Non-pharmacological Treatment Modalities Research Articles

Advances in Local Anesthesia and Pain Management for Practicing Dentists: A Comprehensive Review

One of the most frequent problems that patients bring to a dental clinic is pain in the orofacial region or within the tooth. To identify and solve the issue, a proficient practitioner needs to be equipped with the necessary information and resources. Comprehending the history of pain control in dentistry can provide valuable understanding into the development of the present techniques. Newer and more effective pain management treatments have been created as dentistry continues to advance. Several modalities have been developed to reduce and eliminate this, including pharmacological and non-pharmacological treatment modalities. The goal of the present review of the literature's findings is to provide dentists with reliable information regarding the application of contemporary local anesthetics, alternative methods, and strategies to reduce pain during anesthesia administration, thereby improving patient comfort. Keywords: Local Anesthesia, Anesthetic Agents, NSAIDS, Lignocaine, Management, Pain Control

Effects of an integrative multimodal inpatient program on fatigue and work ability in patients with Post-COVID Syndrome-a prospective observational study.

Post-COVID syndrome (PCS) is characterized by a variety of non-specific symptoms. One of the leading symptoms is fatigue. So far, there is no evidence-based causal therapy established and treatment of PCS is primarily symptom-oriented. The Clinic for Internal and Integrative Medicine in Bamberg, Germany, offers a comprehensive multimodal integrative inpatient therapy for PCS patients. Within a prospective uncontrolled observational study, the results of N = 79 patients were analysed. Post-COVID fatigue patients were hospitalized for up to 14 days. The treatment consists of individual modules depending on the patient's needs. It includes a wide range of integrative non-pharmacological treatment modalities. Outcomes were assessed before and after the inpatient treatment as well as 6 months after discharge from the hospital. Results show that fatigue of post-COVID patients in this study (M = 76.30, SD = 10.18, N = 64) was initially significantly higher than in the subsample "women aged 60-92years" of the general German population (M = 51.5, Schwarz et al. [Schwarz et al. in Onkologie 26:140-144, 2003]; T(63) = 19.50, p < .001). Fatigue was significantly and clinically relevant reduced directly after discharge (MT1 = 76.21, SD = 11.38, N = 42; MT2 = 66.57, SD = 15.55, N = 42), F(1, 41) = 19.80, p < .001, partial eta squared = .326, as well as six months after discharge (MT3 = 65.31, SD = 17.20, N = 42), F(1, 41), p < .001, partial eta squared = .371. Additionally, self-reported ability to work (NRS, 0-10) improved significantly from admission (MT1 = 2.54, SD = 2.23, N = 39) to discharge (MT2 = 4.26, SD = 2.60, N = 39), F(1, 38) = 26.37, p < .001, partial eta squared = .410), as well as to six months later (MT3 = 4.41, SD = 3.23, N = 39), F(1, 38) = 15.00, p < .001, partial eta squared = .283. The study showed that patients suffering from chronic post-COVID syndrome for several months can achieve a significant improvement in their leading fatigue symptoms and a significant improvement in the subjective assessment of their ability to work through a comprehensive two-week multimodal integrative inpatient program.

A comprehensive overview of post-stroke depression treatment options.

Nearly one-third of all stroke patients develop depression at any time after a stroke, and its presence is associated with unfavorable outcomes. This narrative review aims to provide a synopsis of possible pharmacological and non-pharmacological treatment modalities for post-stroke depression (PSD). Several studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors in treating the symptoms of this clinical condition. The treatment of PSD has been recently enhanced by innovative approaches, such as cognitive-behavioral therapy, virtual reality, telehealth, repetitive transcranial magnetic stimulation, and non-conventional therapies, which might improve depression treatment in stroke survivors. Future high-quality randomized controlled trials are necessary to confirm this hypothesis.

Guidelines for pharmacotherapy in Alzheimer's disease - A primer on FDA-approved drugs.

