Is it possible to predict approval of medical rehabilitation by the extent of fatigue and subjective need for rehabilitation? Development, results and acceptance of a short screening

OBJECTIVES: In earlier studies the lack of correlation between subjective need for rehabilitation of the applicant and the medically determined objective need for rehabilitation was reported again and again. The correlation between fatigue and subjective need for rehabilitation was not yet examined so far. Nevertheless fatigue is not defined sufficiently in the ICD, so interactions between chronic fatigue and somatic diseases are not taken into account appropriately. The following questions are considered: How high is the degree of chronic fatigue in insurees applying for rehabilitation? Is there a correlation between degree of fatigue and need for rehabilitation? Is it possible to predict approval of medical rehabilitation by fatigue and need for rehabilitation? How will insurees accept a screening accompanying their application for rehabilitation? METHOD: The study is based on data of 500 (response rate 85.6%) insurees of the pension insurance Braunschweig-Hannover, who had applied for medical rehabilitation between 1/2004 and 3/2004. The screening instrument included: scales on functional activity, mobility, social support, coping (IRES), the Chalder Fatigue Scale, SCL 14, Items concerning need for rehabilitation. As statistical methods t-, chi (2)-test, correlations, covariance-analysis and regression analysis are used. RESULTS: 70.2% of the patients claiming rehabilitation reported relevant clinical symptoms of chronic fatigue. There were no differences in age, work status, motivation, or expectations of returning to work, but differences in sex. Patients with chronic fatigue met more citeria of need for rehabilitation. But the approval of medical rehabilitation could not be predicted by fatigue and need for rehabilitation. Nevertheless the acceptance of the screening was high in the insurees. CONCLUSIONS: Patients with chronic fatigue met more criteria of need for rehabilitation. But the approval of medical rehabilitation could not be predicted by fatigue and need for rehabilitation. We assume that the reduction of activity and participation is associated with the degree of fatigue. It is discussed that the information an investigator may derive from a screening which is accepted by the insurees claiming medical rehabilitation will complete the collected clinical documents in a meaningful manner.     

Mechanisms of resistance and clinical relevance of resistance to β-lactams, glycopeptides, and fluoroquinolones

The widespread use of antibiotics has resulted in a growing problem of antimicrobial resistance in the community and hospital settings. Antimicrobial classes for which resistance has become a major problem include the β-lactams, the glycopeptides, and the fluoroquinolones. In gram-positive bacteria, β-lactam resistance most commonly results from expression of intrinsic low-affinity penicillin-binding proteins. In gram-negative bacteria, expression of acquired β-lactamases presents a particular challenge owing to some natural spectra that include virtually all β-lactam classes. Glycopeptide resistance has been largely restricted to nosocomial Enterococcus faecium strains, the spread of which is promoted by ineffective infection control mechanisms for fecal organisms and the widespread use of colonization-promoting antimicrobials (especially cephalosporins and antianaerobic antibiotics). Fluoroquinolone resistance in community-associated strains of Escherichia coli, many of which also express β-lactamases that confer cephalosporin resistance, is increasingly prevalent. Economic and regulatory forces have served to discourage large pharmaceutical companies from developing new antibiotics, suggesting that the antibiotics currently on the market may be all that will be available for the coming decade. As such, it is critical that we devise, test, and implement antimicrobial stewardship strategies that are effective at constraining and, ideally, reducing resistance in human pathogenic bacteria.     

