What are the diagnostic criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. How do healthcare providers evaluate patients for ME/CFS. What routine tests are performed to rule out other conditions. Why is a comprehensive approach necessary for ME/CFS diagnosis.

Understanding ME/CFS: A Complex Diagnostic Challenge

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) presents a unique challenge for healthcare providers due to its complex nature and lack of a single definitive diagnostic test. The diagnosis of ME/CFS requires a comprehensive evaluation process that incorporates multiple stages, including patient history, physical examination, laboratory tests, and clinical judgment.

Why is diagnosing ME/CFS so challenging? The primary reason lies in the absence of a specific biomarker or test that can conclusively confirm the condition. Instead, healthcare providers must rely on a combination of factors to reach a diagnosis, often through a process of elimination.

Routine Laboratory Tests for ME/CFS Evaluation

While no single test can diagnose ME/CFS, healthcare providers typically perform a series of routine laboratory tests to rule out other conditions and assess the patient’s overall health. These tests include:

• Complete blood count with differential
• Erythrocyte sedimentation rate (ESR)
• Electrolytes
• Fasting glucose
• Renal function tests (creatinine, BUN, GFR)
• Calcium and phosphate levels
• Liver function tests
• C-reactive protein
• Thyroid function tests (TSH, free T4)
• Iron studies
• Celiac disease screening
• Urinalysis

Do these tests definitively diagnose ME/CFS? No, they don’t. In fact, most patients with ME/CFS have routine laboratory results within normal ranges. The purpose of these tests is primarily to identify or rule out other conditions that may be causing the patient’s symptoms.

Additional Testing and Evaluations for ME/CFS

Depending on the patient’s specific symptoms and clinical presentation, healthcare providers may order additional tests to further investigate potential underlying conditions. These may include:

• Autoimmune disease markers (e.g., antinuclear antibodies)
• Vitamin level studies (B12, folate, vitamin D)
• Specific cultures or serological tests for suspected infections
• Neuroimaging procedures (e.g., MRI)
• Physiological tests (sleep studies, exercise testing, tilt table testing)

When are these additional tests necessary? Healthcare providers typically order these tests when there are specific clinical indications or suspicions based on the patient’s history and physical examination findings. However, it’s important to note that excessive testing without clear clinical justification can lead to false-positive results and unnecessary stress for the patient.

The Impact of ME/CFS on Cognitive Function

Cognitive impairment is a common symptom of ME/CFS, affecting many patients’ ability to concentrate, remember information, and organize tasks. To assess the impact of ME/CFS on cognitive function, healthcare providers may recommend specialized testing.

How can cognitive assessments benefit ME/CFS patients? These evaluations can:

• Identify specific areas of cognitive difficulty
• Guide the development of tailored coping strategies
• Help address educational needs for children and adolescents with ME/CFS
• Provide objective evidence of cognitive impairment for disability claims or workplace accommodations

The Importance of a Comprehensive Approach to ME/CFS Diagnosis

Diagnosing ME/CFS requires a holistic approach that considers multiple factors. Healthcare providers must carefully evaluate the patient’s symptoms, medical history, physical examination findings, and laboratory results to reach an accurate diagnosis.

Why is a comprehensive approach crucial for ME/CFS diagnosis? There are several reasons:

1. ME/CFS symptoms can overlap with other conditions, making differential diagnosis essential.
2. The absence of a single definitive test necessitates a thorough evaluation process.
3. Patients may have co-existing conditions that require identification and appropriate treatment.
4. A comprehensive approach helps ensure that other treatable conditions are not overlooked.

Challenges in ME/CFS Diagnosis and Patient Care

Diagnosing and managing ME/CFS presents unique challenges for both healthcare providers and patients. Some of these challenges include:

• The potential exacerbation of symptoms due to extensive testing and frequent healthcare visits
• The variable presentation of ME/CFS, with some patients not appearing visibly ill during office visits
• The need for thoughtful scheduling of follow-up appointments to accommodate patients with severe symptoms
• The importance of balancing thorough evaluation with the risk of over-testing

How can healthcare providers address these challenges? By adopting a patient-centered approach that considers the individual’s needs, limitations, and overall well-being throughout the diagnostic process.

