Improvement In Overall Function Research Articles

Self-Reported Mental Health and Addiction Outcomes of a Novel Community-Based Case Management Program for Frequent Emergency Department Users

Frequent emergency department users with mental illness or addiction often struggle to find the services they need. A pre-test/post-test design assessed outcomes for these individuals after participating in a novel community-based stepped-care program delivering individualized intensive case management services. Results indicated improvement in overall functioning and severity of anxious and depressive symptoms.

Opioid use in impending versus pathologic proximal femur fractures.

e24061 Background: Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for postoperative pain relief. This study compared postoperative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur. Methods: This was a retrospective review of patients using opioids postoperatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and postoperative opioid usage as well as ambulation status and risk factors at three and six months associated with postoperative opioid use were recorded. Results: Twenty-four pathologic fractures and twenty-three impending fractures were included. Preoperative opioid daily morphine milligram equivalent (MME) was significantly higher in the pathologic fracture group (p = 0.021), but there were no significant differences at three or six months. In the impending fracture group, daily MME at three months was significantly higher than preoperative daily MME (p = 0.018) but returned to preoperative levels at six months. There was statistically significant improvement in ambulation status in the combined cohort (p = 0.008) and impending fracture cohort (p = 0.016) at 6 months. Conclusions: Although patients did not experience a significant postoperative change in opioid use, patients with pathologic fractures notably required higher opioid dosages and there was overall improvement in function following fixation. Future studies should examine postoperative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.[Table: see text]

Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial.

Persistent non-specific neck pain (NP) is a widespread condition described as a complex biopsychosocial disorder, characterized by physical and psychological symptoms. Virtual reality (VR) shows promise in NP treatment, potentially reducing pain, kinesiophobia, and improving range of motion (ROM) and motor control. The primary aim of the study was to assess the effectiveness of VR sensorimotor training, combined with manual therapy, in reducing the level of disability in persistent non-specific NP individuals. The secondary aim was to determine if this VR-enhanced approach also contributes to improvement in overall function, pain perception and kinesiophobia. Monocentric, single-blind, randomized controlled trial. We conducted this trial at San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy. Forty NP participants were enrolled in the study and randomly allocated into two groups. The study involved a 6-week rehabilitation program, comprising 12 sessions of 45 minutes each, twice weekly. Both intervention groups underwent manual therapy as a consistent component of their treatment. The Experimental Group (VRT) was additionally engaged in sensorimotor rehabilitation exercises using Virtual Reality, whereas the Control Group (CT) performed the same exercises without VR. We assessed subjects at baseline (T0) and after six weeks of rehabilitation (T1). The primary outcome was the disability (Neck Disability Index) while the secondary outcomes were: pain perception (Numeric Rating Scale, NP and Disability Scale, Central Sensitization Inventory) function (Cervical Kinematics) and kinesiophobia (Tampa Scale of Kinesiophobia). Both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia. Significant advancements in kinematics were observed: VRT group showed enhanced ROM during craniocervical rotation (P=0.039), lateral bending (P=0.001), flexion-extension (P=0.009), and mean velocity across movements (P<0.001), whereas CT group improved in maximal ROM during lateral bending rotation (P=0.001). Between-group analysis, after Bonferroni's correction for multiple comparisons, revealed that VRT group had significantly better outcomes in ROM during rotation (P=0.040), ratio of the primary over the secondary movement while performing rotation (P=0.021), and mean velocity during lateral bending (P=0.031). Sensorimotor training, combined with manual therapy, could enhance kinematic outcomes for NP patients, supporting the potential of VR in rehabilitation. This study highlighted that both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia after sensorimotor training combined with manual therapy. It is important to underscore that in terms of reducing the level of neck disability, both interventions proved to be equally effective. This parity in efficacy is a critical finding, reaffirming the robustness of our therapeutic approaches for this specific outcome.

