Actual vs. best practices for young children with cerebral palsy: A survey of paediatric occupational therapists and physical therapists in Quebec,Canada

Rationale: Cerebral palsy (CP) constitutes a substantial portion of paediatric rehabilitation, yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices. This study describes OT and PT practices for young children with CP in Quebec, Canada.

Methods: This was a cross-sectional survey. All eligible, consenting paediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points—18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability and Health (ICF).

Results: 91.9% of PTs (n?=?62; 83.8% participation rate) and 67.1% of OTs (n?=?85; 91.4% participation rate) reported using at least one standardized paediatric assessment. OT and PT interventions focused primarily on impairments and primary function (such as gait function and activities of daily living). Both professions gave little attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice.

Conclusion: Wide variations and gaps were identified in clinicians’ responses suggesting the need for a basic standard of OT and PT management as well as strategies to encourage knowledge dissemination regarding current best practice.

Fundamento: La parálisis cerebral (PC) constituye una parte sustancial de la rehabilitación pediátrica, sin embargo se sabe poco acerca del ejercicio actual de la terapia física (TF) y de la terapia ocupacional (TO). Este estudio describe la aplicación de la TF y de la TO a niños pequeños con PC en Quebec, Canadá. Métodos: Este fue un estudio prospectivo, de corte transversal. Todos los terapistas físicos (TF) y los terapistas ocupacionales (TO) pediátricos elegibles, previo consentimiento, fueron entrevistados utilizando un cuestionario telefónico estructurado basado en viñetas de dos niños típicos con PC a dos edades - 18 meses y 4 años de edad. Las prácticas reportadas fueron agrupadas en base a la Clasificación Internacional de Funcionalidad, discapacidad y salud (CIF). Resultados: 91.9% de los TFs (n?=?62; 83.8% rango de participación) y 67.1% de los TOs (n?=?85; 91.4% rango de participación) reportaron usar por lo menos una forma de evaluación pediátrica estandarizada. Las intervenciones de TF y TO se enfocaron principalmente en las discapacidades y en las funciones primarias (tales como la marcha y las actividades de la vida diaria). Ambas profesiones prestaron poca atención a las intervenciones relacionadas al juego y a las actividades recreativas y de entretenimiento. Los médicos manifestaron la necesidad de un mayor entrenamiento y educación específicos a la PC y la aplicación de los hallazgos de las investigaciones en la práctica clínica. Conclusión: Se identificaron amplias variaciones y un desconocimiento en las respuestas de los médicos, sugiriendo esto la necesidad de un manejo estándar básico de TF y TO, así como estrategias que impulsen la diseminación del conocimiento en relación a una mejor práctica. Palabras clave: Terapia ocupacional, terapia física, parálisis infantil, Clasificación Internacional de Funcionalidad, tratamiento basado en la evidencia, rehabilitación pediátrica     

Senile dementia of the neurofibrillary tangle type (tangle‐only dementia): Neuropathological criteria and clinical guidelines for diagnosis*

Senile dementia of the NFT type (SD‐NFT) is a subset of dementia in the elderly, characterized by numerous NFT in the hippocampal region and absence or scarcity of senile plaques throughout the brain. Senile dementia‐NFT has also been referred to as tangle‐only dementia, NFT‐predominant form of SD, SD with tangles, or limbic NFT dementia. Herein are proposed the criteria for neuropathological diagnosis of SD‐NFT: (i) late‐onset dementia with abundant NFT in the hippocampal region and absence or scarcity of senile plaques (amyloid β protein deposits) throughout the brain; and (ii) exclusion of other dementias with NFT. Some elderly individuals suffering from memory disorder without obvious dementia have neuropathological findings similar to SD‐NFT, and they would represent a condition in the process of formation of the SD‐NFT pathology. Guidelines for the clinical diagnosis of SD‐NFT are also proposed; development of reliable diagnostic tests is necessary to differentiate AD and other neurodegenerative dementias from SD‐NFT.     

Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA): clinical norms and functional impairment in male and female adults with eating disorders

Aim: The aim of the current study was to collect clinical normative data for the Clinical Impairment Assessment questionnaire (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q) from adult patients with eating disorders (EDs). This study also examined unique contributions of eating disorder (ED) symptoms on levels of ED-related impairment.

Methods: A sample of 667 patients, 620 females and 47 males, was recruited from six specialist centres across Norway. The majority of the sample (40.3%) was diagnosed with eating disorder not otherwise specified (EDNOS), 34.5% had bulimia nervosa (BN), and 25.2% were diagnosed with anorexia nervosa (AN).

