Greater Symptom Improvement Research Articles

Association of robotic approach with patient-reported outcomes after pancreatectomy: a prospective cohort study.

Robotic-assisted pancreatectomy continues to proliferate despite limited evidence supporting its benefits from the patient's perspective. We compared patient-reported outcomes (PROs) between patients undergoing robotic and open pancreatectomies. PROs, measured with the FACT-Hep, FACT-G, and HCS, were assessed in the immediate postoperative (i.e., preoperative to discharge) and recovery (i.e., discharge to three months postoperative) periods. Linear mixed models estimated the association of operative approach on PROs. Minimally important differences (MIDs) were also considered. Among 139 patients, 105 (75.5%) underwent robotic pancreatectomies. Compared to those who underwent open operations, those who underwent robotic operations experienced worse FACT-Hep scores that were both statistically and clinically significant (mean difference [MD] 8.6 points, 95% CI 1.0-16.3). Declines in FACT-G (MD 4.3, 95% CI -1.0 to 9.6) and HCS (MD 4.3, 95% CI 0.8-7.9) scores appeared to contribute equally in both operative approaches to the decline in total FACT-Hep score. Patients who underwent robotic versus open operations both statistically and clinically significantly improved due to improvements in HCS (MD 6.1, 95% CI 2.3-9.9) but not in FACT-G (MD 1.2, 95% CI - 5.1-7.4). The robotic approach to pancreas surgery might offer, from the patient's perspective, greater improvement in symptoms over the open approach by three months postoperatively.

A National Survey on Patient Satisfaction and Use Trends with Revaree, a Hyaluronic Acid Suppository, for Vaginal Dryness

ABSTRACT Introduction During menopause, many women experience vaginal atrophy symptoms including vaginal dryness, burning, stinging, and dyspareunia. Revaree is a non-drug, hormone-free vaginal insert containing hyaluronic acid. Clinical evidence supports the use of hyaluronic acid to reduce vaginal dryness, vaginal itching and burning, and dyspareunia. Objective A national survey study was conducted to affirm results previously reported from controlled clinical trials and to investigate the trends of this product across multiple variables. This study gathered information on the real-world experiences of women, including the use of Revaree and its effect on symptom relief including vaginal dryness, quality of life, and satisfaction. Methods An optional, rolling online survey was emailed to patients who had been taking Revaree for time periods ranging from less than one month to more than one year. Survey data was collected from 3,080 patients between March 2019 and October 2021. A 5-point Likert scale was used to assess patient satisfaction. During the initial 9 months of enrollment, patients received no compensation. To increase enrollment, after the initial 9 months, patients were compensated with a $5 gift card for completing the survey. Results An analysis of survey findings showed that of patients taking Revaree (n=total applicable responses per question): 83% responded that Revaree reduced vaginal dryness (n=3,050); 73% responded that Revaree reduced vaginal burning (n=2,315); 77% responded that Revaree reduced vaginal irritation (n=2,644); 66% responded that Revaree reduced pain during sex (n=2,576); 69% responded that Revaree made sex more comfortable (n=2,617); 66% responded that Revaree improved intimacy with partners (n=2,617); and 72% responded that Revaree improved quality of life (n=2,933). Furthermore, 79% responded that Revaree is easy to insert (n=3,000); 69% responded that Revaree is non-messy (n=3,023); 80% responded that the insert formulation makes Revaree convenient to use (n=2,997); and 60% responded that Revaree makes everyday activities more comfortable (n=2,677). No differences in efficacy (e.g., improvements in vaginal dryness, vaginal burning, and vaginal irritation) were detected when the data were analyzed by user age (age range: 24 – 84). Additionally, no decrease in efficacy was detected with use over time. Of the 3,080 women, 58% reported that they first saw an improvement with Revaree within 2 weeks and 85% reported that they first saw an improvement with Revaree within 8 weeks. Overall, 79% of women reported satisfaction with Revaree (n=3,007); 92% of women would recommend Revaree to friends or family (n=3,079); and 96% plan to continue using Revaree (n=3,079). Conclusions This survey study demonstrated high levels of relief from vaginal atrophy symptoms across a wide age range with the use of Revaree. A majority of women saw great improvement in symptoms within the first month, with continued or higher levels of improvement with continued use. These findings confirm the objective findings of previously published randomized, controlled studies on Revaree's main ingredient, hyaluronic acid. Together, the results of this study support the use of Revaree to alleviate vaginal atrophy symptoms, enhance comfort during intimacy, and improve everyday quality of life. Disclosure Yes, this is sponsored by industry/sponsor: JDS Therapeutics Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: JDS Therapeutics

