Clinical profile of patients with fibromyalgia syndrome

Abstract Introduction: The new diagnostic criteria for fibromyalgia (FM) include the presence of chronic, widespread pain associated with other symptoms such as fatigue, sleep disturbance, anxiety and depression. All these symptoms should be considered when thinking and clinical decision making of physiotherapists dealing with FM. However, it is clear that the other symptoms that accompany the pain are often neglected. Objective: To measure the levels of fatigue, sleep disturbances, anxiety and depression in patients with FM and compare them to levels found in healthy controls. Methods: Forty-six women diagnosed with FM and 30 healthy controls participated in the study. The levels of each of the symptoms were assessed by four validated questionnaires in Brazil (Piper Fatigue Scale - Revised, Pittsburgh Sleep Quality Index, Beck Anxiety Inventory and the Beck Depression Inventory). Statistical analysis was performed using GraphPad Prism software and all tests used a significance level of 5% (α = 0.05). Results: FM patients had significantly elevated levels of fatigue (p = 0.0005), sleep disturbances (p = 0.003), anxiety (p = 0.0012) and depression (p = 0.0003) compared to healthy controls. Symptoms fatigue and depression correlated strongly and positively with one another and with other symptoms evaluated. Conclusion: The other symptoms that comprise the clinical picture of FM need be considered not only in order to recover the health of patients, but above all in an attempt to preserve it and promote it.

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Probability and loss: two sides of the risk assessment coin

The Psychiatrist ◽

10.1192/pb.bp.110.033910 ◽

2011 ◽

Vol 35 (11) ◽

pp. 413-418 ◽

Cited By ~ 11

Author(s):

Matthew M. Large ◽

Olav B. Nielssen

Keyword(s):

Mental Health ◽

Risk Assessment ◽

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

The Other ◽

Current Form ◽

Mental Health Settings ◽

Future Harm ◽

Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

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Fibromyalgia Syndrome and Spa Therapy: Myth or Reality?

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.4137/cmamd.s8797 ◽

2012 ◽

Vol 5 ◽

pp. CMAMD.S8797 ◽

Cited By ~ 18

Author(s):

Giacomo M. Guidelli ◽

Sara Tenti ◽

Emanuele De Nobili ◽

Antonella Fioravanti

Keyword(s):

Pharmacological Treatment ◽

Sleep Disturbances ◽

Fibromyalgia Syndrome ◽

Negative Impact ◽

Modern Medicine ◽

Chronic Widespread Pain ◽

Treatment Modalities ◽

Unknown Etiology ◽

Spa Therapy ◽

Clinical Effects

Fibromyalgia syndrome (FS) is a common musculoskeletal disorder characterized by otherwise unexplained chronic widespread pain, a lowered pain threshold, high tender point counts, sleep disturbances, fatigue, headache, irritable bowel syndrome, morning stiffness, paraesthesias in the extremities, often psychological distress and depressed mood. Consequently, FS has a negative impact on working capacity, family life, social functioning and quality of life. Because of unknown etiology and not clearly understood pathogenesis, there is no standard therapy regime for FS. A variety of medical treatments, including antidepressants, opioids, analgesic or non-steroidal anti-inflammatory drugs, sedatives, muscle relaxants and antiepileptics, have been used to treat FS. Currently, no pharmacological treatment for FS is consistently successful. According to recent guidelines, the optimal treatment of FS requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities. Spa therapy is a popular treatment for FS in many European countries, as well as in Japan and Israel. However, despite their long history and popularity spa treatments are still the subject of debate and their role in modern medicine is still not clear. The objective of this review is to summarize the currently available information on clinical effects and mechanism of action of spa therapy in FS. We also provide some suggestions for further development in this area.

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Effect of insole material on lower limb kinematics and plantar pressures during treadmill walking

Prosthetics and Orthotics International ◽

10.1177/0309364611429986 ◽

2011 ◽

Vol 36 (1) ◽

pp. 53-62 ◽

Cited By ~ 19

Author(s):

Aoife Healy ◽

Dave N Dunning ◽

Nachiappan Chockalingam

Keyword(s):

Contact Area ◽

Repeated Measures ◽

Clinical Decision Making ◽

Clinical Decision ◽

The Other ◽

Medium Density ◽

Ethyl Vinyl ◽

Plantar Pressures ◽

Time Integral ◽

Material Conditions

Background: Currently there is a paucity of research providing recommendations on the type of orthotic or material used in its construction for different patient requirements.Objectives: To gain a greater understanding of the characteristics of orthotic materials and how they affect gait so to enhance the clinical decision-making process.Study Design: Repeated measures.Methods: Plantar pressures and kinematics were evaluated for 10 participants while walking on a treadmill under various conditions which included, shoes only and shoes with four different flat insoles and custom devices created in each of two densities of two materials.Results: For the flat insoles, medium density ethyl vinyl acetate was found to produce greater peak pressures than at least one of the other material conditions and low and medium density polyurethane were most effective at increasing average contact area and at reducing pressure time integral. For the custom devices, while no significant differences were evident, when compared to the shoe only condition, medium density polyurethane increased average contact area by a greater percentage than the other materials.Conclusions: Results for medium density polyurethane suggest a possible difference in loading characteristics, indicating a potential material suitability for patients with a compromised ability to deal with pressure.Clinical relevanceFindings from the present study provide information for a clinician to draw an evidence-based orthotic prescription based on material properties.