The Role of Clinical Expertise in ME/CFS Diagnosis

Given the complex nature of ME/CFS, the role of clinical expertise in diagnosis cannot be overstated. Healthcare providers with experience in ME/CFS are better equipped to navigate the diagnostic process and provide appropriate care for patients.

Why is clinical expertise so important in ME/CFS diagnosis? Experienced providers can:

• Recognize subtle patterns and presentations of ME/CFS
• Efficiently prioritize and sequence diagnostic tests
• Distinguish ME/CFS from other conditions with similar symptoms
• Provide informed guidance on management strategies and symptom relief

The Diagnostic Criteria for ME/CFS

To standardize the diagnosis of ME/CFS, various diagnostic criteria have been proposed over the years. The most widely accepted criteria currently are those published by the Institute of Medicine (IOM) in 2015.

What are the key components of the IOM 2015 diagnostic criteria for ME/CFS?

• Substantial reduction or impairment in the ability to engage in pre-illness levels of activity
• Post-exertional malaise (PEM)
• Unrefreshing sleep
• Either cognitive impairment or orthostatic intolerance (or both)

These symptoms must be present for at least six months and have moderate, substantial, or severe intensity at least 50% of the time to meet the diagnostic criteria.

The Proposed Approach to ME/CFS Diagnosis

Healthcare providers typically follow a structured approach when evaluating patients for ME/CFS. This approach may include:

1. Comprehensive patient history, including onset and pattern of symptoms
2. Physical examination to identify any abnormal findings
3. Initial laboratory testing to rule out other conditions
4. Assessment of symptoms against established diagnostic criteria
5. Additional specialized testing as indicated by clinical findings
6. Evaluation of cognitive function and impact on daily activities
7. Consideration of co-existing conditions and their management

This systematic approach helps ensure a thorough evaluation while minimizing unnecessary tests and patient burden.

Other Conditions to Consider in ME/CFS Evaluation

During the diagnostic process for ME/CFS, healthcare providers must consider and rule out other conditions that may present with similar symptoms. Some of these conditions include:

• Fibromyalgia
• Multiple sclerosis
• Lupus and other autoimmune disorders
• Lyme disease
• Sleep disorders (e.g., sleep apnea)
• Endocrine disorders (e.g., hypothyroidism, adrenal insufficiency)
• Chronic infections
• Psychiatric conditions (e.g., major depression, anxiety disorders)

Why is it crucial to consider these other conditions? Many of these conditions have specific treatments that can significantly improve patient outcomes. Failing to identify and address these conditions could lead to missed opportunities for effective intervention.

Comorbid Conditions in ME/CFS

It’s important to note that patients with ME/CFS may also have co-existing conditions that contribute to their symptoms or require separate management. Common comorbidities in ME/CFS include:

• Fibromyalgia
• Irritable bowel syndrome (IBS)
• Postural orthostatic tachycardia syndrome (POTS)
• Mast cell activation syndrome (MCAS)
• Depression and anxiety
• Migraines
• Joint hypermobility disorders

How should healthcare providers approach comorbid conditions in ME/CFS patients? It’s essential to recognize and address these conditions while still acknowledging the underlying ME/CFS diagnosis. Treating comorbidities can often lead to overall symptom improvement and better quality of life for patients.

The Future of ME/CFS Diagnosis: Emerging Research and Potential Biomarkers

While the current diagnostic process for ME/CFS relies heavily on clinical evaluation and symptom assessment, ongoing research is exploring potential biomarkers and diagnostic tools that could revolutionize the field.

What are some promising areas of research in ME/CFS diagnosis?

