Post-treatment Improvement Research Articles

Therapeutic efficacy and safety of botulinum toxin A injection in plantar fasciitis: A systematic review and meta-analysis.

The purpose of this meta-analysis was to evaluate the therapeutic efficacy and safety of botulinum toxin A (BTA) injections for treatment of plantar fasciitis (PF). This review adhered to the PRISMA guidelines, conducting a comprehensive search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases for eligible studies from their inception to December 30 2023. The inclusion criteria were limited to randomized controlled trials (RCTs) comparing BTA injections with control interventions in terms of pain reduction, functional improvement, or the occurrence of adverse events in treating patients with PF were extracted for meta-analysis. Relevant data were extracted using an electronic spreadsheet and analyzed with Stata 16.0 software. The quality of included studies was assessed using the Cochrane Collaboration's tool. A total of 655 studies were retrieved and subsequently screened. Seven RCTs, comprising 305 participants, met the eligibility criteria and were included in the meta-analysis. The pooled results indicated that BTA injections led to significant pain reduction only at 1-month posttreatment (SMD = -1.72, 95% CI [-3.10, -0.34], p = 0.01]) and sustained functional improvement over twelve months (SMD = 25.10, 95% CI [9.67, 40.53], p = 0.001) compared to the control group. There was no significant difference in the occurrence of adverse events between the BTA and control interventions (OR = 0.16, 95% CI [-1.00, 1.32], p = 0.79). This meta-analysis suggested that BTA injection could be an effective and safe therapeutic strategy for plantar fasciitis. However, further larger-scale, rigorously designed RCTs are needed to validate these findings and determine the optimal injection dosage and site for BTA in the treatment of plantar fasciitis.

Report on a Case Study Process Evaluation of a HeartMath Intervention and Faith Following a Traumatic Experience

An initial study [1] was undertaken on a HeartMath intervention, focusing on coherence, resilience and faith following a traumatic experience. Quantitively, there were significant post-intervention positive improvements in physiological coherence, and improvements in resilience and faith, and, qualitatively, positive integrated thematic changes in experiences of sense of coherence, resilience and faith. Correlations revealed various Sense of Coherence Scale items correlated with Brief Resilience Scale and Santa Clara Strength of Religious Faith Questionnaire items, and there were inter-related and overlapping experiences of sense of coherence, resilience and faith integrated themes and sub-themes. The first study’s recommendations included that a case study process evaluation of a HeartMath intervention and faith following a traumatic experience be undertaken. The aim was to identify causal, correlation and relationship mechanisms of change. For this case study, the sample consisted of five participants purposefully selected from the original cohort. Information from a qualitative questionnaire on before, during and after intervention experience of sense of coherence, resilience, faith and HeartMath, as well as the HeartMath intervention, were collected. Emerging causal, correlation and relationship mechanisms of change in the form of integrated themes and sub-themes are discussed.

Health-related quality of life among extrapulmonary tuberculosis patients and inequalities by disease manifestations: a longitudinal study analysing the impact of TB treatment.

To understand the impact of extrapulmonary tuberculosis (EPTB) and its treatment on quality of life, we analysed patient-reported outcome measures (PROMs) among presumptive ETPB patients. EuroQol's five-dimensional three-level (EQ-5D-3L) questionnaire and the Visual Analogue Scale (EQ-VAS) were used to measure PROMs by 274 presumptive EPTB patients at pre- and post-treatment stages. The patients were categorised as TB and non-TB by using a composite reference standard. Following the EuroQol suggested analysis methods, we calculated the health utility summary measure at the pre- and post-treatment stages. The health state density curve and index were used to analyse inequality in reported health profiles. We investigated factors associated with EPTB patients' health utility through multivariable regression at the pre-treatment stage. The analysis of PROMs showed both physical (mobility, self-care, usual activities) and psychological (pain, discomfort, anxiety & depression) health affected by all EPTB manifestations (lymphadenitis, pleuritis, meningitis and others). Moreover, we found inequality in reported health profiles across disease manifestations at pre- and post-treatment stages. Post-treatment, we found improvement in PROMs and no reports of extreme-level health problems. However, some problems persisted across all dimensions of EPTB manifestations. We found 100% improvement in pleuritis and meningitis manifestations. Socioeconomic status, type of health facility attended, and patients' working capacity were associated with health utility. Despite post-treatment improvement in health, inequality of reported health states by EPTB manifestations persisted, though decreased. This highlights that holistic patient- and health system-level interventions addressing the impact of illness should consider EPTB by its manifestations, not as a single disease entity.

