Treatment Sessions Research Articles

Predictors of treatment attendance in patients with posttraumatic stress disorder and comorbid personality disorders

IntroductionHigh dropout and low treatment attendance rates among patients with posttraumatic stress disorder (PTSD) and personality disorders (PDs) continue to pose a significant challenge. Despite numerous studies focusing on enhancing treatment attendance, the identification of consistent and reliable predictors in patients with PTSD and comorbid PDs remains limited. ObjectivesThis study aims to investigate a wide range of potential predictors of treatment attendance, encompassing demographic, patient-severity, treatment, and therapist-related variables in patients with PTSD and comorbid borderline and/or cluster C PDs. MethodsUtilizing data from 255 patients participating in two randomized controlled trials comparing trauma-focused treatment with or without concurrent PD treatment, candidate predictors were individually analyzed in univariate regression models. Significant predictors were then combined in a multiple ordinal regression model. ResultsIn total, 40% of patients attended fewer trauma-focused treatment sessions than the minimum recommended in treatment guidelines. Out of the 38 candidate predictors examined, five significant, independent predictors of treatment attendance emerged in a multiple ordinal regression model. Higher baseline PTSD severity (OR = 1.04, p = .036), higher education level (OR = 1.22, p = .009) and a stronger patient-rated working alliance (OR = 1.72, p = .047) with the therapist predicted higher treatment attendance. Conversely, inadequate social support from friends (OR = 0.90, p = .042) and concurrent PD treatment and trauma-focused treatment (OR = 0.52, p = .022) were associated with lower treatment attendance. ConclusionsIn conclusion, this constitutes the first study investigating predictors of treatment attendance in patients with PTSD and comorbid PDs. The results highlight the complexity of pinpointing reliable predictors. Nevertheless, the identification of five predictors provides valuable insights, aiding clinicians in customizing treatment strategies for individual patients and enhancing overall treatment attendance.

Addressing Burn Hypertrophic Scar Symptoms Earlier: Laser Scar Revision May Begin as Early as 3-6 Months After Injury.

Fractional ablative CO2 laser (FLSR) is used to treat hypertrophic scars (HTSs) resulting from burn injuries,which are characterized by factors, such as erythema, contracture, thickness, and symptoms of pain and itch. Traditionally, waiting a year after injury for scar maturation before starting laser treatment has been recommended;however, the potential benefits of earlier intervention have gained popularity. Still, the optimal timing for beginning laser intervention in patients with HTSs remains uncertain. This study aims to evaluate the ideal timing for the initiation of FLSR for HTSs using several qualitative and quantitative assessment measures. It was hypothesized that early intervention would lead to similar improvement trends as later intervention, however, would be more ideal due to the shortened time without symptom relief for patients. Patients who received three or more laser treatment sessions and completed both pre- and posttreatment evaluations were included in this analysis (n = 69). FLSR treatment was administered at 4-8-week intervals. Patients starting treatment before 6 months after injury were classified as the early-stage intervention group and those beginning treatment at 6-12 months after injury were classified as the late-stage intervention group. Demographic data, including the age of patients at the time of first treatment, age of scars at the time of first treatment, biological sex, ethnicity, Fitzpatrick skin type, and use of laser-assisted drug delivery, were collected by retrospective chart review. Patients were evaluated on six subjective scales and objectively for scar stiffness with durometry. For all scales, higher scores indicate worse scars. A two-way ANOVA, Student's t-test, and Mann-Whitney U-test were used to compare scores from the pre- to posttreatment evaluations. There were no significant differences between the groups for any of the demographic or scar-specific variables; thus, differences in outcome can be attributed to the timing of intervention. Both groups demonstrated an improvement in scars with treatment over time (p < 0.05). Both early- and middle-stage initiation showed scar symptom improvement in five out of six scales. In the late-stage intervention, the Patient and Observer Scar Assessment Scale-Patientaverage score did not show improvement. In the early-stage intervention, the Vancouver Scar Scaletotal did not show improvement. Quantitative evaluation of scar stiffness by durometry did not show symptom improvement in either group. The Scar Comparison Scaledemonstrated the greatest improvement across groups. Laser treatment led to scar improvement in at least one scale at each stage of initiation. Both intervention timelines resulted in equivalent outcomes, and early intervention should be considered when initiating FLSR treatment in burn scars to alleviate symptoms earlier.