Acute and chronic stress predict anti-depressant treatment outcome and naturalistic course of major depression: A CAN-BIND report

BackgroundIn treatment studies of major depressive disorder (MDD), exposure to major life events predicts less symptom improvement and greater likelihood of relapse. In contrast, the impact of minor life events has received less attention. We hypothesized that the impact of minor events on symptom improvement and risk of relapse would be heightened in the presence of concurrent chronic stress. We also hypothesized that major events would predict less symptom improvement and greater risk of relapse independently of chronic stress. MethodsAdult patients experiencing an episode of MDD were enrolled into a 16-week trial with antidepressant treatments (n = 156). Forty-three fully remitted patients agreed to participate in a naturalistic 18-month follow-up, and 30 had full data for analyses. Life events and chronic stressors were assessed using a contextual life stress interview. ResultsGreater exposure to minor events predicted greater improvement in symptoms during acute treatment, but this relation was specific to those who reported greater severity of chronic stress. During follow-up, however, major life events predicted increased risk of relapse, and this effect was not moderated by chronic stress. LimitationHigh attrition rates led to a small sample size for the follow-up analyses. ConclusionsExposure to minor events may provide an opportunity to practice problem-solving skills, thereby facilitating symptom improvement. Nevertheless, acute treatment did not protect patients from relapse when they subsequently faced major events during follow-up. Therefore, adjunctive strategies may be needed to enhance outcomes during pharmacotherapy, consolidating benefits from acute treatment and providing skills to prevent relapse.

Concordance in PTSD symptom change between DSM-5 versions of the Clinician-Administered PTSD Scale (CAPS-5) and PTSD Checklist (PCL-5).

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) versions of the Clinician-Administered PTSD Scale (CAPS-5) and PTSD Checklist (PCL-5) are widely used PTSD measures. Researchers and clinicians routinely use both measures in tandem to quantify symptom change, despite substantive instrumentation differences beyond administration modality, and absent a theoretical rationale or differential hypotheses for the two measures. The degree to which these measures provide comparable estimates of symptom change is unknown. This study examined concordance in change between CAPS-5 and PCL-5 scores over time. Participants were male veterans (N = 198) randomly assigned to one of two group PTSD treatments. We administered both the CAPS-5 and PCL-5 at baseline, midtreatment, immediately posttreatment, and 3-, 6-, and 12-month posttreatment. Results indicated that CAPS-5 and PCL-5 scores changed over time in a similar manner, as evidenced by generally parallel repeated-measures effect sizes, highly correlated slopes of change (r = .878), and similar associations with improvements in measures of depression and psychosocial functioning. However, the two measures did not produce identical estimates of symptom change. Estimates of symptom improvement were somewhat less concordant at posttreatment follow-up assessments; by the 12-month posttreatment assessment, changes in CAPS-5 scores from baseline indicated somewhat greater symptom improvement than changes in PCL-5 scores (CAPS-5 ESsg = -0.67, PCL-5 ESsg = -0.53). Collectively, results indicate that CAPS-5 and PCL-5 scores produce similar but not identical estimates of PTSD symptom change. Thus, although PCL-5 scores closely approximate symptom change estimated by CAPS-5 scores, the two measures are not interchangeable. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Pilot Clinical Study of the Efficacy and Safety of Phellinus Linteus (Sanghuang) Extract Treatment for Knee Osteoarthritis