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The Evaluation of Sleep Disturbances for Chinese Frontline Medical Workers under the Outbreak of COVID-19

10.1101/2020.03.06.20031278 ◽

2020 ◽

Cited By ~ 5

Author(s):

Jing Qi ◽

Jing Xu ◽

Bozhi Li ◽

Jinsha Huang ◽

Yuan Yang ◽

...

Keyword(s):

Sleep Quality ◽

Subgroup Analysis ◽

Sleep Disturbances ◽

Pittsburgh Sleep Quality Index ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Sectional Study ◽

Online Questionnaire ◽

Cross Sectional ◽

Athens Insomnia Scale

SummaryBackgroundThe outbreak of coronavirus disease 2019 in China remains to be a serious challenge for frontline medical workers (fMW). They are under high risk of being infected and high mental stress, which may lead to sleep disturbances, anxiety, and depression.MethodsWe conducted a cross-sectional study to evaluate sleep disturbances of fMW and made a comparison with non-fMW. The medical workers from multiple hospitals in Hubei Province, China, were volunteered to participate. An online questionnaire, including Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), and Visual Analogue Scale (VAS), was used to evaluate sleep disturbances and mental status of fMW. Sleep disturbances were defined as PSQI>7 points or/and AIS>6 points. We compared the scores of PSQI, AIS, anxiety and depression VAS, and prevalence of sleep disturbances between fMW and non-fMW. Subgroup analysis for different gender in fMW was conducted.FindingsA total of 1306 subjects (including 801 fMW and 505 non-fMW) were enrolled. Compared to non-fMW, fMW had significantly higher scores of PSQI (p< 0.0001), AIS (p<0.0001), anxiety (p<0.0001) and depression (p=0.0010), and higher prevalence of sleep disturbances with PSQI > 7 points (p<0.0001) and AIS > 6 points (p<0.0001). In subgroup analysis, compared to male fMW, female fMW had significantly higher scores of PSQI (p=0.022) and higher prevalence of sleep disturbances with PSQI > 7 points (p<0.0001).InterpretationfMW had higher prevalence of sleep disturbances and worse sleep quality than non-fMW. Female fMW were more vulnerable to having sleep disturbances than male fMW.FundingNone.

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Case discussions using WeChat: Are they reliable?

10.21203/rs.2.21409/v1 ◽

2020 ◽

Author(s):

Yongwei Li ◽

Shugang Hu ◽

Tariq Alkhatatbeh ◽

Jialin Wang ◽

Jidong Song ◽

...

Keyword(s):

Clinical Decision Making ◽

Clinical Decision ◽

Online Discussions ◽

The Other ◽

Surgical Results ◽

Orthopedic Surgeons ◽

Group Members ◽

Case Discussions ◽

Analyze Case ◽

Consistency Rate

Abstract Background : At present, more and more clinicians in China are partaking in case discussions using WeChat groups for the purposes of communication, diagnosis, treatment planning, and information sharing. However, the reliability of discussions using WeChat groups remains debatable. This study aimed to analyze case discussions in WeChat groups and evaluate their significance. Methods : By taking screenshots of the chat records from the most-used WeChat groups by orthopedic surgeons, all of the data related to the cases were collected from June to August in 2019. We analyzed the purpose, participation, and completeness of each case. Furthermore, we analyzed whether the conclusion reached in each case discussion, which was supported by the majority of members, was consistent with the opinion of three experts after evaluating all of the data from the case records. Results : Seven WeChat groups and 60 cases were included. WeChat group members often discussed cases to show surgical results (40.0%), to obtain treatment advice (39.0%), and to seek diagnostic advice (9%). The rate of ‘likes’ for ‘surgical results show’ was greater than the rate of ‘likes’ for alternative purposes (P<0.05). The percentage of complete, relatively complete and incomplete cases was 23%, 32%, and 45%, respectively. The relatively complete cases received more effective comments than the other cases (P<0.05). The cases for diagnostic purposes were more complete than those for other purposes (P<0.05). Among 60 cases, only 29 cases led to the same conclusions being reached among the three experts and WeChat group members. The consistency rate of conclusions relating to treatment was higher than that associated with the other purposes (P<0.05). The consistency rate of the complete cases was higher than that of the relatively complete and incomplete cases (P<0.05). Conclusions : Clinicians should treat discussions in WeChat groups for clinical decision-making with caution. Online discussions using WeChat groups should be standardized in respect to the cases presented and the comments that are generated.

