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Hussein S, Eiriksson L, MacQuarrie M, Merriam S, Dalton M, Stein E, Twomey R. Healthcare system barriers impacting the care of Canadians with myalgic encephalomyelitis: A scoping review. J Eval Clin Pract 2024; 30:1337-1360. [PMID: 39031904 DOI: 10.1111/jep.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/25/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Myalgic encephalomyelitis (ME, also known as chronic fatigue syndrome or ME/CFS) is a debilitating, complex, multisystem illness. Developing a comprehensive understanding of the multiple and interconnected barriers to optimal care will help advance strategies and care models to improve quality of life for people living with ME in Canada. OBJECTIVES To: (1) identify and systematically map the available evidence; (2) investigate the design and conduct of research; (3) identify and categorize key characteristics; and (4) identify and analyse knowledge gaps related to healthcare system barriers for people living with ME in Canada. METHODS The protocol was preregistered in July 2022. Peer-reviewed and grey literature was searched, and patient partners retrieved additional records. Eligible records were Canadian, included people with ME/CFS and included data or synthesis relevant to healthcare system barriers. RESULTS In total, 1821 records were identified, 406 were reviewed in full, and 21 were included. Healthcare system barriers arose from an underlying lack of consensus and research on ME and ME care; the impact of long-standing stigma, disbelief, and sexism; inadequate or inconsistent healthcare provider education and training on ME; and the heterogeneity of care coordinated by family physicians. CONCLUSIONS People living with ME in Canada face significant barriers to care, though this has received relatively limited attention. This synthesis, which points to several areas for future research, can be used as a starting point for researchers, healthcare providers and decision-makers who are new to the area or encountering ME more frequently due to the COVID-19 pandemic.
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Affiliation(s)
- Said Hussein
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren Eiriksson
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Maria Dalton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eleanor Stein
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Liaghat A, Konsman JP. Methodological advice for the young at heart investigator: Triangulation to build better foundations. Brain Behav Immun 2024; 115:737-746. [PMID: 37972881 DOI: 10.1016/j.bbi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
In medicine and science, one is typically taught the main theories in a discipline or field along with standard models before receiving more instructions on how to apply certain methods. The aim of this work is not to address one method, but rather methodology, the study and evaluation of methods, by taking a philosophy of science detour. In this, a critique of biomedicine will be used as a starting point to address some positions regarding reductionism, specifying notions such as systems and mechanisms, as well as regarding the mind-body problem discussing psychosomatic medicine and psychoneuroimmunology. Some recommendations to make science more pluralistic, robust and translationally-relevant will then be made as a way to foster constructive debates on reductionism and the mind-body problem and, in turn, favor more interdisciplinary research.
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Affiliation(s)
- Amirreza Liaghat
- IMMUNOlogy from CONcepts and ExPeriments to Translation, CNRS UMR 5164, University of Bordeaux, 33076 Bordeaux, France
| | - Jan Pieter Konsman
- IMMUNOlogy from CONcepts and ExPeriments to Translation, CNRS UMR 5164, University of Bordeaux, 33076 Bordeaux, France.
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Goldberg NC, Poirier S, Kanas A, McCorkell L, McGinn CA, Re’em Y, Kuehnel K, Muirhead N, Ruschioni T, Taylor-Brown S, Jason LA. A new clinical challenge: supporting patients coping with the long-term effects of COVID-19. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2022; 10:212-230. [PMID: 38283613 PMCID: PMC10822158 DOI: 10.1080/21641846.2022.2128576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Mental Health Practitioners (MHPs) have a unique opportunity to provide resources and support to those suffering from Long COVID (LC), the post infectious illness that often follows an acute SARS-CoV-2 infection. In working with these individuals, MHPs can learn from the experiences of patients with another post-infectious disease known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS was once thought to be a psychologically mediated disorder caused by deconditioning and the fear of exertion following a precipitating event such as a viral infection. Research now shows that LC and ME/CFS are biomedical, multisystem, complex physiologic diseases. This article provides a framework to MHPs for the treatment of LC patients using knowledge derived from three decades of research on ME/CFS.
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Affiliation(s)
| | - Sabrina Poirier
- Research – Myalgic Encephalomyelitis and Other Complex Chronic Illnesses, New York, NY, USA
| | | | - Lisa McCorkell
- Patient-Led Research Collaborative, Salt Lake City, UT, USA
| | - Carrie Anna McGinn
- Patient Advocate/Patient Partner in Research – Long COVID and Myalgic Encephalomyelitis, Salt Lake City, UT, USA
| | - Yochai Re’em
- Psychiatrist Specializing in Treating Patients with Long COVID, Salt Lake City, UT, USA
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Huang Y, Xu J, Liu Q, Zeng Z, Zhang Y. Stellate ganglion block successfully relieved medically unexplained chronic pain: a case report. J Int Med Res 2022; 50:3000605221086735. [PMID: 35301893 PMCID: PMC8935417 DOI: 10.1177/03000605221086735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Medically unexplained symptoms refers to a clinical syndrome characterized by somatic symptoms that cannot be reasonably explained by any organic disease. Chronic pain can be a type of medically unexplained symptom. The current treatment modalities for chronic pain mainly include drugs and psychotherapy. The use of stellate ganglion block for treatment of chronic pain has rarely been reported. Herein, we report a patient whose chronic pain was completely relieved after receiving a stellate ganglion block.
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Affiliation(s)
- Yiting Huang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Jian Xu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Qingyan Liu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Zhimin Zeng
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Yuenong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
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Heightman M, Prashar J, Hillman TE, Marks M, Livingston R, Ridsdale HA, Bell R, Zandi M, McNamara P, Chauhan A, Denneny E, Astin R, Purcell H, Attree E, Hishmeh L, Prescott G, Evans R, Mehta P, Brennan E, Brown JS, Porter J, Logan S, Wall E, Dehbi HM, Cone S, Banerjee A. Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals. BMJ Open Respir Res 2021; 8:e001041. [PMID: 34764200 PMCID: PMC8587466 DOI: 10.1136/bmjresp-2021-001041] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients. METHODS In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression. RESULTS 1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6-52.8) years vs 58.3 (47.0-67.7) years and 48.5 (39.4-55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118-298) days, 69 (51-111) days and 76 (55-128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%-85%). Less than half of employed individuals could return to work full time at first assessment. CONCLUSION Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.
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Affiliation(s)
- Melissa Heightman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jai Prashar
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Toby E Hillman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Marks
- University College London Hospitals NHS Foundation Trust, London, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Robert Bell
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Michael Zandi
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Patricia McNamara
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Alisha Chauhan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Denneny
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Ronan Astin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Purcell
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Rebecca Evans
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Puja Mehta
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Ewen Brennan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy S Brown
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Joanna Porter
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Sarah Logan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Wall
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
- Francis Crick Institute, London, UK
| | | | - Stephen Cone
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Amitava Banerjee
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
- Barts Health NHS Trust, London, UK
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