What factors determine therapists’ acceptance of new technologies for rehabilitation – a study using the Unified Theory of Acceptance and Use of Technology (UTAUT)

Abstract

Purpose: The aim of this study was to examine what factors affect the acceptance behavior and use of new technologies for rehabilitation by therapists at a large rehabilitation hospital in Canada. Method: A self-administrated paper-based survey was created by adapting scales with high levels of internal consistency in prior research using the Unified Theory of Acceptance and Use of Technology (UTAUT). Items were scored on a 7-point Likert scale, ranging from “strongly disagree (1)” to “strongly agree (7)”. The target population was all occupational therapists (OT) and physical therapists (PT) involved with the provision of therapeutic interventions at the hospital. Our research model was tested using partial least squares (PLS) technique. Results: Performance expectancy was the strongest salient construct for behavioral intention to use new technologies in rehabilitation, whereas neither effort expectancy nor social influence were salient constructs for behavioral intention to use new technologies; (4) facilitating condition and behavioral intention to use new technologies were salient constructs for current use of new technologies in rehabilitation, with facilitating condition the strongest salient for current use of new technologies in rehabilitation. Conclusion: In a large rehabilitation hospital where use of new technologies in rehabilitation is not mandatory, performance expectancy, or how the technology can help in therapists’ work, was the most important factor in determining therapists’ acceptance and use of technologies. However, effort expectancy and social influence constructs were not important, i.e. therapists were not influenced by the degree of difficulty or social pressures to use technologies. Behavioral intention and facilitating condition, or institutional support, are related to current use of new technologies in rehabilitation.

• Implications for Rehabilitation

• Rehabilitation professionals who are faced with using new technologies are less concerned about effort and social pressures, than they are about what the technologies can do for them or their clients.

• When it comes to new rehabilitation technologies, actual users express intention.

• Rehabilitation professionals’ acceptance and adoption of technologies rely on conditions that facilitate their use. These conditions include scheduling, support and a conductive environment.

     

What is the impact,prevalence, disability,and quality of life of pediatric headache?

Pediatric headache is a common health problem in children, with a significant headache reported in more than 75% by the age of 15 years. Pediatric migraine occurs in up to 10.6% of children between the ages of 5 and 15 years and in up to 28% of adolescents between the ages of 15 and 19 years. Given this high frequency, the impact of this disease on the lives of these children and their parents can be quite significant. This impact can be assessed with disease-specific disability and impairment as well as disease non-specific effects on quality of life. The goal of evaluation should be recognition of this impact, whereas the goal of management should be effective treatment that minimizes the impact of this disorder in the short term and for the life of the patient.     

Diversity,Epidemiology, and Genetics of Class D β-Lactamases

Class D β-lactamase-mediated resistance to β-lactams has been increasingly reported during the last decade. Those enzymes also known as oxacillinases or OXAs are widely distributed among Gram negatives. Genes encoding class D β-lactamases are known to be intrinsic in many Gram-negative rods, including Acinetobacter baumannii and Pseudomonas aeruginosa, but play a minor role in natural resistance phenotypes. The OXAs (ca. 150 variants reported so far) are characterized by an important genetic diversity and a great heterogeneity in terms of β-lactam hydrolysis spectrum. The acquired OXAs possess either a narrow spectrum or an expanded spectrum of hydrolysis, including carbapenems in several instances. Acquired class D β-lactamase genes are mostly associated to class 1 integron or to insertion sequences.Class D β-lactamases, also known as oxacillinases or OXA-type β-lactamases (OXAs), are active-serine-site enzymes like Ambler class A and class C β-lactamases, differing from class A and C enzymes in amino acid structure, whereas class B β-lactamases are metalloenzymes with a Zn²⁺ ion(s) in the active site (4, 71, 78). Even though class D includes mostly enzymes with higher hydrolysis rates for cloxacillin and oxacillin than for benzylpenicillin (hence the name oxacillinases), not all class D β-lactamases have this characteristic. Most of the class D enzymes belong to group 2d of the Bush functional classification scheme for β-lactamases (23). Among the four β-lactamase molecular classes, class D β-lactamases are the most diverse enzymes (107). This diversity is observed at both the genetic and biochemical levels, with enzymes possessing either a narrow or expanded spectrum of hydrolysis. In addition, several class D β-lactamases have an expanded spectrum of activity resulting from point mutations.Although many class D β-lactamase genes are embedded into class 1 integrons, recent reports indicated that other specific genetic structures, including insertion sequences and transposons, may be associated with class D β-lactamase genes. Numerous class D β-lactamase genes have been identified as a source of acquired resistance in gram-negative bacteria, but recent studies have shown that class D β-lactamases are also naturally produced in clinically significant pathogens and environmental species (107).This review focuses on the diversity and substrate profiles of class D β-lactamases, their sources, and the genetics of acquisition of the corresponding genes. All the class D β-lactamases for which a sequence is available in the GenBank databases are listed in Table ​Table11.