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Yoga Protocol for Cancer Patients: A Systematic Exploration of Psychophysiological Benefits

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190729143742 ◽

2019 ◽

Vol 14 (4) ◽

pp. 261-268

Author(s):

Mara Mirandola ◽

Miguel David Sabogal Rueda ◽

Federica Andreis ◽

Fausto Meriggi ◽

Claudio Codignola ◽

...

Keyword(s):

Quality Index ◽

Sleep Disturbances ◽

Pittsburgh Sleep Quality Index ◽

Depression Scale ◽

Anxiety And Depression ◽

Quality Of Sleep ◽

Hospital Anxiety ◽

Significant Difference ◽

Brief Fatigue Inventory

Background: Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the “Yoga in Oncology” project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer. Methods: Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index. Results: Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep. Conclusion: It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients’ behavior.

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To report or not to report: a proposal on how to deal with altered test results in hemolytic samples

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-1064 ◽

2017 ◽

Vol 55 (8) ◽

pp. 1109-1111 ◽

Cited By ~ 12

Author(s):

Janne Cadamuro ◽

Cornelia Mrazek ◽

Elisabeth Haschke-Becher ◽

Sverre Sandberg

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Information ◽

Clinical Decision ◽

General Information ◽

The Other ◽

Test Results ◽

Scientific Discussion ◽

Laboratory Values ◽

Test Result

Abstract Preanalytically altered test results are a challenge every laboratory has to face. The release of such results may be to the harm of the patient by triggering wrong clinical decision making in monitoring or treatment. On the other hand, their deletion also might be to the harm of the patient by delaying the time to decision making as the exact value sometimes is not even necessary but rather an answer to the question “Is it raised or lowered”. Based on this dilemma and forced to produce laboratory values without any clinical information on the respective patient, laboratories have developed their own preferred way on how to deal with preanalytically altered test results. Some release the value with a comment, some reject the value with or without a comment and others again provide only general information about the hemolytic sample. To date there is no guideline or standardization to this postanalytical topic. Therefore, with this opinion paper, we want to start the scientific discussion on this important issue by providing one possible method to overcome the lack of clinical information which the laboratory would need to correctly decide whether or not to release an altered test result. We suggest providing the clinician with all the information on the hemolytic sample and its impact on the respective parameter needed to make his/her own decision on the usage of the respective test result. We believe that reporting a preanalytically altered laboratory value including a respective comment is preferable to not reporting it.

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Time-Frequency-Domain Copula-Based Granger Causality and Application to Corticomuscular Coupling in Stroke

International Journal of Humanoid Robotics ◽

10.1142/s021984361950018x ◽

2019 ◽

Vol 16 (04) ◽

pp. 1950018

Author(s):

Qingshan She ◽

Hang Zheng ◽

Tongcai Tan ◽

Botao Zhang ◽

Yingle Fan ◽

...

Keyword(s):

Frequency Domain ◽

Granger Causality ◽

Motion Control ◽

Clinical Decision Making ◽

Clinical Decision ◽

Functional Coupling ◽

Healthy Controls ◽

Force Output ◽

Stroke Patients ◽

Time Frequency

The corticomuscular coupling (CMC) characterization between the motor cortex and muscles during motion control is a valid biomarker of motor system function after stroke, which can improve clinical decision-making. However, traditional CMC analysis is mainly based on the coherence method that can’t determine the coupling direction, whereas Granger Causality (GC) is limited in identifying linear cause–effect relationship. In this paper, a time-frequency domain copula-based GC (copula-GC) method is proposed to assess CMC characteristic. The 32-channel electroencephalogram (EEG) signals over brain scalp and electromyography (EMG) signals from upper limb were recorded during controlling and maintaining steady-state force output for five stroke patients and five healthy controls. Then, the time-frequency copula-GC analysis was applied to evaluate the CMC strength in both directions. Experimental results show that the CMC strength of descending direction is greater than that of ascending direction in the time domain for healthy controls. With the increase of grip strength, the bi-directional CMC strength has an increasing trend. Meanwhile, the bi-directional CMC strength of right hand is larger than that of left hand. In addition, the bi-directional CMC strength of stroke patients is lower than that of healthy controls. In the frequency domain, the strongest CMC is observed at the beta frequency band. Additionally, the CMC strength of descending direction is slightly larger than that of ascending direction in healthy controls, while the CMC strength of descending direction is lower than that of ascending direction in stroke patients. We suggest that the proposed time-frequency domain analysis approach based on copula-GC can effectively detect complex functional coupling between cortical oscillations and muscle activities, and provide a potential quantitative analysis measure for motion control and rehabilitation evaluation.