Evaluation of the effectiveness of picosecond KTP and fractional thulium lasers on pigmented-type periorbital dark circles.

To determine the effectiveness of picosecond KTP in reducing peri-ocular dark circles caused mainly by excessive pigmentation and to compare Picosecond KTP with Thulium laser ability in reducing the intensity and extent of peri-ocular dark circles. This split-face prospective study included twelve women with periorbital dark circles (pigmented or mixed-pigmented type). The left lower eyelid was treated using the PicoHi machine (HIRONIC Ltd), a full beam Q-switched Nd-YAG provided by KTP crystal (523nm) at settings of 0.3J/cm2, 5mm, 5Hz, and 300 Ps. Whereas the right lower eyelid was treated using the Lavieen machine (WON TECH Co., Ltd), a fractional Thulium laser (1927nm) at setting 1320mJ/cm2, 30 × 15mm, 1500 microseconds. Patients received a series of 3 treatment sessions, given at 4-week intervals. The 532-nm full beam Q-switched KTP and fractional Thulium lasers were more likely to induce post-inflammatory hyperpigmentation rather than decrease the pigmentation. The risk is higher with a Q-switched KTP laser, which may be attributed to the skin tone of the participants. Nonetheless, some improvement in the pigmented type of PDCs, although not detected clinically, was documented by the VISIA software. No solid conclusion can be drawn from the results of the study. Picosecond KTP and Thulium lasers may have a role in reducing PDCs yet more studies should be performed in order to determine the exact impact these lasers have.

Fractional Ablative Carbon Dioxide Laser-Assisted Photodynamic Therapy for keloids: Clinical, Histopathological and Immunohistochemical Evaluation

Abstract Background Keloids present a therapeutic challenge due to lack of satisfactory treatment and high rate of recurrence. Various treatment modalities exist, including intralesional steroids, photodynamic therapy (PDT), lasers and different combinations have been used to reach better results. Aim To study whether fractional ablative CO2-assisted delivery of Methylene blue-PDT is an effective method of treatment of keloids. Methods twenty patients with untreated keloids have been treated with 3 monthly sessions of fractional CO2 laser and methylene blue PDT. In the first session debulking of the keloid’s height by at least 50% with ablative CO2 was performed. Patients were photographed and assessed before treatment and 2 months after last session, clinically using modified Vancouver Scar Scale (mVSS) &amp; patient and observer scar assessment scale (POSAS), histopathologically by H&amp;E, Masson trichrome and immunohistochemically by TGF-b. Results total score for mVSS dropped from 8.25 ± 2.489 to 6.45 ± 2.8 (p = 0.013) after treatment, with a percentage change of -18.6 ± 39.6. Also, POSAS (observer) decreasaed from 26.90 ± 6.545 to 18.75 ± 8.045 (p = 0.001). POSAS (patient) decreased from 27.40 ± 6.644 to 19.05 ± 7.722 (p = 0.0001) Histopathologically, collagen improved from 3.45 ± 1.05to 2.65 ± 0.875. The TGFb staining increased post treatment but not significantly. Conclusions clinical and histopathological improvement was seen after MB-PDT but further controlled studies are needed to compare its effectiveness with other established modalities. Also compare results of different parameters of fractional CO2-PDT, more treatment sessions and study the long term follow up results.

Efficacy of a nurse-led sexual rehabilitation intervention for women with gynaecological cancers receiving radiotherapy: results of a randomised trial.

The multicentre randomised SPARC trial evaluated the efficacy of a nurse-led sexual rehabilitation intervention on sexual functioning, distress, dilator use, and vaginal symptoms after radiotherapy for gynaecological cancers. Eligible women were randomised to the rehabilitation intervention or care-as-usual. Four intervention sessions were scheduled over 12 months, with concurrent validated questionnaires and clinical assessments. Primary outcome was the Female Sexual Function Index (FSFI). A generalised-mixed-effects model compared groups over time. In total, 229 women were included (n = 112 intervention; n = 117 care-as-usual). No differences in FSFI total scores were found between groups at any timepoint (P = 0.37), with 12-month scores of 22.57 (intervention) versus 21.76 (care-as-usual). The intervention did not significantly improve dilator use, reduce sexual distress or vaginal symptoms compared to care-as-usual. At 12 months, both groups had minimal physician-reported vaginal stenosis; 70% of women were sexually active and reported no or mild vaginal symptoms. After radiotherapy and brachytherapy, 85% (intervention) versus 75% (care-as-usual)of participants reported dilation twice weekly. Sexual rehabilitation for women treated with combined (chemo)radiotherapy and brachytherapy improved before and during the SPARC trial, which likely contributed to comparable study groups. Best practice involves a sexual rehabilitation appointment 1 month post-radiotherapy, including patient information, with dilator guidance, preferably by a trained nurse, and follow-up during the first year after treatment. NCT03611517.