The biology of reactivity in human relationships: a conversation with Victoria Harrison

AbstractThe concept of differentiation of self and its relationship to the natural capacity of humans and other social animals to adapt underpins clinician and researcher Victoria Harrison's long‐term investigation of the biology of reactivity in relationships. Victoria's early research related to infertility and reproduction demonstrated how reactivity in at least three prior generations can contribute to chronic conditions, such as endometriosis, that are less amenable to intervention. Her most recent project, the ‘Observations of Change in Physiology and Family’ research, highlights how work on differentiation of self improves functional outcomes in physical and mental health for the family. While an individual may not experience the ‘calm mind’ that is often the goal of conventional therapeutic intervention, a significant reduction in symptoms and an improvement in overall functioning and relatedness are outcomes. This occurred when participants focused on increasing person‐to‐person contact with extended family members, reducing their emotional reactivity to significant others in the important triangles of their life and family and maintaining intellectual activity, often described as curiosity, even while reacting.

Addressing caregiver needs of brain injury survivors through telehealth: A pilot qualitative study

AbstractObjectiveThis study sought to identify effective means for delivering services to address the unique needs of caregivers for traumatic brain injury (TBI) survivors.BackgroundCaregivers for TBI survivors face unique and intense challenges, including deep isolation. When these caregivers fail to thrive, the entire family system suffers.MethodEmploying a pilot study utilizing qualitative methods, we explored the effectiveness of an intervention piloting telehealth counseling to address some of the unique caregiving challenges for the TBI survivor's caregiver. We conducted two focus groups of four participants to obtain qualitative data.ResultsQualitative analysis identified key themes: isolation, boundary issues, challenges of therapy, and the benefits of telehealth counseling.ConclusionsResults indicate an improvement in overall functioning of caregivers when accessing telehealth services.ImplicationsOn a micro level, results demonstrate that telehealth services can help TBI caregivers prevent boundary enmeshment. On a macro level, results have implications for increased investment and resources for those who serve the TBI population through an online format as well as proposed best practices for the method of service delivery.

The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial

Medically Unexplained Physical Symptoms (MUPS) are prevalent among primary care patients and frequently lead to diminished quality of life, increased healthcare costs, and decreased work participation. We aimed to examine the effects of a work-focused structured communication tool based on cognitive-behavioral therapy in patients with MUPS. In a Norwegian two-arm cluster randomized trial, the effectiveness of the structured communication tool Individual Challenge Inventory Tool (ICIT) was compared to usual care for patients with MUPS using a two-arm cluster randomized design. Enrollment period was between March 7 and April 1, 2022. Ten groups (clusters) of 103 General Practitioners (GPs) were randomized to provide the ICIT or usual care for 11 weeks. Patients received two or more sessions with their GP, and outcomes were assessed individually. Primary outcome was patient-reported change in function, symptoms, and quality of life measured by the Patient Global Impression of Change (PGIC). Secondary outcomes included sick leave, work-related self-efficacy (RTW-SE), health-related quality of life (RAND-36), and patient experiences with consultants (PEQ). The trial was registered on ClinicalTrials.gov (NCT05128019). A total of 541 patients with MUPS were enrolled in the study. In the intervention group 76% (n=223) showed a significant overall improvement in function, symptoms, and quality of life as measured by the PGIC, compared to 38% (n=236) in the usual care group (mean difference-0.8 ([95% CI-1.0 to-0.6]; p<0.0001). At 11 weeks, the intervention group had a 27-percentage point decrease in sick leave (from 52.0 to 25.2), compared to 4-percentage point decrease (from 49.7 to 45.7) in the usual care group. Furthermore, compared to usual care, the intervention group reported significant improvements in work-related self-efficacy, health-related quality of life, and greater satisfaction with the communication during the consultations. No adverse events were reported. The implementation of the structured communication tool ICIT in primary care significantly improved patient outcomes and reduced sick leave among patients with MUPS. The study was funded by The Norwegian Research Fund for General Practice.