Background: To evaluate the efficacy and safety of Phellinus linteus (PL) extract for the treatment of knee osteoarthritis (KOA) a pilot clinical study was performed.Methods: There were 24 patients with KOA who enrolled in this double-blind, randomized, controlled, clinical trial. There were 3 groups: PL 1,000 mg/day (PL 1,000), PL 1,500 mg/day (PL 1,500), and dextrin 3,000 mg/day (placebo). Patients took capsules twice a day, 3 capsules at a time, over 8 weeks. Patients were monitored prior to treatment (Visit 1: Week 0), and followed up every 4 weeks (Visit 2: Week 4 and Visit 3: Week 8) where outcome measurements were taken. The primary outcome measure was the score from the Korean version of the Western Ontario and McMasters Universities from baseline to Week 8. The secondary outcomes were measurements from the visual analog scale, quality of life scale, erythrocyte sedimentation, and c-reactive protein. Adverse events were recorded at every visit.Results: The Korean version of the Western Ontario and McMasters Universities score showed the greatest improvement in symptoms of KOA in the PL 1,500 group compared with the placebo group. The erythrocyte sedimentation tended to decrease in the PL 1,500 group compared with the placebo group (which was within the normal range). The visual analog scale score decreased in all groups, with no significant differences between groups. No adverse events related to PL were reported. There were no abnormal hematological or physical findings.Conclusion: This pilot clinical trial was the first step to assess the efficacy and safety of PL used in the treatment of patients with KOA.

The role of pre-existing knowledge and knowledge acquisition in internet-based cognitive-behavioural therapy for eating disorders

Knowledge is a relevant concept in internet-based cognitive-behaviour therapy (I-CBT), yet little research has sought to understand the role of knowledge in I-CBT for eating disorders. This study addressed this gap. Data were analysed from 293 participants enrolled in a RCT of I-CBT for eating disorder symptoms. A test assessing knowledge of CBT principles and eating disorders was administered before and after I-CBT. Participants had high knowledge to begin with, correctly answering 72% of items. A significant increase in knowledge scores and knowledge confidence was observed after ICBT. While no relationship between the degree of knowledge gain and the degree of symptom improvement emerged, an increase in confidence in one's knowledge was associated with greater symptom improvement. Higher baseline knowledge levels predicted lower likelihood of drop-out and a higher likelihood of adherence, but were unrelated to symptom-level improvement. Findings suggest that while new knowledge can be acquired through I-CBT, the degree of knowledge gain alone is not sufficient to explain improvement in symptoms. Pre-existing knowledge levels may be an important prognostic indicator of patient progress and compliance to I-CBT. Ensuring that patients can correctly apply the key I-CBT skills may be more important than knowledge gain.

Application of Heterogeneity of Treatment-Effects Methods: Exploratory Analyses of a Trial of Exercise-Based Interventions for Knee Osteoarthritis.

To evaluate heterogeneity of treatment effects in a trial of exercise-based interventions for knee osteoarthritis (OA). Participants (n = 350) were randomized to standard physical therapy (PT; n = 140), internet-based exercise training (IBET; n = 142), or wait list (WL; n = 68) control. We applied qualitative interaction trees (QUINT), a sequential partitioning method, and generalized unbiased interaction detection and estimation (GUIDE), a regression tree approach, to identify subgroups with greater improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score over 4 months. Predictors included 24 demographic, clinical, and psychosocial characteristics. We conducted internal validation to estimate optimism (bias) in the range of mean outcome differences among arms. Both QUINT and GUIDE indicated that for participants with lower body mass index (BMI), IBET was better than PT (improvements of WOMAC ranged from 6.3 to 9.1 points lower), and for those with higher BMI and a longer duration of knee OA, PT was better than IBET (WOMAC improvement was 6.3 points). In GUIDE analyses comparing PT or IBET to WL, participants not employed had improvements in WOMAC ranging from 1.8 to 6.8 points lower with PT or IBT versus WL. From internal validation, there were large corrections to the mean outcome differences among arms; however, after correction, some differences remained in the clinically meaningful range. Results suggest there may be subgroups who experience greater improvement in symptoms from PT or IBET, and this finding could guide referrals and future trials. However, uncertainty persists for specific treatment-effects size estimates and how they apply beyond this study sample.