• Neuroimaging studies to identify brain abnormalities associated with ME/CFS
• Metabolomic profiling to detect unique metabolic signatures
• Immunological markers related to inflammation and immune dysfunction
• Genetic and epigenetic studies to identify potential risk factors or disease mechanisms
• Microbiome analysis to explore the role of gut bacteria in ME/CFS

While these research areas show promise, it’s important to note that they are still in the exploratory stages. Currently, no single biomarker or test has been validated for widespread clinical use in ME/CFS diagnosis.

The Importance of Patient Education and Support

As healthcare providers navigate the complex process of diagnosing ME/CFS, patient education and support play crucial roles in ensuring optimal outcomes. Patients should be informed about the nature of ME/CFS, the diagnostic process, and potential management strategies.

How can healthcare providers effectively educate and support ME/CFS patients?

• Provide clear, accurate information about ME/CFS and its impact on daily life
• Explain the diagnostic process and the rationale behind various tests
• Discuss potential management strategies and their expected outcomes
• Offer resources for patient support groups and additional information
• Address concerns about work, school, or disability accommodations
• Encourage open communication and collaboration in the care process

By fostering a supportive and informative environment, healthcare providers can help patients navigate the challenges of ME/CFS diagnosis and management more effectively.

The Role of Interdisciplinary Care in ME/CFS Management

Given the multifaceted nature of ME/CFS and its impact on various aspects of a patient’s life, an interdisciplinary approach to care is often beneficial. This approach involves collaboration among different healthcare specialists to address the diverse needs of ME/CFS patients.

Which healthcare professionals might be involved in ME/CFS care?

• Primary care physicians
• ME/CFS specialists
• Neurologists
• Rheumatologists
• Psychologists or psychiatrists
• Physical therapists
• Occupational therapists
• Nutritionists
• Pain management specialists

By working together, these professionals can provide comprehensive care that addresses the various symptoms and challenges associated with ME/CFS, ultimately improving patient outcomes and quality of life.

Evaluation | Diagnosis | Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

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Handout: ME/CFS Assessment Overview Table pdf icon[PDF—1 page]

Evaluation of ME/CFS requires multiple stages based on patient symptoms and complete history, physical exam findings, review of any recent laboratory test results, and clinical judgment. As for any condition, healthcare providers typically determine the sequence and prioritization of laboratory testing based on individual patients’ presentations. While not all of the tests listed below may be needed initially or at the same time, the tests below are performed routinely for patient evaluations by healthcare providers with clinical expertise in ME/CFS, largely with the goal of identifying other illnesses:

• Complete blood count with differential
• Erythrocyte sedimentation rate (ESR)
• Electrolytes
• Fasting glucose
• Renal function: creatinine, blood urea nitrogen (BUN), glomerular filtration rate
• Calcium
• Phosphate
• Liver function: bilirubin, alanine aminotransferase (ALT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total protein, albumin/globulin ratio
• C-reactive protein

• Thyroid Function: thyroid-stimulating hormone (TSH), free thyroxine (free T4)
• Iron studies to assess for both iron overload and deficiency: serum iron, transferrin saturation, ferritin
• Celiac disease screening laboratory tests
• Urinalysis

Despite being substantially debilitated, most people with ME/CFS have routine laboratory test results that are within normal ranges. Further testing may be indicated to confirm a diagnosis for illness other than ME/CFS if suggested by an individual patient’s history and/or physical findings. For example, if autoimmune disease is suspected, the healthcare provider may order additional tests such as antinuclear antibodies. However, healthcare providers should be cautious of extensive testing in the absence of clinical suspicion because of the risk of false-positive tests.