Results: There were significant differences for global EDE-Q and CIA scores between females and males. In the female sample, significant differences were found on several EDE-Q sub-scales between the AN and BN group, and between the AN and EDNOS group. No significant differences were found between the diagnostic groups on the CIA. In the male sample, no significant differences were found between diagnostic groups on the EDE-Q or CIA. A multiple regression analysis revealed that 46.8% of the variance in impairment as measured by the CIA was accounted for by ED symptoms.

Conclusions: Body mass index, Eating Concern, Shape/Weight Concern, and binge eating served as significant, unique predictors of impairment. The results from the present study contribute to the interpretation of EDE-Q and CIA scores in ED samples.     

Common themes and cognitive biases in the negative thoughts of women with recurrent genital herpes: clinical reflections and implications for cognitive behaviour therapy

There is a relatively high prevalence of psychological distress among individuals with recurrent genital herpes. Clinical experience suggests that women who experience psychological distress typically present to clinical psychology services with similar negative thoughts and cognitive biases. The current paper describes seven themes that were common in the negative thoughts of five women presenting with psychological distress associated with recurrent genital herpes. Simple content theme analysis was used to analyse assessment and therapy session notes. Themes included: negative perceptions of the self and sex/sexual history; concerns about the risk and responsibility of transmitting the virus to sexual partners; concerns about the experience of disclosure and the possibility of rejection following disclosure; and misinterpretation of bodily sensations. A number of cognitive biases were evident in the women's negative thoughts. Cognitive biases included catastrophising, predicting the future, all-or-nothing thinking and self-blame. Implications for the practice of cognitive behaviour therapy with individuals who are distressed by a diagnosis of recurrent genital herpes are discussed.     

临床医学研究生抑郁与焦虑状况与应对方式的关系

目的 探讨我校临床医学研究生抑郁、焦虑状况与应对方式的关系.方法 采用随机整群抽样的方式抽取我校549名临床医学研究生进行问卷调查,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)和应付方式问卷(CSQ)进行调查.结果 共发放问卷549份,收回有效问卷510份,有效率为92.9％.本次调查结果显示临床医学研究生抑郁、...     

Holistic Treatment Response: An International Expert Panel Definition and Criteria for a New Paradigm in the Assessment of Clinical Outcomes of Spinal Cord Stimulation

BackgroundTreatment response to spinal cord stimulation (SCS) is focused on the magnitude of effects on pain intensity. However, chronic pain is a multidimensional condition that may affect individuals in different ways and as such it seems reductionist to evaluate treatment response based solely on a unidimensional measure such as pain intensity.AimThe aim of this article is to add to a framework started by IMMPACT for assessing the wider health impact of treatment with SCS for people with chronic pain, a ”holistic treatment response”.DiscussionSeveral aspects need consideration in the assessment of a holistic treatment response. SCS device data and how it relates to patient outcomes, is essential to improve the understanding of the different types of SCS, improve patient selection, long-term clinical outcomes, and reproducibility of findings. The outcomes to include in the evaluation of a holistic treatment response need to consider clinical relevance for patients and clinicians. Assessment of the holistic response combines two key concepts of patient assessment: (1) patients level of baseline (pre-treatment) unmet need across a range of health domains; (2) demonstration of patient-relevant improvements in these health domains with treatment. The minimal clinical important difference (MCID) is an established approach to reflect changes after a clinical intervention that are meaningful for the patient and can be used to identify treatment response to each individual domain. A holistic treatment response needs to account for MCIDs in all domains of importance for which the patient presents dysfunctional scores pre-treatment. The number of domains included in a holistic treatment response may vary and should be considered on an individual basis. Physiologic confirmation of therapy delivery and utilisation should be included as part of the evaluation of a holistic treatment response and is essential to advance the field of SCS and increase transparency and reproducibility of the findings.     

Psychometric performance and clinical meaningfulness of the Patient Assessment of Constipation – Quality of Life questionnaire in prucalopride (RESOLOR®) trials for chronic constipation

Background The Patient Assessment of Constipation–Quality of Life (PAC‐QOL) is a self‐reported questionnaire measuring health‐related quality of life (HRQL) of constipated patients and was used as secondary endpoint in three identical double‐blind, randomized, placebo‐controlled Phase III clinical trials. These 12‐week trials in subjects with severe chronic constipation evaluated the effects of prucalopride, a selective 5‐HT₄ agonist given orally once daily. Methods To consolidate the main treatment effect results observed in the prucalopride trial populations, analyses were undertaken on the pooled data of the three trials to confirm the psychometric properties of the PAC‐QOL and to provide guidance for the interpretation of the clinical significance of its scores. Key Results The evaluation of the psychometric properties confirmed the PAC‐QOL reliability, validity and responsiveness to measure the impact of chronic constipation symptoms on HRQL in the prucalopride trials. The 1‐point improvement in PAC‐QOL scores used as target response level for the main treatment effect analyses was validated as a relevant definition of response for treatment group comparisons. Cumulative distribution curves, drawn for each treatment group to provide more complete information on treatment effects than single minimal important difference point estimates, demonstrated consistent superior effects of prucalopride over placebo on all PAC‐QOL scores. Conclusions & Inferences The PAC‐QOL questionnaire is a useful measurement tool to assess, from a patient perspective, the potential therapeutic value of chronic constipation treatments in clinical trials and, by directly reflecting the patient’s own perspective on constipation and its treatment, eventually also for informing daily medical practice.     

