Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: an experimental study

Objective The aims of this study were to examine (i) base line pressure pain thresholds in patients with chronic fatigue syndrome and those with chronic low back pain compared with healthy subjects, (ii) the change in mean pain threshold in response to exercise, and (iii) associations with exercise induced increase in nitric oxide Participants Twenty six patients with chronic fatigue syndrome suffering of chronic pain, 21 patients with chronic low back pain and 31 healthy subjects Methods Participants underwent a submaximal aerobic exercise protocol on a bicycle ergometer, preceded and followed by venous blood sampling (nitric oxide) and algometry (hand arm calf low back) Results Patients with chronic fatigue syndrome presented overall lower pain thresholds compared with healthy sub jects and patients with chronic low back pain (p<0 05) No significant differences were found between healthy subjects and patients with chronic low back pain After submaximal aerobic exercise, mean pain thresholds decreased in patients with chronic fatigue syndrome and increased in the others (p<0 01) At baseline nitric oxide levels were significantly higher in the chronic low back pain group After controlling for body mass index no significant differences were seen be tween the groups at baseline or in response to exercise Nitric oxide was not related to pain thresholds in either group Conclusion The results suggest hyperalgesia and abnormal central pain processing during submaximal aerobic exercise in chronic fatigue syndrome, but not in chronic low back pain Nitric oxide appeared to be unrelated to pain processin

Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial.

&lt;b&gt;Objective&lt;/b&gt;: It was hypothesized that the use of exercise limits prevents symptom increases and worsening of their health status following a walking exercise in people with Chronic Fatigue Syndrome (CFS). &lt;b&gt;Design&lt;/b&gt;: An uncontrolled clinical trial (semi-experimental design). &lt;b&gt;Setting&lt;/b&gt;: Outpatient clinic of a university department. &lt;b&gt;Subjects&lt;/b&gt;: 24 patients with CFS. &lt;b&gt;Interventions&lt;/b&gt;: Subjects undertook a walking test with the two concurrent exercise limits. Each subject walked at an &lt;i&gt;intensity&lt;/i&gt; where the maximum heart rate was determined by heart rate corresponding to the respiratory exchange ratio =1.0 derived from a previous sub-maximal exercise test and for a duration calculated from how long each patient felt they were able to walk. &lt;b&gt;Main outcome measures&lt;/b&gt;: The Short Form 36 Health Survey or SF-36, the CFS Symptom List, and the CFS-Activities and Participation Questionnaire were filled in prior to, immediately and 24 hours post-exercise. &lt;b&gt;Results&lt;/b&gt;: The fatigue increase observed immediately post-exercise (p=0.006) returned to pre-exercise levels 24 hours post-exercise. The increase in pain observed immediately post-exercise was retained at 24 hours post-exercise (p=0.03). Fourteen of 24 subjects experienced a clinically meaningful change in bodily pain (change of SF-36 bodily pain score ³10). Six of 24 participants indicated that the exercise bout had slightly worsened their health status, and 2 of 24 had a clinically meaningful decrease in vitality (change of SF-36 vitality score ³20). There was no change in activity limitations/participation restrictions. &lt;b&gt;Conclusion&lt;/b&gt;: It was shown that the use of exercise limits (limiting both the intensity and duration of exercise) prevents important health status changes following a walking exercise in people with CFS, but was unable to prevent short-term symptom increases

Assessment and treatment of visuospatial neglect using active learning with Gaussian processes regression

Visuospatial neglect is a disorder characterised by impaired awareness for visual stimuli located in regions of space and frames of reference. It is often associated with stroke. Patients can struggle with all aspects of daily living and community participation. Assessment methods are limited and show several shortcomings, considering they are mainly performed on paper and do not implement the complexity of daily life. Similarly, treatment options are sparse and often show only small improvements. We present an artificial intelligence solution designed to accurately assess a patient's visuospatial neglect in a three-dimensional setting. We implement an active learning method based on Gaussian process regression to reduce the effort it takes a patient to undergo an assessment. Furthermore, we describe how this model can be utilised in patient oriented treatment and how this opens the way to gamification, tele-rehabilitation and personalised healthcare, providing a promising avenue for improving patient engagement and rehabilitation outcomes. To validate our assessment module, we conducted clinical trials involving patients in a real-world setting. We compared the results obtained using our AI-based assessment with the widely used conventional visuospatial neglect tests currently employed in clinical practice. The validation process serves to establish the accuracy and reliability of our model, confirming its potential as a valuable tool for diagnosing and monitoring visuospatial neglect. Our VR application proves to be more sensitive, while intra-rater reliability remains high

Management of headache disorders: design of a randomised clinical trial screening for prognostic patient characteristics

Contains fulltext : 51576.pdf (publisher's version ) (Open Access)BACKGROUND: Treatment of headache disorders is not always optimal. Patients are treated in multiple ways, and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies. The coexistence of headache and neck pain can lead to the referral to a musculoskeletal physiotherapist. This treatment can only be successful if an underlying cervical segmental dysfunction is present. In such cases a physical treatment can be a valuable option that should be considered. The aim of this study is to identify prognostic therapeutic patient characteristics and to increase the number of correct physiotherapy referrals. METHODS/DESIGN: This trial is designed to identify patient characteristics which can influence the prognosis of the patient. Patients with recurrent headache and co-existent neck pain are recruited via a multicenter setup. After screening for eligibility, subjects are tested at baseline and randomly allocated to one of two treatment groups. Testing includes the administering of questionnaires (a Headache Diagnosis Questionnaire, Headache Inventory List and the Headache Impact Test (HIT-6)) and physical tests (Thermal Stimuli, Manual Cervical Spine Examination and Pressure Algometry). Treatment groups are a usual care group (UC) administered by the General Practitioner (GP) and a usual care plus musculoskeletal physiotherapy treatment group (UCMT). UC is based on the Dutch GP Guideline for Headache. UCMT consists of the UC plus a combination of exercises and spinal cervical mobilisations. Follow-up measurements consist of the completion of the Headache Inventory List, the HIT-6 and scoring of the global perceived effect (GPE). The latter allowing the distinction between responders (positive effect) and non-responders (no effect or worse). Logistic regression analysis will be used to identify the specific patient characteristics of the responders and the non-responders. The additional value of the musculoskeletal physiotherapy will be examined. Follow-up measurements up to 52 weeks are scheduled. DISCUSSION: This trial aims to identify prognostic patient characteristics, in order to supply a useful diagnostic tool for all health care workers, dealing with headache sufferers

A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients

No summary availabl

Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial

Objective To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to breast cancer

Управление деловой карьерой персонала в организации общественного питания

Проблема исследования заключается в необходимости управления деловой карьеры персонала в организации ООО «Бриз» для повышения качества ее работы в целом. Целью выпускной квалификационной работы является анализ управления деловой карьерой и разработка мероприятий по ее усовершенствованию деловой карьеры персонала в организации общественного питания ООО «Бриз».Объектом исследования является деловая карьера персонала в организации ООО «Бриз».Предметом исследования является управление деловой карьерой персонала в организации ООО «Бриз». Структура работы. Выпускная квалификационная работа состоит из: введения, двух глав, заключения, списка использованной литературы, приложений