The growing prevalence of dementia makes it important for us to better understand its pathophysiology and treatment modalities, to improve the quality of life of patients and caregivers. Alzheimer's disease (AD), a neurodegenerative disease, is the most common form of amnestic dementia in the geriatric population. Pathophysiology of AD is widely attributed to aggregation of amyloid-beta (Aβ) plaques and hyperphosphorylation of tau proteins. Initial treatment modalities aimed to increase brain perfusion in a non-specific manner. Subsequent therapy focused on rectifying neurotransmitter imbalance in the brain. Newer drugs modify the progression of the disease by acting against aggregated Aβ plaques. However, not all drugs used in therapy of AD have been granted approval by the United States Food and Drug Administration (FDA). This review categorizes and summarizes the FDA-approved drugs in the treatment of AD in a manner that would make it a convenient reference for researchers and practicing physicians alike. Drugs that mitigate symptoms of dementia may be categorized into mitigators of Behavioral and Psychological Symptoms of Dementia (BPSD), and mitigators of cognitive decline. BPSD mitigators include brexpiprazole, an atypical antipsychotic with a once-daily dosage suited to treat agitation in dementia patients, and suvorexant, an orexin receptor antagonist used to treat sleep disturbances. Cognitive decline mitigators include cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine and glutamate inhibitors such as memantine. Donepezil is the most commonly prescribed drug. It is cheap, well-tolerated, and may be prescribed orally once daily, or as a transdermal patch once weekly. It increases ACh levels, enhances oligodendrocyte differentiation and also protects against Aβ toxicity. However, regular cardiac monitoring is required due to reports of cardiac conduction side effects. Rivastigmine requires a twice-daily oral dosage or once-daily replacement of transdermal patch. It has fewer cardiac side effects than donepezil, but local application-site reactions have been noted. Galantamine, in addition to improving cognitive symptoms in a short span of time, also delays the development of BPSDs and has minimal drug-drug interactions by virtue of having multiple metabolic pathways. However, cardiac conduction disturbances must be closely monitored for. Memantine, a glutamate regulator, acts as an anti-Parkinsonian agent and an antidepressant, in addition to improving cognition and neuroprotection, and requires a once-daily dosage in the form of immediate-release or sustained-release oral tablets. Disease-modifying drugs such as aducanumab and lecanemab reduce the Aβ burden. Both act by binding with fibrillary conformations of Aβ plaques in the brain. These drugs have a risk of causing amyloid-related imaging abnormalities, especially in persons with ApoE4 gene. Aducanumab is administered once every 4 weeks and lecanemab once every 2 weeks. The decision on the choice of the drug must be made after considering the availability of drug, compliance of patient (once-daily vs. multiple doses daily), cost, specific comorbidities, and the risk-benefit ratio for the particular patient. Other non-pharmacological treatment modalities must also be adopted to have a holistic approach toward the treatment of AD.

Managing Behavioral and Psychological Symptoms of Dementia In The Era Of Boxed Warnings

Dementias are the most common neurodegenerative conditions in human beings. As we age, the incidence and prevalence of dementias increase. Currently in the United States, there are over 6 million individuals with dementias. This number is projected to rise to over 13 million over the next thirty years. Despite emerging data on various important aspects of dementia, the diagnosis and management of these disorders is not standardized. The data on the management dementias is still limited with none of the pharmacotherapeutic agents available in the market showing any longer-term benefits. Behavioral and Psychological Symptoms of Dementia (BPSD) refers to a group of non-cognitive symptoms and behaviors that occur commonly in patients with dementia. They result from a complex interplay between various biological, psychological, and social factors involved in the disease process. BPSD is associated with increased caregiver burden, institutionalization, a more rapid decline in cognition and function and overall poorer quality of life. It also adds to the direct and indirect costs of caring for patients with dementia. Available data indicate efficacy for some non-pharmacological and pharmacological treatment modalities for BPSD. However, recently the use of psychotropic medications for the treatment of BPSD has generated controversy due to increased recognition of their serious adverse effects. We will also provide an evidence-based guideline to assess and manage these individuals.

Xerostomia - Non-Pharmacological Treatment Modalities and Its Review

Xerostomia is a complicated condition that is becoming more prevalent in the elderly population due to several causes ranging from developmental to iatrogenic. Pharmacological treatment improves the symptoms but increases the adverse effects of the latter and worsens the situation again. Keeping this in mind non-pharmacological interventions are currently used or under supervision to bypass the complications of pharmacological treatment. This article aims to review the prevalence incidence causes signssymptoms and most importantly the success rate of non-pharmacological interventions. Articles in PubMed Cochrane database and Web of Science were analysed till date to establish the effectiveness of different modalities such as acupuncture electrostimulation hyperbaric oxygen HBO therapy and low-level laser therapy LLLT etc. Newer treatment modalities such as gene therapy and stem cell therapy are under trial. This paper provides a broad idea of the different non-pharmacological interventions currently used and our newer future for treating dry mouth.

Effects of moxibustion on cognition and activities of daily living in post-stroke cognitive impairment: A systematic review and meta-analysis of randomized controlled trials.

Post-stroke cognitive impairment (PSCI) imposes a huge burden on patients and society as a whole; however, unequivocally effective treatments for PSCI are still lacking. Therefore, the exploration of effective and safe non-pharmacological treatment modalities for PSCI is a key imperative. Moxibustion has been widely used for cognitive rehabilitation; however, there is a paucity of systematic reviews of the available evidence. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated the effectiveness of moxibustion for treatment of PSCI to provide evidence base for the treatment of PSCI with moxibustion. To evaluate the efficacy of moxibustion in improving cognitive function and activities of daily living (ADLs) in patients with PSCI. Systematic review and meta-analysis of RCTs. Patients with a clinical diagnosis of PSCI. Relevant studies published in English or Chinese were retrieved from ten databases until December 2021. RCTs that assessed the efficacy of moxibustion on cognitive functioning and ADL in patients with PSCI were included. Two reviewers independently identified the trials and extracted the data. Risk-of-bias was assessed using the Cochrane Risk of Bias Tool. Cochrane's Review Manager (RevMan 5.4) software was used for the meta-analysis. Eighteen RCTs (1290 participants) qualified the inclusion criteria and were included. Compared with the control group, the addition of moxibustion significantly improved the cognitive function, evaluated using the Montreal Cognitive Assessment (MoCA) [pooled mean difference (MD): 2.27, 95% CI: 1.98, 2.55, I2 = 22%]. The pooled MD of Mini-Mental State Examination (MMSE) score was 1.85 (95% CI: 1.56, 2.15, I2 = 26%), and the pooled odds ratios (OR) total effective rate was 4.74 (95% CI: 2.55, 8.80, I2 = 0%) (p < 0.05 for all). Moxibustion also significantly improved ADL, assessed using Modified Barthel Index (MBI) (pooled MD=4.10, 95% CI: 2.10 to 6.10, I2 = 0%) and Barthel Index (pooled MD: 8.63, 95% CI: 7.47, 9.79, I2 = 5%) (p < 0.05 for all). Compared with control group, the addition of moxibustion significantly improved the cognition and ADL of patients with PSCI. Nurses can incorporate moxibustion into the rehabilitation nursing of PSCI.

COMPUTER ELECTROACUPUNCTURE FOR IRRITABLE BOWEL SYNDROME: EFFICACY AND SEARCH FOR EFFICACY PREDICTORS

Non-pharmacological treatment modalities, in particular, a new technique in reflexology – computerized electroacupuncture (CEAP), allow us to increase the efficacy while treating patients with irritable bowel syndrome (IBS). Search for predictors of CEAP efficacy in IBS will optimize the choice of patients for treatment, improving the CEAP efficacy profile. &#x0D; The aim of the study is to evaluate CEAP efficacy in the complex therapy of various clinical IBS forms.&#x0D; Materials and Methods. The study involved 80 IBS patients. Patients of the main group underwent three courses of CEAP in addition to standard pharmacological therapy, patients of the reference group received only pharmacotherapy. At the beginning and at the end of each CEAP course, the severity of pain syndrome (visual analogue scale), stool frequency, stool consistency (Bristol stool scale), and subjective state indicators (Zung Self-Rating Depression Scale, Spielberger-Khanin test) were assessed.&#x0D; A retrospective analysis of the research results was carried out to search for predictors of CEAP efficacy. The impact of such parameters as patient’s gender, age, disease form and severity on treatment outcome was assessed.&#x0D; Results. After the first CEAP, the severity of abdominal pain in patients of the main group decreased from 6.1 mm to 3.9 mm and after the third CEAP to 3.7 mm. After three courses of CEAP, defecation frequency in IBS patients with diarrhea decreased from 4.7 to 1.9 per day, and in IBS patients with constipation increased from 0.26 to 0.77 per day. The proportion of patients with normal stool consistency increased significantly both among patients with constipation and among those with diarrhea to 47.1 and 55.6 %, respectively. &#x0D; Retrospective analysis showed the best treatment results in patients with mild and moderate IBS.

Theory and Practice of Treatment of Concurrent Major Depressive and Alcohol Use Disorders

IntroductionBoth Major Depressive and Alcohol Use Disorders are highly prevalent. They also are the major contributors to disability and decreased quality of life and, as they are often comorbid with each other, the diagnosis and treatment of concurrent depression and alcohol use disorder represents a challenging task with multiple clinical questions requiring evidence-based recommendations.ObjectivesThe goal of this presentation is to review the optimal strategies to treat concurrent alcohol use and major depressive disorders in the context of current research findings and clinical practice.MethodsNarrative review, knowledge synthesis.ResultsThe most up-to-date research findings in the areas of epidemiology of concurrent depression and alcohol use disorder, their differential diagnosis, and treatment approaches will be reviewed. This review will include the current evidence of effectiveness of various antidepressants in treatment of depression concurrent with alcohol use disorder and antidipsotropic agents use for alcohol use disorder in the context of depressive symptoms, as well as their combinations. We will discuss the timeline of initiation of both antidepressants and antidipsotropic agents, non-pharmacological treatment modalities as well as the clinical tools that can be used to properly monitor patients’ progress and optimize the treatment process, and the integrative teamwork necessary to achieve optimal results.ConclusionsUltimately, the optimal diagnostic and treatment algorithm and the set of evidence-based treatment recommendations will be presented.DisclosureNo significant relationships.

QUANTIFICATION OF THE USAGE OF TREATMENT MODALITIES BY PATIENTS WITH HAND OSTEOARTHRITIS: A LITERATURE REVIEW.

Purpose: The European League Against Rheumatism (EULAR) recommends a combination of non-pharmacological and pharmacological treatment modalities for symptoms of hand osteoarthritis (OA) in order to achieve optimal symptom relief. We aimed to review the actual usage of these treatment modalities for joint complaints in the hand osteoarthritis (OA) population.

QUANTIFICATION OF THE USAGE OF TREATMENT MODALITIES IN PATIENTS WITH HAND OSTEOARTHRITIS: THE HOSTAS COHORT.

Purpose: The European League Against Rheumatism (EULAR) recommends a combination of non-pharmacological and pharmacological treatment modalities for symptoms of hand osteoarthritis (OA) in order to achieve optimal symptom relief. However, there is no available data indicating to what extent these modalities are implemented in routine clinical practice. Therefore, we aimed to assess the usage and determinants of treatment modalities aimed at relieving joint complaints for patients with hand OA in daily clinical practice.

Managing Behavioral and Psychological Symptoms of Dementia In The Era Of Boxed Warnings

Dementias are the most common neurodegenerative conditions in human beings. As we age, the incidence and prevalence of dementias increase. Currently in the United States, there are over 6 million individuals with dementias. This number is projected to rise to over 13 million over the next thirty years. Despite emerging data on various important aspects of dementia, the diagnosis and management of these disorders is not standardized. The data on the management dementias is still limited with none of the pharmacotherapeutic agents available in the market showing any longer-term benefits. Behavioral and Psychological Symptoms of Dementia (BPSD) refers to a group of non-cognitive symptoms and behaviors that occur commonly in patients with dementia. They result from a complex interplay between various biological, psychological and social factors involved in the disease process. BPSD is associated with increased caregiver burden, institutionalization, a more rapid decline in cognition and function and overall poorer quality of life. It also adds to the direct and indirect costs of caring for patients with dementia. Available data indicate efficacy for some non-pharmacological and pharmacological treatment modalities for BPSD. However, recently the use of psychotropic medications for the treatment of BPSD has generated controversy due to increased recognition of their serious adverse effects. We will also provide an evidence-based guideline to assess and manage these individuals.

A randomized clinical trial on the effect of foot reflexology performed in the fourth stage of labor on uterine afterpain\xa0

BackgroundUterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women.MethodsThis single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue scale. The collected data were analyzed in SPSS-16 software at a significance level of P < 0.05.ResultsThe median of the afterpain score in the first hour (P = 0.05) and second hour (P = 0.274) postpartum did not differ significantly between the two groups, but this score was lower in the reflexology group at the third hour (P < 0.001) and fourth hour (P < 0.001) postpartum. The mean total afterpain score in the 4 h postpartum was significantly lower in the reflexology group (P < 0.001).ConclusionThe results revealed that foot reflexology in the fourth stage of labor has positive effects on relief from uterine afterpain. Reflexology is therefore recommended as a measure to reduce postpartum uterine afterpains.