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Basics of Dental Implantology for the Oral Surgeon

Oral and Maxillofacial Surgery for the Clinician ◽

10.1007/978-981-15-1346-6_18 ◽

2021 ◽

pp. 385-405

Author(s):

Supriya Ebenezer ◽

Vinay V. Kumar ◽

Andreas Thor

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

The Other ◽

Oral Surgical Procedures ◽

Implant Placement ◽

Treatment Concepts ◽

Implant Dentistry ◽

New Treatment ◽

Implant Treatment

AbstractOver the past decades, implant dentistry has evolved to be a very predictable treatment modality for the replacement of lost teeth and has now become one of the most common oral surgical procedures carried out worldwide. This chapter introduces the history and evolution of dental implants, discusses the concept of osseointegration, mentions the types of implants and discusses clinical decision making and execution of straight forward implant placement. It must be noted that the field of implantology is rapidly developing with new treatment concepts and increasing use of digital technology. The surgical part of implant treatment although extremely important, is only a part of the overall treatment, the other important factors being the laboratory and prosthodontics. This chapter only provides a basic surgical overview of implantology for the beginner surgeon clinician.

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Disturbed Sleep in Adult Patients with Sickle Cell Disease Assessed by the Pittsburgh Sleep Quality Index.

Blood ◽

10.1182/blood.v110.11.2265.2265 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2265-2265

Author(s):

Jonathan Harrison ◽

Ambrina Faiz ◽

Naomi Schlessinger

Keyword(s):

Sickle Cell Disease ◽

Sleep Quality ◽

Sickle Cell ◽

Sleep Disturbances ◽

Fibromyalgia Syndrome ◽

Pittsburgh Sleep Quality Index ◽

Sleep Apnea Syndromes ◽

Poor Sleep ◽

Cell Disease ◽

Disease Clinic

Abstract Although life expectancy for patients with sickling hemoglobinopathies has been improving in recent years, these patients continue to suffer significant morbidity throughout their lives, and pain is a prominent feature of these disorders. It has been shown that, in the primary care population, patients with the highest risk for sleep disturbances include those with pain (Alattar M, et al., J Am Board Fam Med, 2007, Vol 20, pp 365–74). It has also been reported that patients with sickle cell diseases have clinical features which resemble fibromyalgia syndrome (Schlessinger N, J Rheum, 2004, Vol 31, pp 598–600); fibromyalgia syndrome is characterized both pain and impaired sleep, among other features. In order to further investigate sleep disorders in sickle cell disease patients, patients in a sickle cell disease clinic were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Methods: Using a form IRB-approved specifically for this study, the PSQI was offered to patients in a sickle cell disease clinic, and completed anonymously. Results: 20 patients completed the PSQI with responses meaningful for analysis; they ranged in age from 21 to 50 years. On average, patients reported very poor overall quality of sleep; the mean Global PSQI score was 11.8 (S.D.4.8); this is as compared to historical, healthy control subjects who had a subjective mean Global PSQI score of 2.6. (Buysse D et al, Psychiatry Research, 1989, Vol 28, pp 193–213). All respondents reported that pain contributed to poor sleep at least once during the month prior to the survey, and half of the patients reported that pain contributed to poor sleep at least three times in the week prior to the survey. Fifty percent of those surveyed reported no sense of nocturnal dyspnea whatsoever; only 3 individuals reported that they felt that dyspnea contributed to poor sleep three or more times in the week prior to the survey, and frequent daytime somnolence was reported by only 10 percent of sickle cell patients responding to the survey. Habitual sleep efficiency appears poor in these patients, and subjective sleep quality is also reported as generally poor. Conclusions: Sleep disturbances appear to be very common in sickle cell disease patients, and some, but not all, aspects of these sleep disturbances resemble the characteristics of sleep impairment seen in patients with fibromyalgia syndrome (Osorio C, et al., J Rheum, 2006, Vol 33, pp 1863–65). Although sleep impairment in patients with sickle cell diseases has been attributed to sleep apnea syndromes in a subset of patients with sickle cell diseases, sleep disturbance associated with pain in sickle cell disease appears to be more widespread than could be explained by sleep apnea syndromes. Sleep disturbances associated with pain in sickle cell diseases may in turn lead to further exacerbation of symptoms arising from poor sleep. Interventions to improve sleep may reduce overall pain in these patients, as appears to be the case for patients with fibromyalgia syndrome (Rooks D, Curr Opin Rheum, 2007, Vol 2, pp 111–17).

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