TABLE 1.

Features of oxacillinases

Meanings of “acceptance” for patients with long-term pain when starting rehabilitation

Purpose: The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme. Methods: Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis. Results: The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, “the only way forward”. Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one’s ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, “no way forward” the integration of the aching body in sense of self was impossible and pain was incomprehensible, unacceptable and unfair. Pain was the cause of feeling stuck in the body, affecting the sense of self and the person’s entire life. Conclusions: The meaning of acceptance was related to acceptance of the persistency of pain, to how the individual related to the lived body and the need for changes in core aspects of self, and to the issue of whether to include others in the struggle of learning to move on with a meaningful life.

• Implications for Rehabilitation

• Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes.

• The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation.

• The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process.

• The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.

     

Relativity analysis of middle and old people hypertension and hyperglycemia,diabetes

Background：Hypertension，diabetesaremainriskfactorsofcardiovasculardiseases．Manydatashows：hypertensionmorbidityrateofdiabetespatientsisapparentlyhigherthanthatofnon－diabetespeople．Inforeigncountry，hypertensionmorbidityrateofdiabetespatientsreaches４０％～８０％．Inourcountry，surveyof２２０thousandpeoplein１９９４showedthathypertensionmorbidityrateofdiabetespatientsis５５．４％．insulinresistanceiscommonpathogeneticfoundationofhypertensionandtype２diabetes．Inpreviousreports，therewasli…     

Bactericidal Activity,Absence of Serum Effect,and Time-Kill Kinetics of Ceftazidime-Avibactam against β-Lactamase-Producing Enterobacteriaceae and Pseudomonas aeruginosa

Avibactam, a non-β-lactam β-lactamase inhibitor with activity against extended-spectrum β-lactamases (ESBLs), KPC, AmpC, and some OXA enzymes, extends the antibacterial activity of ceftazidime against most ceftazidime-resistant organisms producing these enzymes. In this study, the bactericidal activity of ceftazidime-avibactam against 18 Pseudomonas aeruginosa isolates and 15 Enterobacteriaceae isolates, including wild-type isolates and ESBL, KPC, and/or AmpC producers, was evaluated. Ceftazidime-avibactam MICs (0.016 to 32 μg/ml) were lower than those for ceftazidime alone (0.06 to ≥256 μg/ml) against all isolates except for 2 P. aeruginosa isolates (1 bla_VIM-positive isolate and 1 bla_OXA-23-positive isolate). The minimum bactericidal concentration/MIC ratios of ceftazidime-avibactam were ≤4 for all isolates, indicating bactericidal activity. Human serum and human serum albumin had a minimal effect on ceftazidime-avibactam MICs. Ceftazidime-avibactam time-kill kinetics were evaluated at low MIC multiples and showed time-dependent reductions in the number of CFU/ml from 0 to 6 h for all strains tested. A ≥3-log₁₀ decrease in the number of CFU/ml was observed at 6 h for all Enterobacteriaceae, and a 2-log₁₀ reduction in the number of CFU/ml was observed at 6 h for 3 of the 6 P. aeruginosa isolates. Regrowth was noted at 24 h for some of the isolates tested in time-kill assays. These data demonstrate the potent bactericidal activity of ceftazidime-avibactam and support the continued clinical development of ceftazidime-avibactam as a new treatment option for infections caused by Enterobacteriaceae and P. aeruginosa, including isolates resistant to ceftazidime by mechanisms dependent on avibactam-sensitive β-lactamases.     