Non-pharmacological Treatment for Chronic Pain in US Veterans Treated Within the Veterans Health Administration: Implications for Expansion in US Healthcare Systems

BackgroundConsensus guidelines recommend multimodal chronic pain treatment with increased use of non-pharmacological treatment modalities (NPM), including as first-line therapies. However, with many barriers to NPM uptake in US healthcare systems, NPM use may vary across medical care settings. Military veterans are disproportionately affected by chronic pain. Many veterans receive treatment through the Veterans Health Administration (VHA), an integrated healthcare system in which specific policies promote NPM use.ObjectiveTo examine whether veterans with chronic pain who utilize VHA healthcare were more likely to use NPM than veterans who do not utilize VHA healthcare.DesignCross-sectional nationally representative study.ParticipantsUS military veterans (N = 2,836).Main MeasuresIn the 2019 National Health Interview Survey, veterans were assessed for VHA treatment, chronic pain (i.e., past 3-month daily or almost daily pain), symptoms of depression and anxiety, substance use, and NPM (i.e., physical therapy, chiropractic/spinal manipulation, massage, psychotherapy, educational class/workshop, peer support groups, or yoga/tai chi).Key ResultsChronic pain (45.2% vs. 26.8%) and NPM use (49.8% vs. 39.4%) were more prevalent among VHA patients than non-VHA veterans. After adjusting for sociodemographic characteristics, psychiatric symptoms, physical health indicators, and use of cigarettes or prescription opioids, VHA patients were more likely than non-VHA veterans to use any NPM (adjusted odds ratio [aOR] = 1.52, 95% CI: 1.07–2.16) and multimodal NPM (aOR = 1.80, 95% CI: 1.12–2.87) than no NPM. Among veterans with chronic pain, VHA patients were more likely to use chiropractic care (aOR = 1.90, 95% CI = 1.12–3.22), educational class/workshop (aOR = 3.02, 95% CI = 1.35–6.73), or psychotherapy (aOR = 4.28, 95% CI = 1.69–10.87).ConclusionsAmong veterans with chronic pain, past-year VHA use was associated with greater likelihood of receiving NPM. These findings may suggest that the VHA is an important resource and possible facilitator of NPM. VHA policies may offer guidance for expanding use of NPM in other integrated US healthcare systems.

Inflammatory Bowel Disease Therapeutics: A Focus on Probiotic Engineering.

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of gastrointestinal (GI) tract with dysregulated mucosal immune functions and disturbed commensal ecosystem of the intestinal lumen. IBD is categorized into two major subsets: Crohn's disease (CD) and ulcerative colitis (UC). Though advent of biologics has shifted the treatment with relatively longer remission compared to small molecule pharmaceuticals, patients still suffer from long-term complications. Since gut-microbiome is now accepted as another human organ holding potential for long-lasting human health, probiotics, and its engineering hold great promises to treat several previously untreatable chronic inflammatory conditions including IBD. Several emerging biological engineering tools have unlimited potential to manipulate probiotic bacterial system. These can produce useful therapeutic biologics with a goal to either ameliorate and/or treat previously untreatable chronic inflammatory conditions. As gut-microbiome is diverse and vary in different ethnic, geographic, and cultural human population, it will be important to develop vision for personalized probiotic treatment and develop the technology thereof to make personalized probiotic options a reality. The aim of this review paper is to present an overview of the current knowledge on both pharmacological and nonpharmacological IBD treatment modalities with a special emphasis on probiotic strains that are developed through the probiotic engineering. These engineered probiotics contain the most anti-inflammatory cytokines found within the human immune response and are currently being used to treat the intestinal inflammation in IBD for the IBD treatment.

Initiation of quarterly palmitate paliperidone in French clinical practice: Results from the observational, cross-sectional OPTIMUS study.