If abnormal laboratory findings are present, further evaluation is warranted. For example, if anemia is identified, further studies are generally indicated to characterize and treat the anemia. These studies might include tests for deficiencies in B12 and folate. Anemia can also be a presenting symptom of celiac disease. (Note: Some healthcare providers with expertise in the diagnosis and management of ME/CFS include vitamin level studies, including B12, folate, and vitamin D, in their initial testing. For patients with cognitive impairment, assessment of B12 and folate can help identify underlying conditions. )

Additional tests such as imaging and physiological assessments may be needed to diagnose underlying illnesses. These tests might include:

• Specific cultures or serological tests if an ongoing or recent infection is suspected.
• MRI or other neuroimaging procedures to evaluate abnormal findings on the neurological examination and to assess for diseases such as multiple sclerosis.
• Physiological testing such as sleep studies, exercise testing (including VO₂max), or tilt table testing to address specific questions, often in consultation with a specialist.

Be aware that a patient can have ME/CFS and a co-existing condition that causes fatigue or other ME/CFS symptoms (e.g., blood pressure abnormalities), and these co-existing conditions should be treated appropriately.

Extensive testing and frequent healthcare provider visits may exacerbate the symptoms of patients with ME/CFS, so when follow-up visits are needed, they need to be scheduled thoughtfully. Some patients with ME/CFS may not look ill during office visits, while those with more severe symptoms might not always be able to keep all of their appointments.

Assessing the Impact of Illness on Cognition

Tests can be useful to assess if and how patients’ cognitive skills, such as concentration, memory, and organization, are or become impacted by illness. This additional testing can also be useful in identifying particular areas in which specific tools or strategies might help. Assessments and strategic interventions may be particularly helpful to children and adolescents with ME/CFS. Academic attendance and performance are important for these patients, and their specific educational needs should be addressed.

Disclaimer: The content of this ME/CFS website is for informational purposes only and does not represent a federal guideline or recommendation for the treatment of ME/CFS. The information provided on this website is not intended to be a substitute for the medical judgment of the healthcare provider and does not indicate an exclusive course of action or treatment.

• Diagnosis
• IOM 2015 Diagnostic Criteria
• Proposed Approach to ME/CFS Diagnosis
• Other Conditions for Evaluation
• Comorbid Conditions
• Presentation and Clinical Course of ME/CFS
• Clinical Care of Patients with ME/CFS
• Healthcare Provider Toolkit

Chronic Fatigue Syndrome (CFS) – Exams, Tests, Diagnosis, Related Conditions

Written by WebMD Editorial Contributors

• See Your Doctor
• What Else Could It Be?
• Checking the Symptoms

There’s no simple blood test or X-ray to diagnose chronic fatigue syndrome – also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). And many of the symptoms of the illness — deep tiredness, unrelieved by rest or sleep, feeling worse after physical or mental exertion, trouble concentrating, feeling worse after standing and remaining on one’s feet and other symptoms– are also seen in other conditions, too, making the diagnosis of ME/CFS more difficult.

If you think you might have ME/CFS, make an appointment to see your doctor. Research shows that getting treatment sooner might bring better results.

Your doctor will ask for a lot of information about your health. Unfortunately, there is not yet a diagnostic test that is sufficiently accurate to be useful. Your doctor will need to rule out other conditions or causes before they can diagnose ME/CFS.

They might order other tests like blood and urine tests and scans. They will need the names of all the prescription and over-the-counter medicine you take, in case one of them is causing your symptoms. Also, tell your doctor if you take any supplements. Even so-called “natural” or “herbal” remedies can have side effects, and they might cause problems if used with other medications you’re taking.

Your doctor will give you a complete physical exam and ask you questions about your emotions. This will give them a better idea of what your needs are. It’s important to make sure you don’t have another disorder, which could be serious and could get better with treatment.

Many people who have ME/CFS have other conditions, too. If you get treated for those, it might also improve your chronic fatigue.

 ME/CFS can look a lot like “mono” (mononucleosis), Lyme disease, lupus, multiple sclerosis, fibromyalgia, sleep disorders, or depression. It affects about 2.5 million Americans, but experts believe only about 20% are diagnosed. 

