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Chronic fatigue syndrome: a clinical view
  1. D W Beverley

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    Audiovisual Department, Southampton University, 2003.

    This is an excellent video which I would highly recommend to anyone who deals with young people and adults with chronic fatigue syndrome (CFS): not only will health professionals find it a useful resource but teachers and families too. The treatment approach of the team in Southampton is presented in a clear and coherent way and the choice of articulate patients and parents to explain the illness and its impact on their lives is particularly helpful. In a logical way the video goes through the causes of CFS and making the diagnosis. A large section of the video is concerned with the treatment programme, stressing the importance of team work and engaging with the family to ensure that they are “on board” with the treatment. Drug usage and symptom relief are discussed, as are the use of complementary therapies. The focus of the treatment in Southampton is graded rehabilitation and cognitive behaviour therapy, and I believe that some patient groups will not rest easy with some of the aspects of care advocated by the Southampton group. At the end of the video is a section on prognosis and discharge.

    Some aspect of the video I found disappointing. For example, it suggests that 2% of young people are affected by CFS and that the sex distribution is equal, but the reason for this statement is not discussed and does not accord with published data. The recent RCPCH/RCGP community based survey suggests a prevalence of 0.066%, two thirds of whom were girls. The consequence of this was to make me feel that if they had got this wrong, what else was wrong in the video? The video tended to avoid some of the contentious aspects of CFS management with which many paediatricians have most difficulty; although education is discussed, there is no mention of the pros and cons of home tuition. Rightly the video stresses the importance of engaging with the whole family, but there is no mention of what to do when the relationship between the family and the therapeutic team breaks down. The role of social services and child protection issues are also not dealt with. It would have been very helpful to have some advice on the management of the very severely affected bed ridden individual; as it is those patients who are the most taxing in terms of treatment.

    Technically, the video is well produced with clear sound and pictures. There are not any glaring continuity problems, though the posterisation of some of the images was a little bit annoying. I wonder in 2003 whether production in DVD format would have been appropriate, with chapter headings for each section, allowing the viewer to jump to their areas of interest.

    Despite my reservations above, this is an excellent resource which would be of value in any departmental library. It should also find a place in the school health service as an information resource for school nurses and teachers.