Boron neutron capture therapy as a larynx-preserving treatment for locally recurrent laryngeal carcinoma after conventional radiation therapy: A preliminary report

ObjectiveLaryngeal preservation and a radical cure are the treatment goals for laryngeal carcinoma, and larynx-preserving therapy is generally preferred for early-stage laryngeal carcinoma. When laryngeal carcinoma recurs locally, patients are often forced to undergo total laryngectomy, resulting in loss of vocal function. However, many patients with laryngeal carcinoma who have residual or recurrent disease after radiotherapy wish to preserve their voice. The purpose of this study was to investigate the possibility of using BNCT as a larynx-preserving treatment for residual or recurrent laryngeal carcinomas following radical irradiation. Patients and MethodsThis study included 15 patients who underwent BNCT for residual or recurrent laryngeal carcinoma after radical laryngeal carcinoma irradiation. The number of treatment sessions for all patients was one irradiation. Before BNCT, the recurrent laryngeal carcinoma stage was rT1aN0, rT2N0, rT2N1, rT3N0, rT3N1, and rT4aN0 in one, six, one, three, one, and three patients, respectively. The median maximum tumor diameter before BNCT was 15 mm (8–22 mm). All patients underwent a tracheostomy before BNCT to mitigate the risk of upper airway stenosis due to laryngeal edema after BNCT. Treatment efficacy was evaluated retrospectively using monthly laryngoscopy after BNCT and contrast-enhanced CT scans at 3 months. The safety of treatment was evaluated based on examination findings and interviews with patients. ResultsThe median hospital stay after BNCT was 2 days (1–6). The response rate at three months after BNCT in 15 patients with locally recurrent laryngeal carcinoma was 93.3 %, and the CR rate was 73.3 %. The most frequent adverse event associated with BNCT was laryngeal edema, which occurred in nine patients the day after BNCT. The average course of laryngeal edema peaked on the second day after BNCT and almost recovered after 1 week in all patients. One patient had bilateral vocal fold movement disorders. None had dyspnea because of prophylactic tracheostomy. No grade four or higher adverse events occurred. Other grade 2 adverse events included pharyngeal mucositis, diarrhea, and sore throat. Three months after BNCT, tracheostomy tubes were removed in nine patients, retinal cannulas were placed in three patients, and voice cannulas were placed in three patients. ConclusionsBNCT for locally recurrent laryngeal carcinoma can safely deliver radical irradiation to tumor tissues, even in patients undergoing radical irradiation. BNCT has shown antitumor effects against recurrent laryngeal carcinoma. However, further long-term observations of the treatment outcomes are required.

The Role of Repetitive Transcranial Magnetic Stimulation in Reduction of Opioid Craving; A Single Blinded Randomized Sham Controlled Clinical Trial

Abstract Background Opioid use disorder (OUD) poses a great concern due to problems associated with their abuse as well as fatal and non fatal overdose consequences. Craving has a complex relationship with opioid use and relapse. Developing new, effective treatments for substance use disorders (SUDs), including opioid use disorders is crucial. This study aimed to assess the effect of 18 sessions of high frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on opioid craving in early abstinence using brief substance craving scale (BSCS) for Tramadol and morphine and Heroin craving questionnaire (HCQ) for Heroin craving. Results There was a statistically significant reduction in craving scores in the group of OUD patients receiving real rTMS compared to those receiving sham rTMS for both BSCS( p value = 0.044) and HCQ (p value = 0.002). A statistically significant positive correlation was revealed between the number of hospital admissions and the mean scores of post rTMS HCQ scores (r = 0.05, p value = 0.040). Conclusion High frequency 10 Hz rTMS over the left DLPFC for 18 treatment sessions reduced craving OUD patients during early abstinence. These preliminary results suggest that 10 Hz rTMS of the left DLPFC may be used in treatment of OUD; so our study recommends that use of rTMS in reduction of opioid craving in early abstinence.