PD45-04 CHANGE IN PROSTATE VOLUME REDUCTION AND SYMPTOMATIC IMPROVEMENT IN MEN TREATED WITH REZUM CONVECTIVE WATER VAPOUR THERMAL THERAPY

You have accessJournal of UrologyCME1 May 2022PD45-04 CHANGE IN PROSTATE VOLUME REDUCTION AND SYMPTOMATIC IMPROVEMENT IN MEN TREATED WITH REZUM CONVECTIVE WATER VAPOUR THERMAL THERAPY Dean Elterman, Katherine Lajkosz, Kevin C. Zorn, Bilal Chughtai, and Naeem Bhojani Dean EltermanDean Elterman More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Naeem BhojaniNaeem Bhojani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezum, convective water vapour thermal therapy is a minimally invasive, office-based treatment for benign prostatic enlargement (BPE). While studies have demonstrated its efficacy in symptom improvement, its effect on objective measures such as prostate volume reduction is poorly characterized. Herein, we evaluate change in prostate volume and the relationship to improvement in symptom score. METHODS: Quality of life outcomes and prostate volume were assessed as baseline and 12-months post-procedure. Percent change from baseline in outcomes and prostate volume were calculated for each patient. The injection to baseline volume ratio was calculated for each patient. The association between total number of vapour injections and changes in outcomes and prostate volume were evaluated using linear regression models. RESULTS: A total of 49 patients underwent the procedure between April 2019 and September 2020, with a mean of age of 67.8 (SD=9.4), mean baseline volume of 73.2cc (SD 27.9) and mean number of vapour injections was 11.0 (SD 3.5). At 12 months, the mean percent change in prostate volume was -30.2% (SD 29.1), with 45/49 (91.8%) patients overall having reduced volume at 12 months. Within the 45 patients with reduced volume at 12 months, every 10% increase in volume reduction was associated with a 7.5% (95% CI 1.40 to 13.6%, p=0.011) decrease in IPSS score at 12 months. There was no significant association between total number of injections or injection to baseline volume ratio and change in volume. CONCLUSIONS: In this cohort of larger size prostates, we demonstrated a 30% prostate volume reduction at 12-months, with a correlation between greater volume reduction and greater symptomatic improvement. There is no association between more injections or the ratio of injections to prostate volume and change in size, refuting the claim that more injections are better. Source of Funding: Not applicable © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e783 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean Elterman More articles by this author Katherine Lajkosz More articles by this author Kevin C. Zorn More articles by this author Bilal Chughtai More articles by this author Naeem Bhojani More articles by this author Expand All Advertisement PDF DownloadLoading ...

Body Mass Index and Exercise Effort Influences Changes in Motor Symptoms After High-Cadence Dynamic Cycling in Parkinson's Disease.

High-cadence dynamic cycling improves motor symptoms of Parkinson's disease (PD), such as tremor and bradykinesia. However, some participants experience greater benefits than others. To gain insight into how individual characteristics and cycling performance affects functional changes, data from two previous studies were used to build several preliminary predictive models. The purpose was to examine which variables contribute to greater improvement in symptoms after high-cadence dynamic cycling. We hypothesized that individuals with higher body mass index (BMI), increased age, more severe symptoms, and higher PD medication dosages were less likely to contribute effort during cycling. UPDRS-III was assessed before and after each session, and cadence and power were recorded every second. Entropy of cadence was calculated, and data were analyzed using analysis of variance and multiple linear regression. The multiple linear regression model of post UPDRS significantly (R2 = 0.81, p < 0.001) explained its variance, with pre UPDRS as the main predictor (p < 0.0001). The binomial logistic model of mean effort did not significantly (R2 = 0.36, p = 0.14) explain the variance. Post-hoc analysis found a significant (β = 0.28, p = 0.03) moderating effect of different levels of BMI on the association between mean effort and post UPDRS. These results suggest that BMI, effort, and baseline UPDRS levels can potentially predict individual responses to high-cadence dynamic cycling.