Optimizing nurse practitioner productivity within the Veterans Health Administration.

Nurse practitioners (NPs) provide high-quality, comprehensive health care at Veterans Health Administration (VHA) medical centers in various practice settings. Accurately determining the productivity of NPs is essential to understanding their overall contribution to veteran care. There is a lack of understanding of the contributors to the variability among VHA medical centers regarding their processes for capturing these data. Using benchmark data from the VHA Support Service Center Capital Assets application, this quality improvement (QI) initiative implemented a series of plan-do-study-act (PDSA) cycles to determine whether increased education regarding billing and coding, along with person classification and labor mapping accuracy, could increase NP productivity. The problem identified through an analysis of NP productivity revealed variability across multiple VHA facilities. The PDSA method was employed in this QI project. The QI team compared the total workload relative value units (wRVU) for NPs in each participating facility pre and post a three-phase intervention. Nurse practitioners' person classification and labor mapping accuracy was evaluated at each site. An educational program regarding billing and coding was developed and delivered to the NP frontline staff. The QI team compared the total wRVUs for the NPs at each facility pre- and postintervention. An increase in the wRVUs was observed following the intervention across six facilities. Five of the seven facilities displayed stability in relative value unit improvement postintervention. Educating frontline NPs on billing, coding, person classification, and labor mapping can improve NP productivity.

Enhancing multisensory rehabilitation of visual field defects with transcranial direct current stimulation: A randomized clinical trial.

Visual rehabilitation is necessary for improving the quality of life of patients with acquired homonymous visual field defects (HVFDs). By modulating brain excitability and plasticity, transcranial direct current stimulation (tDCS) may accelerate and increase the effects of compensatory trainings, which are usually long and intensive. In the present proof-of-principle, double-blind, randomized, sham-controlled study, we assess whether anodal tDCS applied over ipsilesional occipital or parietal cortices can increase the effects of a compensatory audiovisual training for HVFDs. Eighteen participants with chronic HVFDs were randomized to receive anodal or sham tDCS over the ipsilesional parietal or occipital cortex during a 2-week (10 days, 2 h/day) audiovisual treatment aimed at improving oculomotor visual field exploration. Improvements were assessed by administering visual detection with eye movements and visual search tests, and a questionnaire for activities of daily living (ADLs) before the treatment, at its end, and at 1-month and 4-month follow-ups; lesion analyses were performed to look for predictors of treatment effects. Anodal ipsilesional tDCS, regardless of the target area (occipital vs. parietal), speeds up and increases daily improvements during the training. Whereas long-lasting (up to 4 months) post-treatment improvements in visual search and ADLs were observed in all groups, a greater and stable increase of visual detections in the blind hemifield was brought about only by the adjuvant use of occipital tDCS. Compensatory audiovisual rehabilitation of HFVDs is effective and benefits from the adjuvant application of occipital and parietal tDCS, which speeds up and increases training-induced improvement. NCT06116760.

Primary Extradural Meningioma: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes.