Functional Improvements 6+ Months After GOALS Training Predicted Decreased PTSD Symptoms Among Veterans with PTSD/mTBI

<h3>Research Objectives</h3> To examine whether long-term improvements in functional outcomes following Goal-Oriented Attentional Self-Regulation (GOALS) training predicts changes in PTSD symptoms among veterans with comorbid PTSD and mild TBI (mTBI). <h3>Design</h3> Archival data from a randomized-controlled, evaluator-blinded, trial for GOALS executive function training. Assessments of daily and emotional functioning were completed at baseline and 6 months post-treatment. <h3>Setting</h3> VA Medical Center. <h3>Participants</h3> 24 veterans with a history of chronic mTBI and a confirmed diagnosis of PTSD that completed GOALS training. <h3>Interventions</h3> GOALS is a cognitive rehabilitation intervention that incorporates mindfulness-based attention regulation training, and goal management strategies applied to participant-defined goals. It consists of ten 2-hour sessions administered in small group format, and three individual 1-hour sessions. <h3>Main Outcome Measures</h3> The Mayo-Portland Adaptability Inventory (MPAI) and PTSD Checklist, Military Version (PCLM) were chosen from archival data collected from the original study. <h3>Results</h3> Paired-samples T-Tests indicate significant improvements 6 months post GOALS training in total PTSD symptoms on PCLM-Total (p=.007), Re-experiencing (p=.009) and Hyperarousal (p=.002). There were also significant improvements in overall functioning on MPAI-Total (p=.007), including Participation (e.g. initiation, socialization, employment; p=0.01) and Ability (e.g. problem solving, memory, attention; p=0.014) 6 months post GOALS training. Results from simple linear regressions indicate that improved MPAI-Participation 6 months post GOALS training predicted decreases in PCLM-Hyperarousal (R²=.29), PCLM-Avoidance (R²=.20), and PCLM-Reexperiencing (R²=.17). Further, improved MPAI-Ability also predicted decreases in PCLM-Hyperarousal (R²=.19), PCLM-Avoidance (R²=.27), and PCLM-Reexperiencing (R²=.18). <h3>Conclusions</h3> Persistence of improvements in functional abilities 6+ months after GOALS training predicted decreased PTSD symptoms in Veterans with mTBI and PTSD. The results highlight the impact functional status has on emotional functioning, and suggest that improvements in functional abilities following cognitive rehabilitation training may strengthen emotional regulation skills, resulting in decreases in emotional distress. <h3>Author(s) Disclosures</h3> None.

Historical development and contemporary use of neuromodulation in human spinal cord injury.

There is a long history of neuromodulation of the spinal cord after injury in humans with recent momentum of studies showing evidence for therapeutic potential. Nonrandomized, mechanistic, hypothesis-driven, small cohort, epidural stimulation proof of principle studies provide insight into the human spinal circuitry functionality and support the pathway toward clinical treatments. Individuals living with spinal cord injury can recover motor, cardiovascular, and bladder function even years after injury using neuromodulation. Integration of continuous feedback from sensory information, task-specific training, and optimized excitability state of human spinal circuitry are critical spinal mechanisms. Neuromodulation activates previously undetectable residual supraspinal pathways to allow intentional (voluntary) control of motor movements. Further discovery unveiled the human spinal circuitry integrated regulatory control of motor and autonomic systems indicating the realistic potential of neuromodulation to improve the capacity incrementally, but significantly for recovery after severe spinal cord injury. The discovery that both motor and autonomic function recovers with lumbosacral spinal cord placement of the electrode reveals exciting avenues for a synergistic overall improvement in function, health, and quality of life for those who have been living with the consequences of spinal cord injury even for decades.

Effectiveness of Vortioxetine in Patients with Major Depressive Disorder in Real-World Clinical Practice: French Cohort Results from the Global RELIEVE Study.