Brain Structures and Networks Underlying Treatment Response to Deep Brain Stimulation Targeting the Inferior Thalamic Peduncle in Obsessive-Compulsive Disorder

Background: Obsessive-compulsive disorder (OCD) is a debilitating disease with a lifetime prevalence of 2–3%. Neuromodulatory treatments have been successfully used in severe cases. Deep brain stimulation (DBS) targeting the inferior thalamic peduncle (ITP) has been shown to successfully alleviate symptoms in OCD patients; however, the brain circuits implicated remain unclear. Here, we investigate the efficacious neural substrates following ITP-DBS for OCD. Methods: High-quality normative structural and functional connectomics and voxel-wise probabilistic mapping techniques were applied to assess the neural substrates of OCD symptom alleviation in a cohort of 5 ITP-DBS patients. Results: The region of most efficacious stimulation was located in the regions of the ITP and bed nucleus of the stria terminalis. Both functional and structural connectomics analyses demonstrated that successful symptom alleviation involved a brain network encompassing the bilateral amygdala and prefrontal regions. Limitations: The main limitation is the small size of the ITP-DBS cohort. While the findings are highly consistent and significant, these should be validated in larger studies. Conclusions: These results identify a tripartite brain network – composed of the bilateral amygdala and prefrontal regions 24 and 46 – whose engagement is associated with greater symptom improvement. They also provide information for optimizing targeting and identifying network components critically involved in ITP-DBS treatment response. Amygdala engagement in particular seems to be a key component for clinical benefits and could constitute a biomarker for treatment optimization.

Clinical utility of combinatorial pharmacogenomic testing in depression: A Canadian patient- and rater-blinded, randomized, controlled trial

The pharmacological treatment of depression consists of stages of trial and error, with less than 40% of patients achieving remission during first medication trial. However, in a large, randomized-controlled trial (RCT) in the U.S. (“GUIDED”), significant improvements in response and remission rates were observed in patients who received treatment guided by combinatorial pharmacogenomic testing, compared to treatment-as-usual (TAU). Here we present results from the Canadian “GAPP-MDD” RCT. This 52-week, 3-arm, multi-center, participant- and rater-blinded RCT evaluated clinical outcomes among patients with depression whose treatment was guided by combinatorial pharmacogenomic testing compared to TAU. The primary outcome was symptom improvement (change in 17-item Hamilton Depression Rating Scale, HAM-D17) at week 8. Secondary outcomes included response (≥50% decrease in HAM-D17) and remission (HAM-D17 ≤ 7) at week 8. Numerically, patients in the guided-care arm had greater symptom improvement (27.6% versus 22.7%), response (30.3% versus 22.7%), and remission rates (15.7% versus 8.3%) compared to TAU, although these differences were not statistically significant. Given that the GAPP-MDD trial was ultimately underpowered to detect statistically significant differences in patient outcomes, it was assessed in parallel with the larger GUIDED RCT. We observed that relative improvements in response and remission rates were consistent between the GAPP-MDD (33.0% response, 89.0% remission) and GUIDED (31.0% response, 51.0% remission) trials. Together with GUIDED, the results from the GAPP-MDD trial indicate that combinatorial pharmacogenomic testing can be an effective tool to help guide depression treatment in the context of the Canadian healthcare setting (ClinicalTrials.gov NCT02466477).

Efficacy and Safety of the Hexanic Extract of Serenoa repens vs. Watchful Waiting in Men with Moderate to Severe LUTS-BPH: Results of a Paired Matched Clinical Study.