Evaluation of Intralesional Injection of Combined Furosemide and Digoxin Formula In Genital Warts

Abstract Background External genital warts (EGWs) are benign epidermal growths on the anogenital regions, which can occur in both women and men. They are caused by the human papillomavirus (HPV). More than 90% of cases of anogenital warts are caused by HPV types 6 and 11.There are several different ways to treat genital warts with varying degrees of success. However, till now no definitive treatment has emerged as the ideal standard of care in the treatment of genital warts and this has developed the need for new ways and modalities to help manage genital warts more efficiently. Objective To evaluate and verify efficacy, safety and tolerability of intralesional ionic anti-viral injection of combined furosemide and digoxin in treatment of multiple resistant genital warts. Patients and Methods This study included 30 patients divided into 2 groups, 15 patients each, the study group received intralesional injection of combined digoxin and furosemide, one injection every week for maximum 5 injection sessions (5 weeks). 0.3 ml of combined digoxin and furosemide solution was slowly injected into the base of each wart with maximum 5 warts in the session, and the other group received intralesional saline as a control group. Results Both groups demonstrated insignificant differences regarding all demographic characteristics (age, sex, size of warts before treatment, number of warts before treatment and number of sessions) as well as duration of disease. The treatment used in this study was safe and tolerable with no systemic exposure with regards to the cardiac system (by ECG before and after treatment). Future studies are recommended on larger number of the patients with multiple genital warts. It might be helpful to try increasing the number of treatment sessions, increasing the number of warts treated per session, decreasing the interval between the sessions or increasing the concentration of the active treatment. Conclusion Intralesional injection of combined digoxin and furosemide wasn’t effective intreatment of genital warts.

Using PARO, a robotic seal, to support people living with dementia: ‘what works’ in inpatient dementia care settings?

Abstract Introduction: The robotic seal PARO has received increased attention as a new technology to support people living with dementia in terms of emotional and physiological outcomes. However, little research has been conducted to improve understanding of how and why PARO may work within inpatient dementia care. We investigate for whom PARO works best in this setting, and why PARO may work. Methods: Informed by principles from realist methodology, qualitative interviews were conducted with healthcare professionals, participants with dementia and their relatives to explore experiences related to the delivery and receipt of an intervention using PARO in an inpatient dementia ward in the United Kingdom (UK). Observations of PARO intervention sessions were conducted to gain further insight into provision and implementation of sessions using PARO in ‘real time’. Data were analysed using thematic analysis, and using the process of configuration mapping, we constructed a visualisation of our findings framed within the Intervention-Context-Actor-Mechanisms-Outcomes (ICAMO) model. Results: The visualisation of our findings framed within the ICAMO model suggests that PARO may result in positive outcomes within inpatient dementia care due to a range of potential mechanisms, including enhancement of social interactions, developing a sense of attachment, evoking emotive memories, physical interaction, and perceiving the robotic animal as a live being. For these mechanisms to be activated, the sessions should be structured but participant-led, and be delivered as needed in a one-to-one setting by a skilled facilitator. Conclusion: Using PARO in an inpatient dementia care context appeared promising and well-received in this small observational study. This study explicitly considers the context and mechanisms of using PARO within inpatient dementia care settings, presenting findings in a structured visualisation framed within the ICAMO model and offering a theoretical basis for future intervention research.

Biofeedback combined with percutaneous electrical pudendal nerve stimulation for the treatment of low anterior rectal resection syndrome: a study protocol for a randomized controlled trial

BackgroundLow anterior resection syndrome (LARS) is a distressing condition that affects approximately 25–80% of patients following surgery for rectal cancer. LARS is characterized by debilitating bowel dysfunction symptoms, including fecal incontinence, urgent bowel movements, and increased frequency of bowel movements. Although biofeedback therapy has demonstrated effectiveness in improving postoperative rectal control, the research results have not fulfilled expectations. Recent research has highlighted that stimulating the pudendal perineal nerves has a superior impact on enhancing pelvic floor muscle function than biofeedback alone. Hence, this study aims to evaluate the efficacy of a combined approach integrating biofeedback with percutaneous electrical pudendal nerve stimulation (B-PEPNS) in patients with LARS through a randomized controlled trial (RCT).Methods and analysisIn this two-armed multicenter RCT, 242 participants with LARS after rectal surgery will be randomly assigned to undergo B-PEPNS (intervention group) or biofeedback (control group). Over 4 weeks, each participant will undergo 20 treatment sessions. The primary outcome will be the LARS score. The secondary outcomes will be anorectal manometry and pelvic floor muscle electromyography findings and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 29 (EORTC QLQ-CR29) scores. Data will be collected at baseline, post-intervention (1 month), and follow-up (6 months).DiscussionWe anticipate that this study will contribute further evidence regarding the efficacy of B-PEPNS in alleviating LARS symptoms and enhancing the quality of life for patients following rectal cancer surgery.Trial registrationChinese Clincal Trials Register ChiCTR2300078101. Registered 28 November 2023.