Your doctor will review your medical history and test results. They will check to see if you have several key symptoms, beginning with extreme tiredness, or fatigue, that doesn’t improve with bed rest for 6 months or longer.

Then, your doctor will check to see if you have three of these “core” symptoms of CFS:

• Reduced ability to do usual activities for six months or more because of fatigue
• Worsening of symptoms (difficulty thinking, problems sleeping, sore throat, headaches, feeling dizzy, or severe tiredness). after physical or mental exertion
• Trouble falling asleep or staying asleep, and awakening unrested

Along with the three symptoms, you must have one of these for a diagnosis of ME/CFS:

• Problems with thinking and memory
• Worsening of symptoms while standing or sitting upright; you might feel lightheaded, dizzy or weak, and you may have blurred vision or see spots.

It could take a while to get your diagnosis. It’s OK to ask how you can relieve your symptoms while you wait. Your doctor or health professional will schedule follow-up appointments to see how your treatment is working.

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KFC feeds for free everyone who passes the wild test in the restaurant

Oleg Voronin

—
October 21, 2022, 20:50

Fast food restaurant chain KFC presented an unusual PR campaign. This was written in Timeout.com.

According to the source, on October 22, 2022, Hong Kong KFC chain will hold an unusual challenge, in which any visitor can participate. The company installed a huge booth, stylized as a branded chicken cardboard bucket. There, a person sits on a chair, and the “bucket” plays him a minute ASMR track with the sound of roasting chicken.

While the visitor listens to the bird being cooked, the “bucket” measures his brain waves. For anyone who can stay calm during this minute, KFC is giving away a free drink or a coupon for their signature fried chicken.

iGuides in Yandex.Zen — zen.yandex.ru/iguides.ru

iGuides on Telegram — t.me/igmedia

Source:

Timeout.com

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KFC – development of a personalization system for a restaurant

Evrone has extensive experience working with large international companies. However, the task of personalizing interaction with millions of KFC customers has become a real challenge for us.

Task

Today KFC is the leader in the number of restaurants in Russia. The brand intends to provide its franchise partners with even more opportunities for growth through menu personalization and “big data”.

What product does the customer order most often, what does he like? Does he take it in the hall or take it away? What sauces do you prefer? What do you think about stocks? What drinks does he choose in the morning or in the evening?

By accumulating information about consumers, KFC will be able to offer each regular customer what he likes and is more willing to buy. In other words, for KFC it was required:

• Create a system of “recognition” of regular customers.
• Develop a CRM system that, on the one hand, would organize thousands of potential “sets” of customer offers, and, on the other hand, would link this with the technological base of restaurants.

Developing CRM for such a large company is like redesigning a working airport: you need to make everything many times better without destroying what is already there and working along the way.

The first approach – ready-made CRM

Creating a CRM is a big task. Therefore, at first, KFC turned to Evrone for advice and asked for help in choosing a ready-made solution on the market. Perhaps this way it would be possible to use a suitable CRM as a core, “covering” it from above with the modules we need.

Unfortunately, none of the solutions satisfied the customer. No single vendor could provide sufficient flexibility while leaving restaurant chains in control of user data.

As a result, KFC decided on an ambitious task: to create their own CRM. As an experiment, they decided to launch it in several countries.

Evrone’s task was the internal part of the service – everything that worked “under the hood” and had to further communicate with self-service terminals and other devices. At the same time, all new code and fixes had to be covered by tests immediately after being uploaded to the repository.