We investigated changes in symptoms and quality of life (QoL) in men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving the hexanic extract of Serenoa repens (HESr) and compared results with a matched group on watchful waiting (WW). Data was from a real-world, open-label, prospective, multicenter study. This sub-group analysis included patients with moderate-to-severe symptoms receiving either the HESr 320 mg/daily for six months (HESr) or who remained untreated for LUTS/BPH (WW). Changes in urinary symptoms and QoL were measured by IPSS and BII questionnaires. Two statistical approaches (iterative matching and propensity score pairing) were used to maximize between-group comparability at baseline. Tolerability was assessed in the HESr group. After iterative matching, data for analysis was available for 783 patients (102 WW, 681 HESr). IPSS scores improved by a mean (SD) of 3.8 (4.4) points in the HESr group and by 2.2 (4.5) points in the WW group (p = 0.002). Changes in BII score were 1.8 (2.4) points and 1.0 (2.2) points, respectively (p < 0.001). Three patients (0.9%) treated with the HESr reported mild adverse effects. Moderate-severe LUTS/BPH patients treated for six months with the HESr showed greater improvements in symptoms and QoL than matched patients on WW, with a very low rate of adverse effects.

654 PHARYNGEAL POUCH SURGERY IN OCTO- AND NONAGENARIANS IS SAFE AND EFFECTIVE: A MULTICENTER COMPARATIVE COHORT STUDY

Abstract Surgery is the only effective treatment strategy for a symptomatic pharyngeal pouch. However, octo- and nonagenarians are often denied referral to a surgeon because of perceived increased risks. Here, we examine the perioperative outcomes of pharyngeal pouch surgery in octo- and nonagenarians in comparison to patients under 80 years-of-age. Methods Analysis of a prospectively maintained database of 113 patients (≥80 years-of-age: 27, &amp;lt;80 years-of-age: 86) who underwent pharyngeal pouch surgery across seven hospitals from 1 January 2006 to 30 September 2020. Results Patients ≥80 years-of-age had comparable operative time, complication profile, intensive care admission, emergency reoperation, and revisional surgery as their younger counterparts. The severity of complications was not significantly different between the two age groups. No surgical mortality was recorded. Multivariate analysis demonstrated that diverticulectomy combined with cricopharyngeal myotomy independently predicted higher rates of complications (OR: 4.53, 95% CI: 1.43-14.33, p = 0.010), but also greater symptomatic improvement (OR: 4.36, 95% CI: 1.50-12.67, p = 0.007). Importantly, a greater proportion of octo- and nonagenarians experienced improved swallowing than patients &amp;lt;80 years-of-age (96.3% vs. 74.4%, p = 0.013). Advanced age was not predictive of complications on multivariate analysis. Conclusion In appropriately selected patients, pharyngeal pouch surgery can be safely offered to patients above 80 years-of-age resulting in significant improvement in their quality-of-life. These patients should not be denied surgery on the basis of advanced age alone.

Insight as a dual-perspective construct: Convergence between patients' and professional evaluators' perspective on baseline level of insight and on changes in insight.

Insight gained by patients during treatment has been theorized to be a central mechanism of change in psychotherapy, but empirical studies examining the association between patients' insight and psychopathological symptoms have produced mixed results. The present study addresses these inconsistencies by investigating convergence between the perspectives of patient and professional evaluator on insight and disentangling two potentially distinct components of insight: pretreatment individual differences and changes in insight during treatment. A sample of 393 patients receiving psychodynamic psychotherapy completed pre- and posttreatment measures on symptoms and insight. Professional evaluators evaluated patients' insight based on clinical interviews pre- and posttreatment. Polynomial regression and response surface analyses were used to examine congruence. The results indicate that when there was agreement between the patient and the evaluator on insight, both baseline level of insight and the changes in insight during treatment were found to be related to symptomatic change, although showing different patterns of association. Lower baseline levels of insight were significantly associated with greater symptomatic improvement than were higher levels of insight. At the same time, greater increase in insight during treatment was moderately significantly associated with greater reduction in symptoms, as long as the changes in insight were not minimal. The findings underscore the importance of assessing the congruence between patients' and professional observers' perspectives on patient insight and the potentially distinct roles of between-patients baseline differences and within-patient changes in insight during treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome : A Randomized Trial.