Long-term antipsychotic treatment is key to a positive clinical outcome in schizophrenia. Recent guidelines recommend the prescription of long-acting antipsychotic formulations (LAIs) as early as the first episode in patients with schizophrenia. The OPTIMUS study evaluated real-world use of a new three-monthly paliperidone palmitate formulation (PP3M) in France. For this observational cross-sectional study, all French psychiatrists were invited to enrol patients who had initiated PP3M in the previous 4 months. Snapshot data were collected at a routine consultation, without any modification of clinical practice. This population of 350 patients with schizophrenia started on PP3M predominantly included single men, living independently with a diagnosis of schizophrenia for a median of 9.3 years. Demographic characteristics were broadly comparable to those reported in other studies on LAIs. Investigators cited treatment simplification (96.9%) and patient comfort (93.3%) as the most common reasons for switching to PP3M; enhancing adherence was mentioned less often (61.1%) with most patients previously considered as adherent, and a majority of them expressing a positive attitude to their treatment. One-third of patients accepted the psychiatrist's proposal to initiate PP3M treatment without any discussion, and relatives were involved in the therapeutic decision-making process in only 23.7% of cases. After initiation, few changes were seen in professional follow-up frequency or concomitant pharmacological and non-pharmacological treatment modalities except for a decrease in antipsychotic polytherapy. PP3M is mostly prescribed in adherent patients with fairly stable schizophrenia, and the longer dosing interval does not substantially affect patient care.

Pharmacological osteoarthritis therapy and modern therapeutic principles

Introduction. The purpose of treating osteoarthritis is to relieve pain, improve the function of the osteoarthritic joint, and arrest further development of osteoarthritis through non-pharmacological and pharmacological treatment modalities. Pharmacological osteoarthritis therapy. In the treatment of osteoarthritis, guidelines and recommendations are often consulted, but they do not dictate the treatment mode, which is tailored to the individual needs of the patient. These guidelines promote desired and positive treatment outcomes, but cannot predict a specific outcome. They are also valuable when analyzing the use of topical and oral non-steroidal anti-inflammatory drugs, keeping dosage as low as possible for the shortest time. For example, monitoring hepatotoxicity is advised when administering paracetamol, while caution is needed when prescribing drugs with a central effect due to the possible development of addiction and appearance of toxic effects. A significant body of research on the use of chondroprotectors exists, but there is a large discrepancy across studies. Nonetheless, their findings indicate benefits of intra-articular administration of glucocorticoids. However, their more frequent administration can lead to accelerated cartilage loss, while guidelines differ concerning intra-articular administration of hyaluronic acid, the administration of plasma enriched with platelets, and the administration of stem cells due to the heterogeneity of the preparations and the lack of standardization in their administration. Conclusion. Non-surgical therapy is a growing field of research, especially from a pharmacological point of view, intending to find the best treatment to slow down or completely stop further development of osteoarthritis.

Pain management in the emergency department: a clinical review.

Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

The effects of art therapy on Parkinson`s and Alzheimer`s disease

Art therapy is one of the non-pharmacological treatment modalities for many diseases, including neurological and psychiatric disorders. Adrian Hill started art therapy in the 1940s. Parkinson`s disease is one of the progressive neurodegenerative diseases characterized by various motor and non-motor symptoms. As patients with Parkinson`s disease often report low quality of life despite improving their motor symptoms, complementary therapy may reduce their difficulties. Music and dance therapy, clay manipulation therapy, and tai chi training have promising results. There is also art therapy for one of the most common causes of dementia worldwide, Alzheimer`s disease. In addition to standard pharmacological treatment for Alzheimer`s disease e.g. cholinesterase inhibitors, music and visual arts therapy are evolving. This article presented some of the art therapy methods used in the most common neurodegenerative disorders, Parkinson`s and Alzheimer`s. In addition, we also presented some of the limitations of those studies. Some of the limitations are as follows: small sample size, relatively short duration of therapy sessions, and the fact that it is doubtful that art therapy could improve symptoms and cognitive abilities of people with advanced forms of neurodegenerative disorders.

Racial and Ethnic Disparities in Peripheral Artery Disease.

Peripheral artery disease is an obstructive, atherosclerotic disease of the lower extremities causing significant morbidity and mortality. Black Americans are disproportionately affected by this disease while they are also less likely to be diagnosed and promptly treated. The consequences of this disparity can be grim as Black Americans bear the burden of lower extremity amputation resulting from severe peripheral artery disease. The risk factors of peripheral artery disease and how they differentially affect certain groups are discussed in addition to a review of pharmacological and nonpharmacological treatment modalities. The purpose of this review is to highlight health care inequities and provide a review and resource of available recommendations for clinical management of all patients with peripheral artery disease.