AimFunctional recovery is an important treatment goal in patients with major depressive disorder (MDD). The Real-Life Effectiveness of Vortioxetine in Depression (RELIEVE) study assessed the effectiveness of vortioxetine in patients with MDD receiving treatment in routine clinical care settings in France, Italy, Canada, and the United States. This paper presents the study data for the cohort enrolled in France.MethodsRELIEVE was a 6-month, international, observational, prospective cohort study in outpatients initiating vortioxetine treatment for MDD at their physician’s discretion (NCT03555136). Patients were assessed at routine clinic visits at study entry (baseline) and after 12 and 24 weeks of vortioxetine treatment. The primary study outcome was patient functioning, assessed by the Sheehan Disability Scale (SDS). Secondary outcomes included depression severity (assessed by the Patient Health Questionnaire [PHQ-9]), cognitive symptoms (assessed by the Perceived Deficits Questionnaire-Depression [PDQ-D-5]), and cognitive performance (Digit Symbol Substitution Test [DSST]). Changes from baseline to week 24 were assessed using mixed models for repeated measures, adjusted for relevant confounders. Adverse events spontaneously reported by the patient or observed by the investigator were recorded.ResultsData are available for 184 patients in France (mean age, 50.2 years; 65.2% female). Overall, 67.9% of patients had at least one comorbidity and 46.2% reported current anxiety symptoms at baseline. Adjusted least-squares mean (standard error) change in SDS score from baseline to week 24 was −10.9 (0.6) points (P < 0.001). Respective changes for PHQ-9, PDQ-D-5 and DSST scores were −9.3 (0.5), −6.1 (0.4), and +6.9 (1.0) points (all P < 0.0001). Adverse events were reported by 29 patients (15.8%), most commonly nausea (11 patients, 6.0%).ConclusionClinically relevant and sustained improvements in overall functioning, depressive symptoms, cognitive symptoms, and cognitive performance were observed in patients with MDD treated with vortioxetine for 6 months in routine clinical practice settings in France.

Effectiveness of Vortioxetine in Patients with Major Depressive Disorder in Real-World Clinical Practice in Italy: Results from the RELIEVE Study.

PurposeVortioxetine has demonstrated efficacy in randomized controlled trials and is approved for the treatment of major depressive disorder (MDD); however, data are limited concerning its effectiveness when used in routine clinical care. The Real-Life Effectiveness of Vortioxetine in Depression (RELIEVE) study aimed to assess the effectiveness and tolerability of vortioxetine for the treatment of MDD in routine clinical practice in Canada, France, Italy, and the USA. This paper presents findings for the patient cohort in Italy.Patients and MethodsRELIEVE was a 6-month, international, observational, prospective cohort study in outpatients initiating vortioxetine treatment for MDD in routine care settings at their physician’s discretion (NCT03555136). Patient functioning was assessed using the Sheehan Disability Scale (SDS). Secondary outcomes included depression severity (9-item Patient Health Questionnaire [PHQ-9]), cognitive symptoms (5-item Perceived Deficits Questionnaire-Depression [PDQ-D-5]), and quality of life (EuroQol 5-Dimensions 5-Levels questionnaire [EQ-5D-5L]). Changes from baseline to month 6 were assessed using mixed models for repeated measures, adjusted for relevant confounders.ResultsData are available for 231 patients enrolled in Italy (mean age, 55.5 years; 27% >65 years). Overall, 69% of patients reported at least one comorbidity, 55% were overweight/obese, and 47% had current anxiety symptoms. Adjusted least-squares mean (standard error) change in SDS score from baseline to week 24 was −6.6 (0.6) points (P < 0.001). Respective changes in PHQ-9, PDQ-D-5, and EQ-5D-5L scores were −5.9 (0.5), −3.6 (0.4), and +0.13 (0.01) points (all P < 0.0001). Adverse events were reported by 29 patients (13%), most commonly nausea (n = 14, 6%). Eleven patients (5%) discontinued treatment due to adverse events.ConclusionClinically relevant and sustained improvements in overall functioning, symptoms of depression, cognitive symptoms, and health-related quality of life were observed in patients with MDD treated with vortioxetine over a period of 6 months in routine care in Italy, including a high proportion of elderly patients.

Early quality of life (QOL) and symptom analysis from the DREAMseq phase III randomized control trial of combination immunotherapy versus targeted therapy in patients (pts) with BRAF-mutant metastatic melanoma (MM) (ECOG-ACRIN EA6134).

9559 Background: Combinations of either immune checkpoint inhibitors (anti-PD-1/anti-CTLA-4) or BRAF/MEK-targeted therapies have shown significant clinical benefit in pts with BRAFV600 mutant MM. Until recently, little prospective data existed to guide the choice of initial therapy or sequence. Results of the DREAMseq Trial showed that the treatment sequence beginning with nivolumab/ipilimumab (Nivo/Ipi) immunotherapy produced a clinically meaningful 20% improvement in 2-year overall survival (OS) compared to the sequence beginning with dabrafenib/trametinib (Dab/Tram) targeted therapy. The OS and progression-free survival (PFS) curves were biphasic crossing at 10 and 6 months, respectively. Our aim is to characterize QOL trends within and between the initial therapies through 24 weeks (wks). Methods: 265 pts were randomly assigned to Nivo/Ipi for up to 12 wks then Nivo alone (Arm A) or Dab/Tram continuously (Arm B) and at disease progression (PD) received the alternate therapy. QOL was assessed by the PROMIS Profile 29 at baseline, wk 12 (end of cycle (C) 2), and wk 24 (end of C4). Wilcoxon Signed Rank test was used to examine changes over time within treatment arms. OS was estimated by Kaplan-Meier method to compare between pts who stopped treatment for toxicity on Arm A by C2 and who continued on Arm A therapy to C4. A complete case analysis compared QOL domain means for (C2) vs. (C4). Pt-reported adverse events were also collected. Results: Baseline completion rates for the PROMIS-29 for Arm A (n = 108, 81.2%) and Arm B (n = 117, 88.6%) and decreased to 28.6% and 53.8%, respectively at C4. Through C4, the principal reasons for dropout were toxicity (35.2% for Arm A and 11.9% for Arm B) and PD (26.1% for Arm A and 18.6% for Arm B). From Baseline to C2: Arm B reported statistically significant improvements in Pain Interference (-3.45, P = 0.007), Sleep (-2.11, P = 0.014), and Anxiety (-3.74, P &lt; 0.001). By C4, these early differences had dissipated (mean diff. = 0.73 – 1.73, all p = NS). For pts remaining on treatment to C4 (n = 157), a complete case analysis indicates no significant QOL differences between C2 vs C4. Pts stopping for toxicity on Arm A after C2 had similar 2-yr OS to pts who continued on Arm A to C4. QOL at C2 (Arm A: stopping for toxicity vs. on treatment) were meaningful, but underpowered (Physical Health (PH) mean difference = -3.5, p = 0.18). Conclusions: Over the first 12 wks, Dab/Tram is associated with significant improvement in overall function and less disturbance in in sleep, pain, physical function, and PH than Nivo/Ipi as expected by PFS curves and toxicity profiles. These differences dissipate by 24 wks when Arm A therapy has switched to Nivo alone and PFS curves cross. Early QOL and treatment cessation due to Nivo/Ipi toxicity was not associated with differences in 2-yr OS. Clinical trial information: NCT02224781.

Effectiveness of vortioxetine in real-world clinical practice: French cohort results from the global RELIEVE study

IntroductionMajor depressive disorder (MDD) affects around 10% of the French population annually and significantly impacts patient functioning. Efficacy of vortioxetine was demonstrated in randomised controlled trials, data on its real-world performance is needed.ObjectivesTo describe the effectiveness and safety of vortioxetine in real-world setting from patients enrolled from France in the global RELIEVE study.MethodsRELIEVE was a prospective, multi-national, observational study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion. Data were collected at routine clinical visits. Here we present the outcomes of treatment of patients in France. The primary outcome was functioning measured by SDS. Secondary outcomes included depressive symptoms measured by PHQ-9, cognitive symptoms measured by PDQ-5 and DSST. Changes from baseline to month 6 were estimated with a linear mixed model of repeated measures approach.ResultsA total of 184 patients (mean age, 50.2 years, 65% female, 67.9% of patients had at least one comorbidity) were enrolled from France and included in the analysis. Mean(SD) SDS total score, PHQ-9, PDQ-5 scores at baseline were 21.1(5.4), 17.5(4.7) and 11.7(4.4), the scores(SE) decreased by 10.9(0.59), 9.3(0.48) and 6.1(0.37) from baseline to month 6. Mean(SD) DSST improved from 41.6(15.2) at baseline to 49.1(19.0) at month 6. Safety and tolerability profile of vortioxetine was in line with previous studies.ConclusionsSustained improvements in overall functioning, depressive symptoms, cognitive function were observed in patients treated with vortioxetine in a real-world setting, which provided further evidence of effectiveness and safety of vortioxetine in a broad MDD population in France.DisclosureM. Rabbani is an employee of Lundbeck France. K. Simonsen and H. Ren are employees of H. Lundbeck A/S.

5.5 TRANSCRANIAL PHOTOBIOMODULATION IN THE TREATMENT OF SOCIAL AND EXECUTIVE FUNCTION DEFICITS IN AUTISM SPECTRUM DISORDER

No established treatments exist for the core features of autism spectrum disorder (ASD). Transcranial photobiomodulation (tPBM) is thought to enhance neuronal activity and promote cellular plasticity. Recent clinical research interest has focused on its role as a potential treatment in mental illness and neurological conditions including depression and traumatic brain injury. The efficacy of tPBM treatment in ASD remains unexplored. Adult participants meeting the diagnostic criteria for ASD were enrolled to receive twice-weekly tPBM treatments for 8 weeks in an open-label single-group design. ASD symptom severity and executive function deficits were assessed at baseline and endpoint by clinician-, self-, and informant-rated measures. Paired samples t test analyses were performed. Findings were placed in the context of the existing sparse research consisting of clinical trials identified by a detailed MEDLINE literature search with resulting articles assessed for strength of evidence. Finally, interim results from the ongoing 8-week open-label study of daily tPBM treatment in youth with ASD diagnosis are presented. Ten participants (9 males; 30.0 ± 11.9 years old) completed the study. Five participants (50%) met the responder criteria at endpoint. Eight-week transcranial laser therapy (TLT) was associated with significant improvement in ASD severity (Total SRS-2 reduction: –30.6 ± 23, p < 0.001), particularly in Social Awareness (–3.0 ± 1.9, p < 0.001), Social Communication (–10.3 ± 6, p < 0.001), Social Motivation (–5.0 ± 2.4, p < 0.001), and Restricted/Repetitive Behaviors (–7.4 ± 4.1, p < 0.001). Statistically significant improvement at endpoint was shown in Global Assessment of Functioning (GAF) scores (+12.8 ± 4.2, p < 0.001) and Quality of Life Enjoyment and Satisfaction Questionnaire scores (+6.0 ± 7.9, p = 0.02). There were no treatment-limiting adverse events. The adherence rate was 98%. tPBM treatment was associated with improvements in the core features of ASD as well as executive dysfunction, and a significant improvement in overall function. The 98% rate of adherence to scheduled study visits and procedures suggests a high potential of acceptance of this noninvasive intervention. tPBM is a safe, feasible treatment approach and further research into its efficacy in the treatment of the core features of ASD is warranted.

Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention?

BackgroundOver the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice. MethodsData were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning. ResultsAdherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37–0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect. ConclusionsAfter MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.

Role of Square Flaps in Finger Contractures

Reconstruction of finger contractures is a challenge for the plastic surgeon. It is important to restore the length, function, along with providing a good quality skin cover (Sridhar and Hariharan in Int J Sci Stud 5(2):55-58, 2017). This study is aimed to show use of square flap in finger contractures along with determining its functional outcome. Three cases of finger contractures were reconstructed between May 2020 and December 2020 in a tertiary care hospital in north India. Departmental clearance was done. Written informed consent was taken. Results were analyzed as per successful reconstruction, type of reconstruction and stages, complications, and functional outcome. The surgical outcome has shown improvement in overall function. Square flap has proven to be a useful flap in post-burn/trauma finger reconstruction.