Acupuncture has promising effects on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but high-quality evidence is scarce. To assess the long-term efficacy of acupuncture for CP/CPPS. Multicenter, randomized, sham-controlled trial. (ClinicalTrials.gov: NCT03213938). Ten tertiary hospitals in China. Men with moderate to severe CP/CPPS, regardless of prior exposure to acupuncture. Twenty sessions of acupuncture or sham acupuncture over 8 weeks, with 24-week follow-up after treatment. The primary outcome was the proportion of responders, defined as participants who achieved a clinically important reduction of at least 6 points from baseline on the National Institutes of Health Chronic Prostatitis Symptom Index at weeks 8 and 32. Ascertainment of sustained efficacy required the between-group difference to be statistically significant at both time points. A total of 440 men (220 in each group) were recruited. At week 8, the proportions of responders were 60.6% (95% CI, 53.7% to 67.1%) in the acupuncture group and 36.8% (CI, 30.4% to 43.7%) in the sham acupuncture group (adjusted difference, 21.6 percentage points [CI, 12.8 to 30.4 percentage points]; adjusted odds ratio, 2.6 [CI, 1.8 to 4.0]; P< 0.001). At week 32, the proportions were 61.5% (CI, 54.5% to 68.1%) in the acupuncture group and 38.3% (CI, 31.7% to 45.4%) in the sham acupuncture group (adjusted difference, 21.1 percentage points [CI, 12.2 to 30.1 percentage points]; adjusted odds ratio, 2.6 [CI, 1.7 to 3.9]; P<0.001). Twenty (9.1%) and 14 (6.4%) adverse events were reported in the acupuncture and sham acupuncture groups, respectively. No serious adverse events were reported. Sham acupuncture might have had certain physiologic effects. Compared with sham therapy, 20 sessions of acupuncture over 8 weeks resulted in greater improvement in symptoms of moderate to severe CP/CPPS, with durable effects 24 weeks after treatment. China Academy of Chinese Medical Sciences and the National Administration of Traditional Chinese Medicine.

Assessing Changes in Symptoms of Depression and Anxiety During Four Weeks of Cannabis Abstinence Among Adolescents.

Background: Cannabis use is prevalent among adolescents, and many report using in attempts to alleviate negative mood and anxiety. Abstinence from substances such as alcohol and tobacco has been reported to improve symptoms of anxiety and depression. Few studies have examined the effect of cannabis abstinence on symptoms of anxiety and depression.Objective: To test the effect of 4 weeks of continuous cannabis abstinence on depressive and anxious symptoms.Methods: Healthy, non-treatment seeking adolescents who used cannabis at least weekly (n = 179) were randomized to either 4 weeks of cannabis abstinence achieved through a contingency management paradigm (CB-Abst) or cannabis use monitoring without an abstinence requirement (CB-Mon). Abstinence was assessed by self-report verified with quantitative assay of urine for cannabinoids. Anxiety and depressive symptoms were assessed weekly with the Mood and Anxiety Symptom Questionnaire (MASQ).Results: Symptoms of depression and anxiety decreased throughout the study for all participants (MASQ-AA: stnd beta = −0.08, p = 0.01, MASQ-GDA: stnd beta = −0.11, p = 0.003, MASQ-GDD: stnd beta = −0.08, p = 0.02) and did not differ significantly between randomization groups (p's > 0.46). Exploratory analyses revealed a trend that abstinence may be associated with greater improvement in symptoms of anxiety and depression among those using cannabis to cope with negative affect and those with potentially hazardous levels of cannabis use.Conclusions: Among adolescents who use cannabis at least weekly, 4 weeks of cannabis abstinence was not associated with a significant change in anxiety or depressive symptoms compared to continued use. For recreational cannabis users who may be concerned about reducing their use for fear of increased symptoms of anxiety and depression, findings suggest that significant symptom worsening may not occur within the first 4 weeks of abstinence. Further studies are needed in clinical populations where anxiety and depression symptoms are measured more frequently and for a longer period of abstinence. Future studies are also needed to determine whether there are subgroups of adolescents who are uniquely impacted by sustained cannabis abstinence.