Effect of peppermint inhalation versus Swedish massage on chemotherapy induced-nausea and vomiting in children with leukemia: Multi-arm randomised trial design

BackgroundChemotherapy is the foremost treatment for children with leukemia, while causing different serious side-effects. Chemotherapy-induced nausea and vomiting are the most common deliberating side effects and critical concerns of pediatric oncology nurses among those children. AimTo investigate the effect of peppermint inhalation versus Swedish massage on chemotherapy-induced nausea and vomiting in children with leukemia. DesignA multi-arm randomised trial design with three parallel groups. SettingThis study was conducted at outpatient and inpatient Hematology/leukemia Units at Alexandria University Children's Hospital at Smouha. MethodsSeventy-five children with leukemia received the first chemotherapy session. They were randomly allocated into three equal groups, 25 children in each group (control, peppermint inhalation, and Swedish massage groups). Every child is assessed for nausea and vomiting before chemotherapy administration and after for three days for consecutive three sessions of treatment. ResultsStudy findings revealed that children in peppermint inhalation and Swedish massage groups showed significant reduction in mean total score of chemotherapy-induced nausea and vomiting among peppermint inhalation and Swedish groups (15.120 ± 4.585 and 14.680 ± 3.158, respectively) was observed on third chemotherapy session than in control group (45.680 ± 5.793) (p < 0.001). ConclusionIt can be concluded that Swedish massage and peppermint inhalation therapies may have significant antiemetic effects as alleviating the chemotherapy induced nausea and vomiting for children with leukemia. Practice implicationsThis study directs the pediatric oncology nurses to incorporate peppermint inhalation and Swedish massage therapies besides antiemetic drugs in pediatric oncology unit protocols for management of chemotherapy induced nausea and vomiting.

Dual-wavelength dye laser combined with betamethasone injection for treatment of keloids: protocol of a randomised controlled trial

IntroductionKeloids, benign fibroproliferative tumours characterised by excessive fibroblast proliferation and over-deposition of extracellular matrix, pose a therapeutic challenge with high recurrence rates. Betamethasone (diprospan) injection (BI) is one of the...

Fractional picosecond laser treatment of non-acne atrophic scars and scar erythema in Chinese patients.

Fractional picosecond lasers (FPL) are reported to be effective and safe for atrophic acne scars and post-acne erythema. However, there is no evidence regarding the effectiveness and safety of FPL treatment for non-acne atrophic scars and scar erythema among Chinese patients. In this retrospective study, 12 Chinese patients with non-acne atrophic scars, including nine with scar erythema, were treated with one to three sessions of 1064nm FPL treatment. Clinical improvement was objectively assessed through blinded evaluations by external physicians. A modified Manchester Scar Scale (mMSS) and the Clinician Erythema Assessment Scale (CEAS) were individually used to evaluate atrophic scars and scar erythema based on photographs. Physician-assessed and subject-assessed Global Aesthetic Improvement Scale (GAIS) were used to assess changes before and after FPL treatment. Patient satisfaction and adverse events were also documented. Total mMSS scores, as well as three parameters (color, distortion, and texture), were significantly decreased after FPL treatment, with a mean reduction of 3.18±1.60 in total scores (p<0.05). The CEAS scores were significantly reduced from 2.41±0.98 before treatment to 0.41±0.40 at the final visit (p<0.05). Based on physician-assessed and subject-assessed GAIS scores, 11 (91.7%) patients were improved after FPL treatment. 33.3% of patients were very satisfied, and 41.7% were satisfied. No serious, prolonged (>3weeks) adverse events were observed. Our study suggests that 1064nm FPL treatment may be a promising option for non-acne atrophic scars, especially with scar erythema. Further studies are needed to confirm our results.