Co-localization of Protein Z, Protein Z-Dependent protease inhibitor and coagulation factor X in human colon cancer tissue: implications for coagulation regulation on tumor cells

Introduction

Several hemostatic system components, including factor X (FX), contribute to cancer progression. The Protein Z (PZ)/protein Z-dependent protease inhibitor (ZPI) complex directly inhibits factor Xa proteolytic activity. The aim of this study was to determine the antigenic distribution of ZPI and PZ, in relation to FX, as well as indicators of blood coagulation activation (F1+2 and fibrin) in human colon cancer tissue.

Materials & methods

Studies were performed on human colon cancer fragments. Immunohistochemical (IHC) ABC procedures and double staining method employed polyclonal antibodies against PZ, FX, F1+2 and monoclonal antibodies against ZPI and fibrin. In-situ hybridization (ISH) methods employed biotin-labeled 25-nucleotide single-stranded DNA probes directed to either FX, PZ or ZPI mRNAs.

Results

Expression of FX, PZ and ZPI in association with colon cancer cells was observed by IHC. Moreover, the presence of both F1+2 and fibrin in association with colon cancer cells was found, which indicates that blood coagulation activation proceeds extravascularly at the tumor site. Furthermore, expression of FX and PZ was visualized in association with endothelial cells. In turn, colon cancer-associated macrophages were characterized by FX , PZ and ZPI presence. The double staining studies revealed strong FX/PZ, FX/ZPI, as well as PZ/ZPI co-localization on colon cancer cells. ISH studies revealed the presence of FX mRNA, PZ mRNA and ZPI mRNA in colon cancer cells indicating induced synthesis of these proteins.

Conclusions

The localization of PZ/ZPI and FX in colon cancer cells indicates that PZ/ZPI may contribute to anticoagulant events at the tumor site. Strong co-localization of PZ/ZPI and FX in cancer cells, and the presence of the mRNAs encoding the proteins, suggests their role in the tumor's biology. However, the presence of F1+2 and fibrin at the colon cancer site also suggests that the regulation of FXa by the PZ/ZPI complex at this site is incomplete.     

Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized,multicentre, double-blind,clinical trial

BackgroundConstraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase.ObjectivesTo evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke.MethodsThis randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life.ResultsThe active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176).ConclusionsCombining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time.     

Validation of the Insomnia Severity Index (ISI) for identifying insomnia in young adult cancer survivors: comparison with a structured clinical diagnostic interview of the DSM-5 (SCID-5)

ObjectivesInsomnia is a common problem affecting young adult cancer survivors (YACS) even years after treatment, yet it often goes unidentified and untreated. The Insomnia Severity Index is a widely-used insomnia measure, but has not been studied as an insomnia screener for YACS. The goal of this study was to validate the ISI in YACS by determining its utility in identifying YACS with insomnia disorder diagnosed with the Structured Clinical Interview for the DSM-5 (SCID-5).Methods250 YACS completed the ISI and SCID-5 Insomnia Module. Area under the curve (AUC) was calculated to reflect the ISI's discrimination between YACS with and without SCID-5 insomnia disorder. An ISI cut-off score with sensitivity ≥0.85 and specificity ≥0.75 was deemed acceptable.ResultsOf 250 participants, 52 met criteria for SCID-5 insomnia disorder diagnosis. The ISI had excellent discrimination, with an AUC = 0.91. A cut-off score ≥8 met study clinical screening criteria with sensitivity of 0.85 and specificity of 0.77. A cut-off score ≥7 with a higher sensitivity (0.96) but lower specificity (0.70) was noted as a potential alternative. Cut-off scores ≥12 and ≥ 14 were recommended for applications prioritizing overall accuracy.ConclusionsResults support validity of the ISI for identifying YACS with insomnia disorder. For clinical screening, data support the use of an ISI cut-off score ≥8 in YACS, and additional cut-off scores were found for research purposes or higher sensitivity. Results of this study and prior studies of the ISI offer important reminders that cut-off scores derived from different populations are not generalizable.