Efficacy,tolerability, and safety of cannabinoids for chemotherapy-induced nausea and vomiting—a systematic review of systematic reviews

Background

There is growing public and legislative body support for the medical use of cannabis products, for example, for chemotherapy-induced nausea and vomiting (CINV), in Germany.

Methods

A comprehensive literature search until November 2015 was conducted in MEDLINE, DARE and Cochrane libraries for systematic reviews of randomized controlled trials (RCTs) comparing herbal or pharmaceutical cannabinoids (CB) versus placebo or conventional antiemetics for CINV. Outcomes were reduction of CINV for efficacy, drop-out rates due to adverse events for tolerability, and serious adverse events for safety. The methodology quality of the systematic reviews was evaluated by the tool assessment of multiple systematic reviews (AMSTAR).

Results

Six systematic reviews of RCTs included the pharmaceutical CBs dronabinol, levonantradol, and nabilone or whole plant extract (e.g., nabiximol) compared with placebo or conventional antiemetics. There was moderate quality evidence on the efficacy of CBs compared to placebo and conventional antiemetics for CINV. There was moderate quality evidence that pharmaceutical CBs were less tolerated and less safe than placebo and conventional antiemetics in CINV. One RCT examining whole plant extract was included into the systematic reviews. No RCT was found comparing CBs with neurokinine?1 receptor antagonists.

Conclusions

With safe and effective antiemetics available, CBs cannot be recommended as first- or second-line therapy for CINV. Some guidelines recommend pharmaceutical CBs as third-line treatment in the management of breakthrough nausea and vomiting. Due to the lack of RCT data and safety concerns, herbal cannabis cannot be recommended for CINV.

     

Do Performance Measures of Strength,Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

Objective

To investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months.

Investigating acceptance in adjustment to chronic pain: Is acceptance broader than we thought?

Research on the role of acceptance in adjustment to persisting pain has been facilitated by the development of the Chronic Pain Acceptance Questionnaire (CPAQ). However, to date the CPAQ has been used to explore acceptance of pain without taking into account the likely contribution of other cognitive variables that have been shown to influence adjustment to persisting pain. This study examined the role of pain acceptance, as measured by the CPAQ, in accounting for adjustment to pain when controlling for the effects of other cognitive variables. The results indicated that while the Activity engagement subscale of the CPAQ was predictive of depression severity, neither of the CPAQ's two subscales was predictive of pain severity or physical disability. These findings differ from some reported previously and they suggest that the CPAQ, by itself, may not be sufficient to explain the processes of acceptance of pain and, hence, adjustment to pain. The findings also indicate that the Pain willingness subscale of the CPAQ is not robust and should be discarded. A broader approach to investigating acceptance of pain is proposed.     

Does experience of the 'occult' predict use of complementary medicine? Experience of, and beliefs about, both complementary medicine and ways of telling the future

This study looked at the relationship between ratings of the perceived effectiveness of 24 methods for telling the future, 39 complementary therapies (CM) and 12 specific attitude statements about science and medicine. A total of 159 participants took part. The results showed that the participants were deeply sceptical of the effectiveness of the methods for telling the future which factored into meaningful and interpretable factors. Participants were much more positive about particular, but not all, specialties of complementary medicine (CM). These also factored into a meaningful factor structure. Finally, the 12 attitude to science/medicine statements revealed four factors: scepticism of medicine; the importance of psychological factors; patient protection; and the importance of scientific evaluation. Regressional analysis showed that belief in the total effectiveness of different ways of predicting the future was best predicted by beliefs in the effectiveness of the CM therapies. Although interest in the occult was associated with interest in CM, participants were able to distinguish between the two, and displayed scepticism about the effectiveness of methods of predicting the future and some CM therapies.