opportunity for successful integrated health care collaboration. Theresults indicated that only a small percentage of PCOM medical students were aware of PANDAS and that the efforts to promote interdisciplinary health care collaboration on the campuses of PCOM have been inconsistent. The data from the survey were then used to construct a working model of specific considerations for both the school psychologist and the physician to consider when working with children with PANDAS/PANS

Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – a mixed methods systematic review

BACKGROUND: Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. METHODS: The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. RESULTS: A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. DISCUSSION: Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach

Assessment of highly distributed power systems using an integrated simulation approach

In a highly distributed power system (HDPS), micro renewable and low carbon technologies would make a significant contribution to the electricity supply. Further, controllable devices such as micro combined heat and power (CHP) could be used to assist in maintaining stability in addition to simply providing heat and power to dwellings. To analyse the behaviour of such a system requires the modelling of both the electrical distribution system and the coupled microgeneration devices in a realistic context. In this paper a pragmatic approach to HDPS modelling is presented: microgeneration devices are simulated using a building simulation tool to generate time-varying power output profiles, which are then replicated and processed statistically so that they can be used as boundary conditions for a load flow simulation; this is used to explore security issues such as under and over voltage, branch thermal overloading, and reverse power flow. Simulations of a section of real network are presented, featuring different penetrations of micro-renewables and micro-CHP within the ranges that are believed to be realistically possible by 2050. This analysis indicates that well-designed suburban networks are likely to be able to accommodate such levels of domestic-scale generation without problems emerging such as overloads or degradation to the quality of supply

Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – A mixed methods systematic review protocol

Background: Musculoskeletal (MSK) pain conditions have a substantial influence on the quality of life. Psychosocial factors such as depression, anxiety and social isolation have been shown to play an important role in the development and management of MSK pain. Therefore, clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing MSK pain. However, it remains unclear how osteopaths implement a BPS framework in the management of MSK pain. This protocol describes the objective and methods of a systematic review of barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with MSK pain. Methods: The following electronic databases from January 2005 to March 2019 will be searched: PubMed, AMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), and SCOPUS. Two independent reviewers will review the title, abstract and full-text article retrieved from the databases to assess potentially eligible studies. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the biopsychosocial approach in osteopathic practice will be included in the review. Data synthesis for qualitative studies will be done using the GRADE‐CERQual tool. Data synthesis methods for mixed method studies will be decided after data extraction and assessment. Discussion: This systematic review will provide critical insights into the barriers and facilitators experienced by osteopaths to implement the BPS framework in their practice. This may be important and timely as a BPS framework has been recommended by various clinical practice guidelines. © 2020 Elsevier Lt

The effect of bovine colostrum supplementation on intestinal injury and circulating intestinal bacterial DNA following exercise in the heat

Purpose Exercise-induced changes in intestinal permeability are exacerbated in the heat. The aim of this study was to determine the effect of 14 days of bovine colostrum (Col) supplementation on intestinal cell damage (plasma intestinal fatty acid-binding protein, I-FABP) and bacterial translocation (plasma bacterial DNA) following exercise in the heat. Methods In a double-blind, placebo-controlled, crossover design, 12 males completed two experimental arms (14 days of 20 g/day supplementation with Col or placebo, Plac) consisting of 60 min treadmill running at 70% maximal aerobic capacity (30 ??C, 60% relative humidity). Blood samples were collected pre-exercise (Pre-Ex), post-exercise (Post-Ex) and 1 h post-exercise (1 h Post-Ex) to determine plasma I-FABP concentration, and bacterial DNA (for an abundant gut species, Bacteroides). Results Two-way repeated measures ANOVA revealed an arm ?~ time interaction for I-FABP (P = 0.005, with greater Post- Ex increase in Plac than Col, P = 0.01: Plac 407 ?} 194% of Pre-Ex vs Col, 311 ?} 134%) and 1 h Post-Ex (P = 0.036: Plac 265 ?} 80% of Pre-Ex vs Col, 229 ?} 56%). There was no interaction (P = 0.904) but there was a main effect of arm (P = 0.046) for plasma Bacteroides/total bacterial DNA, with lower overall levels evident in Col. Conclusion This is the first investigation to demonstrate that Col can be effective at reducing intestinal injury following exercise in the heat, but exercise responses (temporal pattern) of bacterial DNA were not influenced by Col (although overall levels may be lower).publishersversionPeer reviewe

Deciphering the pathogenesis of tendinopathy: a three-stages process

Our understanding of the pathogenesis of "tendinopathy" is based on fragmented evidences like pieces of a jigsaw puzzle. We propose a "failed healing theory" to knit these fragments together, which can explain previous observations. We also propose that albeit "overuse injury" and other insidious "micro trauma" may well be primary triggers of the process, "tendinopathy" is not an "overuse injury" per se. The typical clinical, histological and biochemical presentation relates to a localized chronic pain condition which may lead to tendon rupture, the latter attributed to mechanical weakness. Characterization of pathological "tendinotic" tissues revealed coexistence of collagenolytic injuries and an active healing process, focal hypervascularity and tissue metaplasia. These observations suggest a failed healing process as response to a triggering injury. The pathogenesis of tendinopathy can be described as a three stage process: injury, failed healing and clinical presentation. It is likely that some of these "initial injuries" heal well and we speculate that predisposing intrinsic or extrinsic factors may be involved. The injury stage involves a progressive collagenolytic tendon injury. The failed healing stage mainly refers to prolonged activation and failed resolution of the normal healing process. Finally, the matrix disturbances, increased focal vascularity and abnormal cytokine profiles contribute to the clinical presentations of chronic tendon pain or rupture. With this integrative pathogenesis theory, we can relate the known manifestations of tendinopathy and point to the "missing links". This model may guide future research on tendinopathy, until we could ultimately decipher the complete pathogenesis process and provide better treatments

International Olympic Committee consensus statement on pain management in elite athletes

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic