Multidisciplinary Treatment Program Research Articles

Adherence to Cardiac Rehabilitation in Patients with Acute Myocardial Infarction After PCI: A Scoping Review.

Cardiac rehabilitation (CR) is a multidisciplinary intervention program aimed at enhancing the physical, psychological, and social functioning of patients with cardiovascular disease. Although CR is cost-effective and reduces mortality and readmission rates, and many patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) do not adhere to CR. This review aimed to synthesize the evidence on adherence to CR in patients with AMI after PCI (AMI-PCI). The review was conducted using the methodology proposed by the Joanna Briggs Institute (JBI) to guide reviews and reporting using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extended for Scoping Reviews (PRISMA-ScR). We searched PubMed, Web of Science, CINAHL, Embase, Ovid, and Scopus databases, and two reviewers independently screened the abstracts and full texts of eligible studies against the inclusion and exclusion criteria. Disagreements were resolved in consultation with a third reviewer. A total of 10 studies were included in the analysis. The results demonstrated that CR reduces the incidence of complications and improves the quality of life of patients with AMI-PCI. However, the CR adherence rate was low, and the factors affecting it are complex and varied, including age, sex, and employment status. Furthermore, interventions to improve adherence in patients with AMI-PCI mainly combined the internet-based interventions, including videoconferencing tele-training, with wearable device monitoring and intelligent management platform follow-up. All these interventions have shown promising results compared with routine care. Adherence to CR in patients with AMI-PCI is generally low, and CR adherence is affected by many factors; however, relevant research designs are rare and simple. Healthcare professionals should pay more attention to adherence to CR in this population and use a variety of interventions to improve it.

Hybrid SPEAK OUT! protocol improves aerodynamic measurements and PROMs in Parkinson's disease.

SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD). This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peakexpiratoryflow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire. The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs. These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed. What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.

Clinicopathologic factors correlated with lymph node metastasis in gastric cancer: a retrospective cohort study involving 5606 patients

BackgroundThe identification of risk factors associated with lymph node metastasis (LNM) in gastric cancer will establish a crucial foundation for the implementation of endoscopic operation and multidisciplinary treatment program. Methods5606 gastric cancer patients with comprehensive clinicopathological data were enrolled through systematic searching and rigorous screening. Of the 5606 patients, 1438 were diagnosed with early gastric cancer (EGC), which would be utilized for further analysis. Subsequently, univariate and multivariate logistic regression analyses were conducted to identified the risk factors. ResultsThe rates of LNM in T1a, T1b, T2, T3, T4a, and T4b stage gastric cancer were 7.0%, 19.4%, 48.4%, 77.1%, 83.8%, and 89.6% respectively. Female [odds ratio (OR)=1.559, P=0.032], lower tumor location (OR=1.773, P=0.023), tumor size >2cm (OR=2.007, P<0.001), mixed (OR=2.371, P=0.001) and undifferentiated histological types (OR=2.952, P<0.001), T1b stage (OR=2.041, P<0.001), presence of ulceration (OR=1.758, P=0.027), and lymphovascular invasion (LVI) (OR=5.722, P<0.001) were identified as independent risk factors for LNM in EGC. A nomogram was constructed using appropriate predictors to preoperatively predict the risk of LNM in EGC cases. ConclusionsThis study identified the clinicopathological factors associated with LNM in EGC and developed a prediction model, thereby facilitating the integration of diverse treatment modalities in managing EGC patients.

The Role of Pharmacists' Interventions in Increasing Medication Adherence of Patients With Epilepsy: A Scoping Review.

Epilepsy is a chronic disease that requires long-term treatment and intervention from health workers. Medication adherence is a factor that influences the success of therapy for patients with epilepsy. Therefore, this study aimed to analyze the role of pharmacists in improving the clinical outcomes of epilepsy patients, focusing on medication adherence. A scoping literature search was conducted through the ScienceDirect, PubMed, and Google Scholar databases. The literature search included all original articles published in English until August 2023 for which the full text was available. This scoping review was carried out by a team consisting of pharmacists and neurologists following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews and the Joanna Briggs Institute guidelines, including 5 steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. The literature search yielded 10 studies that discussed pharmacist interventions for patients with epilepsy. Five articles described educational interventions involving drug-related counseling with pharmacists. Two articles focused on similar pharmacist interventions through patient education, both verbal and written. Three articles discussed an epilepsy review service, a multidisciplinary intervention program involving pharmacists and other health workers, and a mixed intervention combining education and training with therapy-based behavioral interventions. Pharmacist interventions have been shown to be effective in improving medication adherence in patients with epilepsy. Furthermore, these interventions play a crucial role in improving other therapeutic outcomes, including patients' knowledge of self-management, perceptions of illness, the efficacy of antiepileptic drugs in controlling seizures, and overall quality of life.

Exploring the effects of fitbit incentive on treatment outcomes in veterans undergoing intensive pain rehabilitation program

ObjectiveThis study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment.MethodsAmong 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program.ResultsCompared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes.ConclusionThe implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.

Assessing multidisciplinary follow-up pattern efficiency and cost in follow-up care for patients in cervical spondylosis surgery: a non-randomized controlled study.

The use of multidisciplinary treatment programs in out-of-hospital healthcare is a new area of research. Little is known about the benefits of this method in the management of discharged patients undergoing cervical spondylosis surgery. This study aimed to explore the effect of a contracted-based, multidisciplinary follow-up plan in patients after cervical spondylosis surgery. This non-blinded non-randomized controlled study was conducted with 88 patients (44 in the intervention group, 44 in the control group). The clinical outcomes, including Neck Disability Index (NDI), pain score (VAS), Self-Efficacy for Managing Chronic Disease 6-item Scale (SECD-6), and 12-Item Short-Form Health Survey (SF-12) score were assessed at the time of discharge, 24-72 h, 1 month, and 3 months post-discharge. The complications, patient satisfaction, and economic indicators were assessed at the final follow-up (3 months). Patients who received contracted follow-up showed greater improvement in neck dysfunction at 24-72 h, 1 month, and 3 months after discharge compared to those who received routine follow-up (p < 0.001). At 1 month after discharge, the intervention group exhibited better self-efficacy (p = 0.001) and quality of life (p < 0.001) than the control group, and these improvements lasted for 3 months. The intervention group reported lower pain scores at 24-72 h and 1 month (p = 0.008; p = 0.026) compared to the control group. The incidence of complications was significantly lower in the intervention group (11.4%) compared to the control group (40.9%). The total satisfaction score was significant difference between the two groups (p < 0.001). Additionally, the intervention group had lower direct medical costs (p < 0.001), direct non-medical costs (p = 0.035), and total costs (p = 0.04) compared to the control group. However, there was no statistically significant difference in indirect costs between the two groups (p = 0.59). A multidisciplinary contract follow-up plan has significant advantages regarding neck disability, self-efficacy, quality of life, postoperative complications, patient satisfaction, and direct costs compared with routine follow-up.

Impact of Intensive Lifestyle Intervention on Remission of Metabolic Syndrome, Prediabetes, Diabetes, and Hypertension in Adults Living with Obesity

Background: Lifestyle intervention programs have long been shown to be effective in preventing cardiometabolic risk factors (CMRFs) such as metabolic syndrome (MS), impaired fasting glycaemia (IFG), type II diabetes (T2DM), and hypertension (HTA). However, their potential for remission of these CMRFs in overweight/obese adults is less clear. The importance of attaining remission has significantly increased as these CMRFs are more and more prevalent. Objectives: The aim of this study is to determine the impact of an intensive lifestyle intervention program on the remission of MS, IFG, T2DM, and HTA in overweight/obese adults. Methods: Forty participants living with overweight/obesity were enrolled in an 18-month multidisciplinary primary prevention body mass loss intervention program. MS, IFG, T2DM, and HTA statuses were assessed at baseline, 9 months, and the end of the program. Results: At baseline, 25 participants (64.1%) had MS, 7 (17.9%) had IFG, 4 (10.2%) were living with diabetes, and 28 (70.0%) had HTA. At 18 months, six (24%) of the participants living with MS, two (28.6%) of the participants with IFG, two (50%) of the participants with diabetes, and two (7.1%) of the participants with HTA met all criteria for remission. Conclusion: An intensive lifestyle intervention program consisting of monitored exercise training and lifestyle modification counselling has great potential for achieving remission of CMRFs in adults living with overweight/obesity.

Comorbid treatment of traumatic brain injury and mental health disorders.

The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. This article reviews the EHVP. The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.

Weaning buprenorphine in pregnant patients#

Objective Evaluate maternal and neonatal outcomes after buprenorphine wean compared to patients maintained on buprenorphine throughout pregnancy. Methods Prospective cohort study of pregnant patients with opioid use disorder enrolled in a multidisciplinary treatment program between 2015 and 2022. All patients were offered Medications to treat Opioid Use Disorder (MOUD) primarily with buprenorphine. Patients had at least 2 prenatal visits and negative urine drug tests (UDT) prior to weaning. The experimental group underwent a buprenorphine wean greater than 20% of their baseline dose. The control group was maintained on buprenorphine throughout the pregnancy. Relapse was defined as patient reported use or positive UDT during weekly assessments. Mass spectrophotometer was used for detection of drugs in samples. Fisher’s exact tests were used to compare outcomes in weaned and control groups. Results 334 of 456 (73%) patients were treated with buprenorphine during pregnancy, with 39 in the experimental group and 295 in the control group. The mean dose for buprenorphine was similar between the groups (wean: 10.6 mg ± 5.6 vs. control: 10.3 mg ± 4.6, p = 0.76) but was significantly lower at delivery (wean: 4.4 ± 4.6 mg vs. control: 13.0 ± 4.7, p < 0.0001). Mean gestational age at initiation of the buprenorphine wean was 22.7 weeks. 10 of 39 (26%) who weaned were able to completely discontinue buprenorphine prior to delivery. Demographic data was similar between the groups, including overdose history. Overdose history at time of enrollment had a higher trend in the non-weaning group. neonatal opioid withdrawal syndrome (NOWS) treatment was significantly lower in the wean group (23 vs. 47%, p = 0.006), as was highest Finnegan score (9.6 ± 4.5 vs. 12.3 ± 4.0, p = 0.0003). Birthweight percentile was significantly higher in the wean group (44.3 ± 29.9 vs. 34.8 ± 24.4, p = 0.03). Gestational age at delivery, mode of delivery, and complications (HTN, DM, preterm labor, or short cervix) at delivery did not significantly differ between the groups. Conclusion Despite counseling to stay on buprenorphine, there are patients who desire to wean. The NOWS rate in the weaned cohort was significantly lower than the controls with no observed increase in maternal or neonatal morbidity. There were no maternal overdoses or deaths during the pregnancy. Larger studies are needed to evaluate this approach.

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain

Change in the motivation pattern of adolescents before and after participation in a multidisciplinary health promotion program

Introduction: there is evidence that multidisciplinary interventions are an efficient approach to achieving weight loss and other health-related goals. However, dropout rates of these programs are high among adolescents. The suggestion is that understanding the motivation of individuals to participate in these projects is fundamental to developing strategies for permanence and, consequently, promoting better results. Objective: the main aim of this study was to describe the motivations of overweight adolescents participating in a multidisciplinary health promotion project. Methods: this qualitative study was conducted from March to July 2021 using the Bardin content analysis technique. The tool used for data collection was the semi-structured interview, analyzed means by the software QSR NVivo 11 by grouping the speech into clusters. These, in turn, were evaluated in three categories: (1) motivation, (2) food, and (3) physical exercise. Results: the age of the participants was 13.8 ± 2.4 years old, with body mass index of 31.8 ± 8.5 kg/m². Regarding family income, 41.66% had a monthly payment of 3 to 6 minimum wages. Regarding parents’ educational level, 70.83% of mothers had completed higher education, while 29.16% had completed high school. According to the respondent’s answers, weight loss was the greatest motivation to participate in a multidisciplinary obesity treatment program. In category 2, it was observed that adolescents associated the act of eating with feelings such as anxiety and nervousness. In category 3, the impact of the pandemic was found under the modalities of physical exercise practiced. Conclusion: the results describe the motivation of overweight adolescents to participate in a multidisciplinary program, in addition to elucidating participants’ perception of their health and related habits, strategies for health promotion, and consequent improvement of the quality of life of these individuals.

51 Impact of Blast Exposures on the Cognitive Abilities of Warfighters

Objective:There is growing evidence to indicate that blast exposure military personnel experience throughout their career can have a negative impact on their brain health. The majority of research in the area of blast related neurotrauma has been focused on traumatic brain injury (TBI); however, the blast exposure may often be independent of TBI. It is common in both active duty military and veterans to report years of blast exposure from combat and training. The objective of this study was to explore the relationship between blast exposure and cognitive functioning in military personnel seeking treatment for a mild TBI.Participants and Methods:Participants were recruited from a military hospital while enrolled in a multidisciplinary treatment program for TBI. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Exclusion criteria included invalid performance on a performance validity test and a symptom validity test. 97 participants were included in the analysis with an average age of 34.0 (SD = 7.9) and average 4.0 combat deployments (SD = 3.6). Blast exposure history was measured by the overall score from the Blast Exposure Threshold Survey (BETS) which assessed the frequency and duration of use of various blast sources. Outcomes included the Neurobehavioral Symptom Inventory (NSI) and the Global Deficit Scale (GDS) an objective measure of cognitive deficiency. GDS was calculated from seven measures: Hopkins Verbal Learning Test-Revised Total and Delayed Recall (HVLT-TR and HVLT-DR); DKEFS System Color-Word Condition 3 Inhibition (CW3), Color-Word Condition 4 Switching (CW4) and Trail Making Condition 3 Letter Sequencing (TM3), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores (M=50, SD = 10) were converted to deficit scores and averaged to calculate GDS. To adjust for nonnormal distributions, non-parametric statistics were examined.Results:The BETS was not related to GDS (rho = -.055); however, there was a significant correlation between higher levels on the BETS and better performance on measures of selective attention (PASAT rho = .307) and processing speed (SDMT rho = .218). The correlation between BETS and the other neuropsychological measures were not meaningful (all rho’s &lt;.10). Those with an impaired GDS, did not differ from others on the BETS. BETS was also not associated with neurobehavioral symptoms (rho = .125). BETS had moderate correlations with number of combat deployments (rho =.483), severity of combat exposure (rho =.556). It was not related to education (rho = .004) or pre-morbid intelligence (rho =-.029).Conclusions:The BETS was not related to GDS (rho = -.055); however, there was a significant correlation between higher levels on the BETS and better performance on measures of selective attention (PASAT rho = .307) and processing speed (SDMT rho = .218). The correlation between BETS and the other neuropsychological measures were not meaningful (all rho’s &lt;.10). Those with an impaired GDS, did not differ from others on the BETS. BETS was also not associated with neurobehavioral symptoms (rho = .125). BETS had moderate correlations with number of combat deployments (rho =.483), severity of combat exposure (rho =.556). It was not related to education (rho = .004) or pre-morbid intelligence (rho =-.029).

Obesity and the risk of multiple or severe frequent knee pain episodes: a 4-year follow-up of the ELSA-Brasil MSK cohort.

Knee pain is an important health problem due to its high prevalence, negative impact on daily activities and quality of life, and societal burden. While the link between excess weight and knee pain has been well-documented in the literature, many studies are limited to patients with osteoarthritis or use cross-sectional data. This longitudinal study investigated whether overweight and obesity were associated with the frequency and severity of frequent knee pain (FKP) episodes over 4 years in civil servants enrolled in the ELSA-Brasil MSK cohort. Knee pain was assessed during baseline face-to-face interviews (2012-2014) and four yearly telephone follow-ups (2015-2019). Disabling FKP episodes or those of moderate to very severe intensity were classified as severe. Multinomial logistic regression models adjusted for confounders were used to test for associations in two participant groups: those with knee pain at baseline (prognosis cohort) and those without knee pain (incidence cohort). A total of 2644 participants were included: 54.2% female, mean age 55.8 (SD 8.8) years. In the incidence cohort (n = 1896), obesity increased the risk of one (OR: 1.63; 95% CI 1.13-2.37) and multiple FKP episodes (OR: 2.61; 95% CI 1.71-3.97), as well as the risk of non-severe (OR: 1.72; 95% CI 1.04-2.84) and severe FKP episodes (OR: 2.10; 95% CI 1.50-2.95). In the prognosis cohort (n = 748), obesity increased the risk of multiple (OR: 2.54; 95% CI 1.60-4.05) and severe FKP episodes (OR: 2.31; 95% CI 1.49-3.59). Overweight presented the same trends but fell short of significance. These results provide further support that overweight and obesity are important contributors to the incidence and worsening of FKP, and that weight management must be prioritized in multidisciplinary knee pain prevention and treatment programs to reduce the burden of musculoskeletal disorders.

Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine

IntroductionLittle is known about the prevalence and associations between war-related variables among Ukrainians during the Russian invasion. The present study assesses the prevalence and associations between exposure to war (EW), nightmares of war (NW), insomnia, and war-related post-traumatic stress disorder (WPTSD) among university students from Ukraine. MethodsDuring the war, an online cross-sectional study was performed among university students (N = 1072) from western Ukraine. Newly developed questions evaluated EW and NW, while insomnia was measured using Athens Insomnia Scale (AIS), and for assessing war-related PTSD symptoms, we adopted an abbreviated six-item PTSD checklist (PCL-6). The associations between exposure to war, nightmares of war, and symptoms of insomnia and PTSD were examined using network analysis (NA). ResultsAmong university students, 98 % declared exposure to war, 86 % dreamed nightmares of war, 49 % experienced insomnia symptoms, and 27 % presented symptoms of PTSD. A network analysis found that war-related PTSD has a central and the greatest impact on the frequency of war nightmares and the severity of insomnia symptoms. LimitationsSelf-report measurements were applied to a gender-unbalanced sample of university students from the western regions of Ukraine, so it would be inappropriate to generalize to the population directly affected by the war. ConclusionsWar-related PTSD symptoms had the most significant impact on the other variables. Therefore, war-related PTSD should be a priority in treatment among university students in Ukraine. However, multidisciplinary integrative intervention programs that treat nightmares, insomnia, and PTSD, can be the most effective.

Reconnecting Hope: The Treatment of Eating Disorders in Rural America

Eating disorders (EDs), a significant public health concern, impact millions of Americans every year. Many people with EDs are often overlooked for multiple reasons, including the stereotype that EDs predominantly affect thin, White, affluent young women and girls. One historically overlooked group is impoverished individuals in rural areas of the United States (U.S.), who may, in fact, be at an increased risk for EDs. The Reconnect Eating Disorders treatment program (REDTP) at Ozark Center is the first comprehensive, evidence-based, multidisciplinary ED treatment program to be developed in a Certified Community Behavioral Health Organization (CCBHO) in the U.S. CCBHOs are a unique model of financially sustainable integrated care well-suited to the treatment of biopsychosocial illnesses such as EDs because CCBHOs offer a full range of services to treat both physical and mental health. This paper details the development of REDTP, including its team, barriers, and successes. The role of Community Support Specialists/Reconnect Coaches and Healthcare Home/Medical Support is reviewed, which includes providing outpatient care and intensifying treatment for the most acute clients. Key domains of growth for REDTP included selecting core evidence-based treatments, building a team and defining team roles, and intensive training to develop evidence-based ED expertise. Persistent barriers included staffing limitations for providing intensive treatment to a small number of clients. Adult case studies of REDTP clients are presented. Recommendations for future ED and other specialized treatment programs in low resource agencies are provided.

Multi-disciplinary community-based group intervention for fibromyalgia: a pilot randomized controlled trial.

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.

Outcomes for binge eating disorder in a remote weight-inclusive treatment program: a case report

BackgroundThere are no known published reports on outcomes for medically and psychiatrically compromised patients with binge eating disorder (BED) treated remotely in higher level of care settings. This case report presents outcomes of an intentionally remote weight-inclusive partial hospitalization and intensive outpatient program based on Health at Every Size® and intuitive eating principles.Case presentationThe patient presented with an extensive trauma background and long history of disturbed eating and body image. She was diagnosed with BED along with several comorbidities, most notably major depressive disorder with suicidality and non-insulin dependent diabetes mellitus. She completed a total of 186 days in the comprehensive, multidisciplinary treatment program encompassing individual and group therapy, as well as other supportive services such as meal support and in vivo exposure sessions. Upon discharge, her BED was in remission, her major depressive disorder was in partial remission, and she no longer exhibited signs of suicidality. Overall, she showed decreases in eating disorder, depressive, and anxiety symptoms as well as increases in quality of life and intuitive eating throughout treatment, which were largely maintained after one year.ConclusionsThis case highlights the potential of remote treatment as an option for individuals with BED, especially in cases where access to higher levels of care might be limited. These findings exemplify how a weight-inclusive approach can be effectively applied when working with this population.

Aerobic Exercise, Cognitive Performance, and Brain Activity in Adolescents with Attention-Deficit/Hyperactivity Disorder.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder for which behavioural treatments such as exercise are recommended as part of a multi-disciplinary treatment program. Exercise improves executive function in individuals with ADHD, but limited information exists regarding the mechanisms involved in the response. We examined task-evoked brain responses during exercise and seated rest in 38 adolescents (n = 15 ADHD; age = 13.6+/-1.9, male = 73.3%, n = 23 typically developing (TD; age = 13.3+/-2.1, male = 56.5%)). Participants completed a working memory and inhibitory task while cycling at a moderate intensity for 25 minutes (i.e., exercise condition) and while seated on the bike without pedalling (i.e., control condition). Conditions were randomized and counter-balanced. Functional near-infrared spectroscopy measured relative changes in oxygenated hemoglobin concentration in 16 brain regions-of-interest. Brain activity for each cognitive task and condition was examined using linear mixed effects models with a false discovery rate correction (FDR). The ADHD group had slower response speeds for all tasks and lower response accuracy in the working memory task during exercise compared to the TD group (p < 0.05). For the inhibitory task, the ADHD group had lower brain activity in the inferior/superior parietal gyrus during exercise compared to the control condition, while the opposite was true for TD (FDRcorrected, p < 0.05). For the working memory task, higher brain activity during exercise was observed, regardless of group, in the middle and inferior frontal gyrus and the temporoparietal junction (FDRcorrected, p < 0.05). Dual-task performance is challenging for adolescents with ADHD and exercise may modulate neuronal resources in regions such as the temporoparietal junction and frontal areas known to be hypoactive in this population. Future research should examine how these relationships change over time.