Impact of treatment improvement on long-term anxiety: Results from CAMS and CAMELS.

This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years post-treatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall functioning years later (M = 7.72 years). CAMS procedures were registered on clinialtrials.gov. Improvements in factors related to functioning (i.e., overall functioning, family dysfunction, caregiver strain) were associated with improvements in anxiety severity in CAMELS (|βys| ≥ .04, ps ≤ .04). Improvements in factors related to psychopathology (i.e., anxiety severity, caregiver psychopathology) were associated with improvements in overall functioning in CAMELS (|βys| ≥ .23, ps ≤ .04). It was changes in each of the variables examined (rather than baseline values) that predicted anxiety severity and overall functioning. Both youth and family factors play a significant role in long-term treatment outcomes. Therapists would be wise to monitor how these factors change throughout treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Critical Solution to Power Grid Problems Using Smart Grid –A Case Study on Karnataka Power Transmission Control Limited (KPTCL)

Karnataka Power Transmission Corporation Limited (KPTCL) is a power distribution and transportation company in Karnataka state established in the year of 1999 under the company act 1956. Now it is one of the big government sector company owned by government of Karnataka with 1000 cores of share capital. Karnataka Electric Board (KEB) is the parent body of KPTCL, until 2002 KEB did all the functions such as distribution and transmission of electric power throughout the state. After that it was divided in to distribution and Transmission Company called KPTCL and power generating company known as Karnataka Power Corporation Limited (KPCL). The ultimate goal of KPTCL is to provide uninterrupted power supply to all customers in state of Karnataka with minimum distribution and transmission cost and lowest unit price. KPTCL purchases power from KPCL for fixed rate under the Karnataka regulation act. KPCL contains several power generation projects which include different types such as hydraulic power, thermal power, wind power, etc. KPTCL also purchases power from power stations such as National Thermal Power Corporation (NTPC) and Atomic power stations like Kalpakkam and Kaiga which is owned by central government. Power generation is not a big deal for any state government but real challenge is to transmission of uninterrupted power and distribution of power to different parts of the state using power grid. So there should be proper data analysis in the entire grid and all transmission station throughout the state in order to identify the loop holes, actual capacity, requirement, request from consumers, and also to identify any damages. The ultimate solution for all this is introduction of smart grid concept in power grid. In this paper I reviewed about operational and technical structure of the KPTCL and factors to be considered while performing data analytics in power grid and adoption of smart grid concept over traditional grid using SCADA technology to perform data analytics and finally listed out some improvements in overall functioning of KPTCL after implementation of smart grid.

Prospect of Brainwave Entrainment to Promote Well-Being in Individuals: A Brief Review

Brainwave entrainment (BWE) refers to the use of external stimuli to produce a frequency following response of brainwaves to match the frequency of the external stimuli. The current paper is a brief review and aims to focus on BWE process as a therapeutic approach to vitalize cognitive functioning along with well-being of individuals. Also, it aims to observe the prospect of BWE as an intervention in India. Thirty studies met the criteria and were critically analyzed on the basis of demographic and clinical variables. Findings suggest a shift from the physiological to psychological implications of BWE. Review suggests that there is a dearth of longitudinal studies and with children. However, some studies have highlighted improvement in overall functioning after BWE sessions. The paper suggests that there is a need to conduct studies on clinical and child population to apply BWE as an intervention to promote overall well-being in children.