Objective: This systematic review consolidates the literature on primary extradural meningiomas (PEMs), a rare subset of meningiomas. We describe the clinical features, management strategies used, and treatment outcomes for published cases. Methods: A systematic review was conducted using PRISMA guidelines across multiple databases to 29 July 2024. Inclusion criteria were adult patients with primarily extradural meningioma and where individual patient clinical data were provided. Results: Of 216 studies that met the initial search criteria, 41 satisfied the final inclusion criteria. These 41 studies included 82 patients with 84 total PEMs. The cohort was balanced between sexes with a median age of 46 (range 18-82). Frequent symptoms at initial presentation included pain/headache (46%), weakness (44%), paresthesias (24%), and a palpable superficial mass (23%). The median duration of symptoms to diagnosis was 11 months (range 0.75-120). Surgical resection was the primary treatment approach, achieving a gross total resection in 67% of cases. The majority of lesions were classified as WHO grade 1 (87%). A recurrence was identified during the published follow-up in 11% of cases and a higher WHO grade was expectedly associated with a greater risk of recurrence. The described practice was to use adjuvant radiotherapy in recurrent and high-grade cases. Most cranial lesions were located in the frontal bone, while most spinal lesions affected the cervical spine. Post-treatment symptom improvement or resolution was described in almost all patients at the last follow-up. Conclusions: In comparison to intradural meningiomas, PEMs largely follow a more indolent course with a longer duration of symptoms prior to diagnosis, more benign symptoms, a higher proportion of grade 1 tumors, and favorable outcomes; however, there is a small subset of PEMs with extension outside the cranium and spine that require specific considerations for management.

The Efficiency of a Video-Assisted Instructional Module in Enhancing Staff Nurses' Understanding of Surgical Foot Surgery Practice

The study aimed to evaluate the effectiveness of a Video-Assisted Teaching Module (VATM) in enhancing knowledge on the practice of surgical fomentation for patients with diabetic foot among staff nurses at Vinayaka Mission Kirupananda Variyar Medical College Hospital, Salem. The objectives included assessing pre-existing knowledge, evaluating VATM’s effectiveness, and analysing demographic variables' impact. A pre-experimental research design was employed, with 48 staff nurses selected using purposive sampling. Data was collected using a closed-ended questionnaire before and after the VATM intervention. The pre-test mean score was 12.73 (42%), and the post-test mean score increased to 19.19 (64%), demonstrating the VATM’s effectiveness with a 22% improvement. The highest effectiveness (26%) was in the "surgical fomentation" domain, while the "articles required" domain showed the lowest effectiveness (17%). Data analysis revealed significant improvement in knowledge post-intervention, with no significant association between knowledge scores and demographic variables such as age, gender, or educational background. The study concludes that VATM is an effective tool for improving nurses' knowledge on surgical fomentation, supporting better care for diabetic foot patients. The results emphasize the need for ongoing educational interventions to enhance nursing practices.

Yoga-Based Group Intervention for Inpatients with Schizophrenia Spectrum Disorders-Feasibility, Acceptability, and Preliminary Outcomes of a Rater-Blinded Randomized Controlled Trial.

The efficacy of yoga as an adjunctive treatment for schizophrenia spectrum disorders (SSD) has garnered interest. While yoga may positively influence various symptom domains, further investigation is needed due to the limited number, quality, and generalizability of studies. This study assessed the feasibility and acceptability (primary outcome) of a yoga-based group intervention (YoGI) developed in a participatory approach and explored its preliminary effectiveness. In addition to the primary outcomes, this preregistered randomized controlled trial examined rater-blinded general psychopathology, positive- and negative symptoms, and self-rated depression, anxiety, stress, body mindfulness, mindfulness, psychological flexibility, cognition, social functioning, quality of life, and medication regime at baseline and postintervention as secondary outcomes. Fifty inpatients with SSD received either TAU (n = 25) or YoGI + TAU (n = 25) for four weeks. Outcomes showed 95% protocol adherence of YoGI, feasibility, and retention rates of 91% and 94%, respectively, and a dropout rate of 6%. ANCOVA revealed significant between-group postintervention improvements for YoGI + TAU in positive symptoms, depression, cognitive fusion, and a mindfulness subscale. Medium-to-large pre- to postintervention effects were found for body mindfulness, positive, negative, and general psychopathology, cognitive fusion, depression, anxiety, stress, quality of life, and attention in YoGI + TAU, while within-group changes were consistently smaller in TAU. No severe adverse events were reported. This trial supports the feasibility and acceptability of YoGI for inpatients with SSD and provides preliminary evidence of YoGI's benefits beyond TAU. Further robust, multicentric RCTs are warranted to deepen our understanding of YoGI's therapeutic potential and inform clinical interventions for SSD.

Developing graduate attributes through the application of coaching theory

Graduate attributes (GAs) have been formally adopted by higher education institutions for some time and describe the skills and competences that students should develop over the course of their studies. GAs are considered to be important to universities as they act as a means to represent and extend their brand, while also providing a channel to maintain connection with industry. However, despite regular engagement with industry, employers remain unsatisfied with graduate transferable skills. This may be caused by a lack of a common theoretical underpinning to develop such attributes. Therefore, the aim of this study was to provide an evidence-based methodology which develops transferable skills in university graduates. Two classes at a public university in Hong Kong were used in this study. One class received a 12-week intervention incorporating a variety of coaching activities. The second class acted as a control group. Students were asked to complete pre-intervention surveys which provided self-reports of current ratings in GAs and resourcefulness behaviours. After completion of the 12-week intervention, students were asked to complete post-intervention surveys, again reporting self-ratings on the same topics. Survey data was analysed to identify changes in student scores, which highlighted improvements in all graduate attribute ratings post-intervention. Furthermore, help-seeking behaviours were shown to have significant improvement post intervention. The findings of this study suggest that coaching practices may provide an efficient and effective way to develop transferable skills in students, and this paper provides discussion on the implications of these results.

SURG-45. OUTCOMES OF PATIENTS RECEIVING SURGICAL RESECTION AND STEREOTACTIC RADIOSURGERY VS. STEREOTACTIC RADIOSURGERY ALONE FOR MOTOR CORTEX METASTASES

Abstract BACKGROUND Local therapy for brain metastases typically involves stereotactic radiosurgery (SRS), with surgical resection considered for larger and/or symptomatic tumors. For lesions in eloquent areas, surgical management is controversial given the risks of neurologic deficits. This study compared clinical outcomes in patients with motor cortex metastases who received surgery + SRS or SRS alone. METHODS Patients treated for motor cortex metastases from 1/2018 – 12/2022 were identified. Demographic/preoperative variables included age, gender, race, tumor histology, adjuvant therapies, pre-treatment neurological exam, and Karnofsky Performance Scale. Treatment variables included the number of brain metastases, maximum tumor diameter, and radiation dose/number of fractions. Outcome measures included post-treatment neurological exam, seizures, and overall survival (OS). RESULTS 351 charts were identified – 80 surgery + SRS and 271 SRS alone. 50 consecutive patients in each group were included in this analysis. Surgery + SRS patients were younger (59.0 vs. 63.9; P=0.020) with larger tumors (2.8 vs. 0.83cm; P<0.001), while the SRS only group had more brain metastases per patient (2 vs. 6; P<0.001). No differences were seen in the remaining demographic/preoperative variables. Pre-treatment, surgery + SRS patients had significantly increased frequency (45/50, 90% vs. 25/50, 50%; P<0.001) and severity (4 vs. 5; P=0.001) of motor deficits, and a higher likelihood of seizures (25/50, 50% vs. 8/50, 16%; P<0.001). Despite the surgery + SRS group being more symptomatic pre-treatment, the frequency and severity of motor deficits and seizures was similar between cohort’s post-therapy. Surgery + SRS patients also demonstrated higher rates of pre- to post-treatment improvement in motor function (29/45, 64% vs. 3/25, 12%; P<0.001) and longer OS from the date of treatment (7.5 vs 4 months; P=0.021). CONCLUSION Given the equivalent neurological outcomes, higher rates of functional improvement, and improved oncologic outcomes, surgery should be a consideration for patients with brain metastases in eloquent areas, particularly those with symptomatic lesions.

Improvement in depressive symptoms is associated with sustained improvement in fatigue impact in adults with multiple sclerosis

BackgroundFatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). Behavioral interventions that target one or more behaviors such as sleep hygiene, exercise, energy management, cognitive processes, as well as mood have been shown to reduce fatigue in people with MS. Yet, little is known about mechanisms of intervention effects on MS fatigue. Research suggests that depressive symptoms may be an important intervention target for improving MS fatigue. This study examined the association between pre- to post-intervention improvement in depressive symptoms and improvement in MS fatigue impact from pre-intervention through six months post-intervention. MethodsThis study is a secondary analysis of data from a randomized controlled trial comparing a fatigue self-management intervention to general MS education for improving fatigue in people with MS. Adults with MS (N = 218) were recruited for the parent trial from the Portland, Seattle, Baltimore, and North Florida/South Georgia VA Medical Centers, affiliated academic medical centers, and surrounding communities. Both study interventions showed similar efficacy, so participants were combined into one sample for this secondary analysis. Structural equation modeling was used to examine whether clinically significant change in depressive symptoms (a 17.5 % reduction in the total Beck Depression Inventory-II score) from pre- to post-intervention, was associated with improvement in fatigue impact on the physical, cognitive, and psychosocial subscales of the Modified Fatigue Impact Scale from pre-intervention through six-month follow-up. ResultsParticipants were predominantly female (72 %), middle-aged (M = 53.7 ± 10.1), and White (76 %) with a disease duration of 12.5 ± 8.4 years. Over half of the sample (58 %) had relapsing-remitting MS. Clinically significant improvement in depressive symptoms was associated with reduction in physical fatigue impact (β = -0.17, p = .004, 95 % CI [-0.28, -0.05]), cognitive fatigue impact (β = -0.20, p = .000, 95 % CI [-0.31, -0.10]), and psychosocial fatigue impact (β = -0.13, p = .03, 95 % CI [-0.25, -0.01]) through the six-month follow-up controlling for baseline depressive symptoms and fatigue impact, MS subtype (RRMS or Progressive MS), and income level. The model demonstrated adequate fit, χ2(6) = 12.747, p = .047, RMSEA = 0.072, CFI = 0.986, SRMR = 0.016, and accounted for 32 %, 39 %, and 28 % of the variance in physical, cognitive, and psychosocial fatigue impact respectively, which corresponded with large effect sizes. ConclusionThese findings, building on previous research, support the importance of reducing depressive symptoms for improving fatigue impact in people with MS. Future research should examine whether explicit focus on reducing depressive symptoms or related cognitive behavioral factors reduces fatigue in people with MS.

How I Do It: Process Control in Medical Student Experiences of Surgery

ObjectiveExtreme variation exists in teaching and clinical exposure for medical students, both from specialty-to-specialty but also between universities. There is mounting literature highlighting the need to reform and standardise surgical education to allow for unified graduate competency. In line with the recommendations from the GMC2 and the Royal College of Surgeons England (RCSE) 3, Queens University Belfast (QUB) significantly revised their undergraduate medical programme. Within this new curriculum is the introduction of Specialty Focus week in Surgery. This report reviews the processes used in the introduction of this week. DesignThe initial curriculum was formulated with a weekly timetable consisting of tutorials, bedside teaching and students following a peri-operative case. Run charts were populated with an alert when feedback dropped below a certain standard, which then triggered an intervention. ParticipantsFeedback was collected via a QR code from the first 200 surgical student. SettingsBelfast City Hospital in association with Queens university Belfast (QUB) undergraduate surgical curriculum. ResultsRun charts resulted in an alert when feedback dropped below 8/10. Following this we implemented smaller group bedside teaching. There was a significant improvement in feedback post intervention (P=0.04) with no further alerts. Overall feedback had a non-significant feedback improvement post intervention (P=0.07) with once again, no further alerts. ConclusionThis review has shown how we have provided some standardisation of local surgical teaching, as well as having a process centred model of monitoring. This curriculum is easy to implement and could be reproduced elsewhere.

Targeting Higher-Order Dimensions of Personality in Treatment as a Parsimonious Means to Address Co-Occurring Psychopathology

People with borderline personality disorder (BPD) commonly have co-occurring mental health conditions that may be accounted for by higher-order factors in dimensional models of psychopathology. BPD Compass is a cognitive-behavioral treatment developed to target broad personality domains (i.e., negative affectivity, antagonism, disinhibition) associated with BPD and related conditions. The purpose of the present study was to explore the extent to which BPD Compass can serve as a transdiagnostic intervention for these comorbid conditions. Participants (N = 100; Mage = 28.13, 73.7% female, 79.6% White, 66% sexual minority) were assigned to either immediately begin treatment (randomized and naturalistic) or receive treatment after an 18-week waiting period. At baseline, participants met criteria for an average of 3.28 (SD = 2.02, range: 0-8) comorbid diagnoses ranging in clinical severity from 3.30 (for substance use disorder) to 4.91 (for persistent depressive disorder). Post-treatment clinical severity ratings (CSRs) for those randomized to receive BPD Compass were below clinical thresholds for all assessed conditions except premenstrual dysphoric disorder, whereas post-waitlist CSRs remained above clinical thresholds for all disorders except bipolar II, agoraphobia, and major depressive disorder. Collapsed across all patients who received BPD Compass, pre- to post-treatment improvements in were significant and large in magnitude for most disorders assessed. These results suggest that BPD Compass may be an efficacious transdiagnostic intervention, though our small sample and high rate of dropout warrant further study.

Treatment of sleep-disordered breathing among children with myelomeningocele.

Studies have shown a high prevalence of sleep-disordered breathing (SDB) among children with myelomeningocele (MMC), but there are few published data on the longitudinal care of these patients. The objective of this study was to determine the effectiveness of standard treatments for SDB in children with MMC. The authors analyzed records from three multidisciplinary spina bifida clinics to identify all patients with both MMC and SDB diagnosed by polysomnography (PSG). The primary outcome of this study was a change in apnea-hypopnea index (AHI; the number of apneic or hypopneic events per hour of sleep) before and after clinically recommended SDB treatments. Clinical and demographic variables were recorded and evaluated for possible association with posttreatment improvement of AHI. Analysis included change in AHI (a continuous variable) and whether SDB improved (defined as an AHI < 2.5 or decrease of AHI by ≥ 50% from baseline). Seventy-one eligible patients (aged 2 days-21 years, 52% male) had an initial AHI > 2.5 and had follow-up PSG after treatment for SDB. The mean AHI decreased from 20.5 (SD 21.6) at baseline to 11.6 (SD 15.7) after treatment (p = 0.0006). Children treated with supplemental oxygen and with continuous positive airway pressure had improvement on PSG (18 of 25 and 12 of 18, respectively). Children treated with adenotonsillectomy were less likely to improve (7 of 19). Forty-one patients (58%) improved from a baseline AHI > 2.5 to an AHI < 2.5 after treatment. Children with MMC and SDB who undergo standard SDB treatments guided by pediatric sleep medicine physicians show improvement in PSG parameters after treatment.

Exploring the effect of peppermint oil massage on pulmonary function in patients with bronchial asthma: insights from a case series

Bronchial asthma (BA) is a chronic inflammatory disorder characterized by airway hyperresponsiveness and obstruction, leading to symptoms such as coughing, wheezing, and shortness of breath. Management typically involves inhaled corticosteroids, but their adverse effects necessitate exploring alternative therapies. Aromatherapy massage, particularly using peppermint oil, may offer therapeutic benefits due to its anti-inflammatory and broncho dilatory properties. This study investigates the impact of upper back massage with peppermint oil on pulmonary function in BA patients. Three female patients with a history of poorly controlled BA participated in this case series. Each patient received a 20-minute upper back massage with peppermint oil daily for 10 days. Pulmonary function tests (PFTs) were conducted before and after the intervention, measuring forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and forced expiratory flow (FEF 25-75%). All patients showed improvement in pulmonary function post-intervention. Case 1: FVC increased from 80% to 97%, FEV1 from 67% to 82%, and PEFR from 72% to 93%. Case 2: FVC improved from 69% to 81%, FEV1 from 64% to 76%, and FEF 25-75% from 40% to 50%. Case 3: FVC rose from 74% to 78%, FEV1 from 55% to 60%, and PEFR from 56% to 63%. Upper back massage using peppermint oil appears to enhance pulmonary function in individuals with bronchial asthma.

Long-term cognitive training enhances fluid cognition and brain connectivity in individuals with MCI

Amnestic mild cognitive impairment (aMCI) is a risk factor for Alzheimer’s disease (AD). Multi-domain cognitive training (CT) may slow cognitive decline and delay AD onset. However, most work involves short interventions, targeting single cognitive domains or lacking active controls. We conducted a single-blind randomized controlled trial to investigate the effect of a 6-month, multi-domain CT on Fluid Cognition, functional connectivity in memory and executive functioning networks (primary outcomes), and white matter microstructural properties (secondary outcome) in aMCI. Sixty participants were randomly assigned to either a multi-domain CT or crossword training (CW) group, and thirty-four participants completed the intervention. We found a significant group-by-time interaction in Fluid Cognition (p = 0.007, F (1,28) = 8.26, Cohen’s d = 0.38, 95% confidence interval [CI]: 2.45–14.4), with 90% of CT patients showing post-intervention improvements (p < 0.01, Cohen’sd = 0.7). The CT group also showed better post-intervention Fluid Cognition than healthy controls (HCs, N = 45, p = 0.045). Functional connectivity analyses showed a significant group-by-time interaction (Cohen’s d ≥ 0.8) in the dorsolateral prefrontal cortex (DLPFC) and inferior parietal cortex (IPC) networks. Specifically, CT displayed post-intervention increases whereas CW displayed decreases in functional connectivity. Moreover, increased connectivity strength between the left DLPFC and medial PFC was associated with improved Fluid Cognition. At a microstructural level, we observed a decline in fiber density (FD) for both groups, but the CT group declined less steeply (1.3 vs. 2%). The slower decline in FD for the CT group in several tracts, including the cingulum-hippocampus tract, was associated with better working memory. Finally, we identified regions in cognitive control and memory networks for which baseline functional connectivity and microstructural properties were associated with changes in Fluid Cognition. Long-term, multi-domain CT improves cognitive functioning and functional connectivity and delays structural brain decline in aMCI (ClinicalTrials.gov number: NCT03883308).

The impact of sex differences on stroke risk factors and 3-month outcomes in patients receiving thrombolytic therapy for acute ischemic stroke

BackgroundAcute ischemic stroke (AIS) is a major public health issue, and women have a disproportionate share of stroke-related disability and mortality, which is poorly understood. This study aimed to determine the effect of sex differences on AIS treated by thrombolysis using recombinant tissue plasminogen activator (rTPA). The study included 134 AIS patients eligible for rTPA. Risk factors, clinical presentation, thrombolysis response, complications, and outcomes were recorded. The outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) 3 months after stroke. The incidence of intracranial haemorrhage was also determined.ResultsAmong 134 AIS patients treated with rTPA (59% male, 41% female), females had higher rates of hypertension (67.3% versus 49.4%, p = 0.040) and atrial fibrillation (AF) (12.7% versus 2.5%, p = 0.020), while smoking was more prevalent in males (31.6% versus 0%, p < 0.0001). Cardioembolism was more frequent in females than in males (23.6% versus 6.3%, p = 0.004). Females also had shorter onset-to-door (110.7 ± 63 versus 131.1 ± 50.2 min, p = 0.035) and onset-to-needle times (151.6 ± 66.5 versus 173.7 ± 50.6 min, p = 0.046). Both sexes showed significant improvements in NIHSS (males: 11.58 ± 3.7 to 6.05 ± 5.6; females: 11.64 ± 4.7 to 6.9 ± 5.9; p < 0.0001) and mRS scores (males: 3.34 ± 1.05 to 2.03 ± 2; females: 3.53 ± 1 to 2.02 ± 2; p < 0.0001) over 3 months, with no significant differences between sexes. Predictors of poor outcome (mRS 3–6) differed: diabetes mellitus (DM) (OR 7.79, p = 0.002) and longer door-to-needle time (OR 1.04, p = 0.008) for males, and hemorrhage (OR 9.41, p = 0.048) for females. Hemorrhage predicted mortality in males (OR 27.08, p < 0.0001), while AF was associated with increased mortality in females (OR 8.06, p = 0.024).ConclusionsThis study revealed sex-specific differences in AIS risk factors, aetiology, and rTPA treatment timelines, although post-treatment improvements were comparable between sexes. Notably, outcome predictors and mortality factors differed by sex. These findings emphasize the need for sex-specific considerations in AIS management and risk assessment.

A comparison of the therapeutic efficacy of Tenofovir Disoproxil Fumarate and Entecavir in patients with chronic Hepatitis-B.

To compare the therapeutic efficacy of tenofovir disoproxil fumarate (TDF) and entecavir (ETV) in patients with chronic Hepatitis-B (CHB). This retrospective study included 110 patients with CHB who received treatment at The First People's Hospital of Linping District, Hangzhou from January 2021 to January 2023. Clinical data of the patients were reviewed and the patients were classified according to the treatment received: TDF group (n=53, patients received TDF treatment) and ETV group (n=57, patients received ETV treatment). Hepatitis-B virus deoxyribonucleic acid (HBV DNA) levels, liver function indicators, hepatitis-B e antigen (HBeAg) seroconversion rate, alanine transaminase (ALT) normalization rate, HBV DNA negative conversion rate, overall efficacy, and incidence of adverse reactions were compared. The total efficacy of the treatment in the TDF group was 94.33%, significantly higher than that in the ETV group (78.95%; P<0.05). After the treatment, the HBV DNA levels in both groups decreased compared to pretreatment levels, and were significantly lower in the TDF group compared to the ETV group (P<0.05). Both groups showed significant post-treatment improvement in liver function that was markedly better in the TDF group compared to the ETV group (P<0.05). The HBeAg seroconversion rate, ALT normalization rate, and HBV DNA conversion rate in the TDF group were significantly higher compared to the ETV group (P<0.05). There was no difference in the incidence of adverse reactions between the two groups. Compared with ETV, TDF has comparable adverse reaction profile but has more significant clinical effects in patients with CHB, improving HBeAg seroconversion rate, ALT normalization rate, and HBV DNA negative conversion rate. TDF is associated with lower HBV DNA levels after treatment and better improvements in liver function of patients.

Internet-based cognitive behavioural therapy for insomnia comorbid with chronic benign pain – A randomized controlled trial

BackgroundComorbid sleep disturbances are common among individuals with chronic pain, and Cognitive Behavioural Therapy for Insomnia (CBT-i) has proven effective for such individuals. Nonetheless, research on web-based CBT-i tailored for patients with both chronic pain and insomnia is limited. This study aimed to evaluate the feasibility and efficacy of internet-based CBT-i and to explore potential mechanisms underlying treatment outcomes. MethodsIn this study, 85 participants suffering from comorbid insomnia and chronic pain were randomized into two groups: Internet-based CBT for Insomnia (ICBT-i) and Internet-based Applied Relaxation (IAR). Both interventions spanned eight weeks, supported by therapeutic guidance throughout. ResultsParticipation was modest, with an average module completion of 2.0 out of 8 for ICBT-i and 2.4 for IAR. Both interventions significantly alleviated insomnia symptoms on one of the insomnia measures post-treatment, without notable differences between them. Directly after treatment, IAR outperformed ICBT-i in reducing pain interference, anxiety, and in enhancing self-rated health, though these differences lessened at the 6-month follow-up. Potential therapeutic mechanisms may involve attenuating maladaptive sleep beliefs and augmenting sleep-related willingness. ConclusionsThe study encountered low engagement rates, with approximately one-third of participants not completing any module. The limited efficacy of ICBT-i may be due to low treatment involvement, with few patients completing key techniques like sleep compression and stimulus control. Despite the low adherence, both interventions yielded post-treatment improvements in insomnia symptoms, but to establish internet-based treatments for insomnia as a viable option in chronic pain management, patient engagement must be improved.

An intensive eye-tracking intervention in children with dyskinetic cerebral palsy: a multiple case study

This study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers’ perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.