Xanomeline‐trospium combination shows promise in treatment of schizophrenia

A drug combining the muscarinic receptor agonist xanomeline and the muscarinic receptor antagonist trospium resulted in greater improvement in symptoms of schizophrenia compared with placebo in a 5‐week trial. The drug was associated with a greater prevalence of cholinergic or anticholinergic adverse events, however. Study results were published in the Feb. 25, 2021 issue of the New England Journal of Medicine.

Health Literacy Among Patients With Chronic Lung Disease Entering Pulmonary Rehabilitation and Their Resident Loved Ones.

The objective of this study was determine the prevalence of low health literacy (HL) and low reading ability among patients with chronic lung disease referred for pulmonary rehabilitation (PR) in the Netherlands and their loved ones; and to understand whether low HL or low reading ability influence PR outcomes. Health literacy was measured using the Health Literacy Survey-Europe Q16 (HLS-EU-Q16). Reading ability and cognitive functioning were measured using the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D) and the Montreal Cognitive Assessment. Exercise capacity, health status, and symptoms of anxiety and depression were assessed. Patients (n = 120) entering PR and loved ones (n = 41) participated. Of all patients, 51% had low HL and 29% had low reading ability. Also, 39% of all loved ones had low HL. PR outcomes were comparable between patients with low or adequate HL. Patients with adequate reading ability showed greater improvement in symptoms of depression than patients with low reading ability (P = .047). Low HL and low reading ability are common among patients entering PR and their loved ones. For patients with low or adequate HL, PR is an effective treatment. Whether considering low HL and low reading ability by offering tailored education during treatment could augment the benefits of PR warrants further study.

The Association Between Psychopathology and Clinical Insight in Patients With Schizophrenia

In Taiwan, few studies have explored the associations between insight and psychopathological dimensions in people with schizophrenia. We aimed to investigate the relationships of clinical insight with different dimensional symptoms in patients with schizophrenia, in addition to clinical variables. This cross-sectional study recruited 90 patients from an acute psychiatric ward from December 2017 to May 2019. We assessed the insight of participants using the Schedule for Assessment of Insight in Psychosis (SIP) and psychopathology using the Positive and Negative Syndrome Scale and its five-factor model. A higher SIP score indicates a poorer insight. In regression analyses, patients' age (t = 3.277, p = 0.002), family history (t = -2.773, p = 0.007), Clinical Global Impressions Scale- Improvement (t = 2.268, p = 0.026), and negative (t = 2.667, p = 0.009), disorganized (t = 2.021, p = 0.047), excited (t = 3.087, p = 0.003), and depressed symptoms (t = -3.950, p ＜ 0.001) were significantly associated with the SIP score. In conclusion, patients with greater insight in the acute phase were associated with younger age, a positive family history, greater improvement of symptoms, less-severe negative symptoms, less-severe disorganized symptoms, less-severe excited symptoms, and more-severe depressed symptoms, but not with cognitive or executive function.

Stellate Ganglion Block for the Treatment of Post-Traumatic Stress Disorder, Depression, and Anxiety

&#x0D; The evidence regarding the clinical effectiveness of stellate ganglion block for the treatment of post-traumatic stress disorder was mixed. A randomized controlled trial included in a systematic review did not detect significant differences in post-traumatic stress disorder symptoms in the stellate ganglion block versus sham groups, while another randomized controlled trial did detect significantly greater improvements in symptoms between these groups. Furthermore, the second randomized controlled trial detected significantly greater improvements in depression, anxiety, and distress, but not in pain and mental and physical functioning for participants receiving stellate ganglion block compared to sham.&#x0D; Authors of the randomized controlled trial included in the systematic review did not detect significant differences in rates of adverse events between groups. Of the 6 adverse events reported in the second randomized controlled trial, 3 were deemed related to stellate ganglion block treatment (injection site pain, self-resolving bradycardia, and temporary laryngeal irritation); the statistical analysis was not reported.&#x0D; Authors of 1 evidence-based guideline were unable to provide recommendations for or against the use of stellate ganglion block for the treatment of post-traumatic stress disorder because of insufficient evidence.&#x0D; No relevant literature or guidelines regarding the clinical effectiveness or use of stellate ganglion block for the treatment of depression or anxiety were identified.&#x0D;