Seasonal impact on the outcome of multidisciplinary pain therapy

ABSTRACT Multidisciplinary pain treatment programs (MPTP) have been considered to be the most effective treatment of chronic pain. In this study, we analyzed the influence of seasons on the outcome of chronic pain patients undergoing MPTP. Therefore, a prospective, observational trial was conducted in patients with chronic pain undergoing a 5-week interdisciplinary treatment program. Psychological stabilization (measured by ADS – Allgemeine Depressionsskala) and pain levels (measured by NRS – numeric rating scale) were considered as primary endpoints. As a result of this study, we could show that chronic pain patients (exempt patients with chronic headache) showed a highly significant better improvement in terms of ADS after MPTP when participating in autumn (coefficient: −11.67, p = .004). Patients treated during winter showed a tendency towards a better improvement in ADS scores (coefficient: −6.89, p = .051). These effects were not found in patients suffering from chronic headache. Finally, patients participating in MPTPs during summer, autumn, and winter presented a tendency of higher reduction in pain scores when compared to patients participating in spring. In conclusion, the effect of MPTPs in terms of psychological stabilization is considered to be best during autumn. This should be therefore considered in planning an MPTP in all patients who do not need immediate psychological stabilization. The treatment effect of MPTP on pain seems not being dependent on a specific season.

Stimulating Reflections on This Issue

Back to table of contents Next article EditorialFull AccessStimulating Reflections on This IssueDanielle W. Lowe, M.D., Ph.D.Danielle W. LoweSearch for more papers by this author, M.D., Ph.D.Published Online:1 Mar 2023https://doi.org/10.1176/appi.ajp-rj.2023.180301AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Sometimes a natural theme occurs in an issue of the American Journal of Psychiatry Residents’ Journal (AJP-RJ), and it would be remiss not to reflect on these articles as a group. The issue starts with a literature review of repetitive transcranial magnetic stimulation (rTMS) as a treatment for anorexia nervosa by Jae H. Kim, B.S., and colleagues (1). Although the efficacy data are limited in both number of trials and length of follow up, the possibility of integrating rTMS into a larger multidisciplinary treatment program to help reduce maladaptive processes in the frontolimbic system is appealing. This review is followed by two History of Psychiatry articles that explore the development and science of rTMS. Dallas Hamlin, M.D., and John Garman, M.D., review the roots of neurostimulation by intertwining the discoveries of electricity and magnetism within the field of psychiatry (2). Alexander Levit, M.D., Ph.D., builds on this foundation, discussing some of the technical details of current and emerging protocols (3). Together, these articles help integrate the reader’s understanding of the fundamentals and potential future directions of rTMS, and I hope you enjoy reading them, as I have.It is also exciting that this issue of the AJP-RJ is being released just a few days before the conclusion of our third virtual residency and fellowship match cycles. I encourage you to read Chris Wang, M.D., and colleagues’ discussion of the limitations and benefits of a virtual match from the perspective of having both types of interviews at different stages of professional training (4). Continued dialogue about how to balance equity and affordability while having a meaningful interview experience is critical. We know even less about the effects of the virtual match on well-being and burnout throughout training. Trainee burnout is not a new topic, and the Accreditation Council for Graduate Medical Education common program requirements include the assessment of and support for well-being (5, 6). However, with only two classes of virtually matched trainees matriculated to date, the longer-term effects of virtual interviews on program satisfaction and burnout are yet to be fully realized. How do virtual interviews contribute to the sense of lack of control during training? What effects did in-person interview dinners and applicant interactions have on trainees in the program? What additional burdens do virtual interviews have on trainees? The authors concluded that a curated group of trainees and faculty could provide enough information about an institution and community’s culture for the interviewee’s match list—but how virtual interviews change the larger residency and fellowship experience remains relatively unknown.Dr. Lowe is a fifth-year child and adolescent psychiatry fellow at the University of North Carolina, Chapel Hill. She is also an American Psychiatric Association Foundation Child and Adolescent Psychiatry fellow (2021–2023) and editor-in-chief of the American Journal of Psychiatry Residents’ Journal (2022–2023).