Unified CRM

Evrone designed and implemented a system that covers all the needs of franchisees and remembers everything they need. Here are its main modules:

• Menu, ingredients, allergens. In the menu – convenient management of all modifiers: dishes, categories, images, combo dishes, fillers, volume and number of dishes. This section also takes into account the schedule and special offers of restaurants. Data from the section can be sent to self-service kiosks and mobile applications of customers. As a result, restaurant employees create menus on the fly, and customers can manage their order.
• Handbooks. This module contains guides about restaurants in all cities and countries of presence. There is available information about legal entities, languages, external systems (for example, product identifiers), calories and other product properties, currencies. Data can be grouped geographically (for example, selecting everything related to restaurants in Spain). Franchisees no longer have to search for this information in disparate information systems.
• Projects, placements, media storages. There are many media platforms in KFC restaurants where information is posted: banners, billboards, kiosks. CRM provided a separate module for storing and managing such content. A restaurant manager can change advertisements and promotions quickly and remotely.
• Segments. In CRM, you can segment the audience according to different parameters. For example, by gender, age, frequency and composition of purchases, and other personal data. As a result, franchisees can create customized offers for segments. With this, you can increase customer engagement and satisfaction, increase the frequency of repeat purchases – and earn more.
• Stop lists. An important part of CRM is that it allows you to automatically remove some dishes from the menu if necessary. If the equipment stops working for any reason, the restaurant director will quickly stop the order of those dishes that are temporarily impossible to cook.

These are only the first parts of the system. The development map of this project is designed for years to come. We can say that we are only at the very beginning of the journey.

Localization and tests

Work in different countries dictates its requirements for CRM. For example, in Israel the working week starts on Sunday and ends on Thursday. In Europe, there are very strict requirements for the collection and storage of users’ personal data. Therefore, each country has its own sequence of testing and launching CRM. The main task is to get quick feedback, and on its basis to make the system more convenient and understandable for operators. In Russia, the system is already working in some restaurants, in other countries it is preparing for testing or waiting for its moment. We have provided in advance the possibility to deploy CRM locally in each country of presence.

Localization testing requires special skills from QA engineers, this process has a number of features that affect the performance of the entire system. For example, for Arab countries, in which they read from right to left, you actually have to do a new layout. There are also many difficulties with normal translation: the encoding may go wrong, some pieces of text will remain untranslated – this often happens with user-friendly notifications and error messages. In addition, when translating, the volume of the text can change significantly, so it will no longer fit organically into the necessary elements: banners, buttons, etc. Experienced QAs are aware of such features and can check for any bottlenecks. Also, a high qualification of a QA engineer requires testing a microservice architecture. A specialist needs to understand how microservices work, how they interact with each other and other system components.

The

CRM stack is a Ruby on Rails application and two microservices. More about the components of the system:

• CRM. The Ruby on Rails framework was used to develop this part of the system. This helped us to build a very flexible system oriented to the customer’s business preferences. Since approaches and tasks in rapidly developing projects often change, it was this language and framework that helped us to flexibly apply all changes in the product architecture.
• UserAPI. Highly loaded microservice for interacting with external devices. It was implemented in the Go programming language.
• StoreAPI. Service for distributing public information about establishments: geosearch, schedules, special offers, as well as for transferring data to kiosks. With this service, the transfer of highly loaded parts of the system to Rust began.

7 backend developers and 9Frontend developers.

What’s next?

Personalization of one of the largest fast food chains, taking into account all the intricacies of local laws and peculiarities of work, is a titanic task. Despite the fact that the first version of CRM has been created and is already running, we are only at the beginning of the journey.

Thanks to working with KFC, we have gained interesting experience in working with promotional campaigns and geolocation. Since the network has many branches, testing and deployment was a big challenge, but we were able to make the system stable.

We are ready to continue helping KFC create the world’s first fully customized restaurants. If you want to automate your business, please contact us using the form below. Our experts will be happy to discuss your processes and the possibility of their digitalization.

Tasks related to the launch of non-standard products, services, innovative products always require extraordinary solutions, good technical training and the ability to experiment from the participants. The Evrone team successfully implemented part of the technical solutions of the YUM digital ecosystem, allowing the QSR market to launch completely new services for the industry, restaurant formats and qualitatively change the relationship with guests.