M208. MEASURES OF COGNITION AND SOCIAL FUNCTIONING IN SCHIZOPHRENIA PATIENTS RECEIVING SEP-363856

BackgroundSEP-363856 is a novel trace amine associated receptor-1 (TAAR1)/5-HT1A agonist with no dopamine-D2/5-HT2A antagonist activity. SEP-363856 showed significant antipsychotic efficacy in patients with schizophrenia, and a safety and tolerability profile similar to placebo and consistent with a non-D2 mechanism of action. Here, we examined measures of cognition and social functioning in schizophrenia patients receiving SEP-363856.MethodsPatients aged 18–40 years with an acute exacerbation of schizophrenia were randomized, double-blind (DB), to 4-weeks of flexible-dose treatment with once daily SEP-363856 (N=120; 50 or 75 mg) or placebo (N=125). Patients (N=156) entering a subsequent 26-week open-label (OL) extension study were evaluated utilizing the Cogstate Brief Battery, administered at DB baseline and week 4, and OL baseline and weeks 12 and 26. Standardized z-scores were calculated for the Cogstate composite and subscale tasks (Detection task, Identification task, One Card Learning task, One Back task). The University of California San Diego Performance Based Skills Assessment (UPSA-B) scale was assessed at the same time-points, as were the following psychiatric scales: Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS), the Montgomery–Åsberg Depression Rating Scale (MADRS), the Clinical Global Impression Scale, severity scale (CGI-S), and the Pittsburgh Sleep Quality Index global score (PSQI-global). Pearson correlation analyses were performed between DB baseline to Week 26 change in Cogstate composite and subscale scores and Week 26 change in the psychiatric scale scores.ResultsSmall improvements, from DB baseline to Week 26, were observed in standardized scores on the Cogstate composite (+0.29), Identification task (+0.19), Detection task (+0.28); One Card learning task (+0.33); and One Back task (+0.33). Improvement from OL baseline at Week 26 was also observed on the mean [SD] UPSA-B total score (+6.2 [11.6]). At DB baseline, there were no correlations between CogState composite score and individual test scores with any of the psychiatric scales. Week 26 improvement in the following Cogstate composite and subscale tasks were correlated with Week 26 improvement in the following psychiatric scale scores: Cogstate composite score (PANSS total, r=-0.26; BNSS total, r=-0.31; CGI-S, r=-0.30; MADRS total, r=-0.23; PSQI-global, r=-0.23); Identification task (PANSS total, r=-0.30; BNSS total, r=-0.30), Detection task (BNSS total, r=-0.30; CGI-S, r=-0.28; PSQI-global, r=-0.23); One Card learning task (MADRS total, r=-0.29); and One Back task (PANSS total, r=-0.26).DiscussionDuring 6-months of open-label extension treatment with SEP-363856, improvement in overall functioning was observed on the UPSA-B scale; and small but consistent improvement in cognition was noted in the Cogstate composite and subscale task scores. Endpoint reduction in the severity of schizophrenia-related symptomatology (eg, on the PANSS, BNSS, MADRS, insomnia) were associated with modest correlations, in the range of 0.2 to 0.3, in cognitive performance as measured by the Cogstate composite and subscale task scores.

Social cognition and interaction training for recent-onset schizophrenia: A preliminary randomized trial.

Comprehensive social cognition training programs have been effective to improve social cognition in people with chronic schizophrenia, although there is insufficient quality evidence for recent-onset psychosis. The aim of this study was to assess the effects of Social Cognition and Interaction Training (SCIT) in a sample of recent-onset schizophrenia outpatients. Sixteen participants who had their first psychotic episode for less than 2 years were randomly allocated to the SCIT group during 20 weeks (weekly sessions) or to a psychoeducation group and completed baseline and post-training assessment for cognitive biases, social cognition, clinical symptoms and functioning. Permutation-based analysis revealed improvements in overall functioning (P = 0.036) and blame score (P = 0.070) in the SCIT group compared to the psychoeducation intervention, with large effect sizes (d = 1.438 and d = 1.204, respectively). There were also large effect sizes for hostility, emotion recognition, social perception, positive and total symptoms (d = 0.833-1.158). These results suggest that SCIT may be an effective tool to improve attributional biases and functional outcomes in recent-onset schizophrenia outpatients. Future controlled trials with larger sample size and follow-up assessments should be developed to further understand effective intervention outcomes for this population.