Text-Based Inference Instruction for Elementary Grade Children with Reading Comprehension Difficulties: An Intervention Research

"The current study investigated the effects of inference instruction on text-based inferences by third graders who are below average in reading comprehension but average in reading fluency and cognitive abilities. Text-based inferences occur when the preceding text has an identifiable causal antecedent. Participants were randomly assigned and attended twelve 30-minute sessions of the inferences training intervention. We have included strategies for integrating information from the text to improve reading comprehension skills. We provide an overview of how specific text-based instruction influences reading comprehension processes and outcomes and can lead to increased reading comprehension. The comparison of pretest and posttest results in the experimental group showed a significant gain in the following variables: generating inferences and providing arguments for using rules and constraints. Finally, we discuss how consideration of these potential sources of instruction has practical implications for designing and selecting instructional materials. Key-words: reading comprehension, text-based inferences, reading comprehension instruction, inferences, inference instruction, reading comprehension difficulties"

Embodied Spatial Navigation Training in Mild Cognitive Impairment: A Proof-of-Concept Trial

Background: Egocentric and allocentric spatial memory impairments affect the navigation abilities of older adults with mild cognitive impairment (MCI). Embodied cognition research hints that specific aids can be implemented into virtual reality (VR) training to enhance spatial memory. Objective: In this study, we preliminarily tested ‘ANTaging’, an embodied-based immersive VR training for egocentric and allocentric memory, compared to treatment as usual (TAU) spatial training in MCI. Methods: MCI patients were recruited for this controlled trial. A cognitive battery was administered at pre-test, after ten sessions of ANTaging or TAU intervention, and at 3-month follow-up (FU). The primary outcomes were spatial cognition tests (Corsi supra-span, CSS; Manikin test, MT). VR egocentric and allocentric performance was also collected. Results: We found that ANTaging significantly improved MT scores at FU compared to TAU. CSS slightly improved in both groups. Concerning secondary outcomes, auditory-verbal forgetting significantly improved at post-test in the ANTaging but not TAU group and significantly declined at FU in the TAU but not in the ANTaging group. Global cognition significantly improved at FU for TAU and remained stable for ANTaging. Other tests showed no improvement or deterioration. Clinical significance showed that ANTaging is effective for CSS. Virtual egocentric and allocentric memory performance improved across ANTaging sessions. Conclusions: ANTaging holds the potential to be superior for improving spatial cognition in MCI compared to TAU. Embodied cognition research provides insights for designing effective spatial navigation rehabilitation in aging.

Exploring the Efficacy of a Remote Strategy-Based Intervention for People With Multiple Sclerosis With Everyday Memory Impairments: A Pilot Study.

This pilot study evaluates a remote strategy-based intervention for individuals with multiple sclerosis who experience everyday memory impairments. The intervention can potentially inform cognitive rehabilitation for this population. To investigate the feasibility and efficacy of an intervention (TELE-Self-GEN) to determine whether it can alleviate everyday memory impairments of individuals with multiple sclerosis. Pretest-posttest. Community. Ten adults with multiple sclerosis. Six synchronous treatment sessions were delivered online via Zoom. The treatment protocol embedded a memory strategy (self-generated learning) within a metacognitive framework, including self-awareness and self-management strategies. The treatment emphasizes when and how self-generation should be used. Measurements assessed feasibility and participants' satisfaction with the intervention and its delivery method, as well as memory, everyday memory, and functional performance. Participants expressed high satisfaction with the virtual treatment, highlighting its convenience as a key factor. Treatment resulted in improvements in memory performance, perceived memory ability in daily life, and functional performance. Results provide initial proof of concept in the utilization of a remotely delivered, strategy-based treatment approach to improve memory performance and functional abilities. The pilot data support a larger randomized clinical trial of the TELE-self-GEN. Plain-Language Summary: The results of this pilot study highlight the promising potential of TELE-self-GEN for people with multiple sclerosis (MS), who face memory challenges every day. This remotely delivered, strategy-based occupational therapy treatment approach, TELE-self-GEN, has the potential to significantly improve functional memory. The study participants reported improvements in their memory performance, perceived memory ability in daily life, and functional performance. These encouraging results serve as a foundation for more extensive clinical trials using TELE-self-GEN for people with MS.

Patient Retention in a Substance Use Disorder Telemedicine Clinic.

Although research has continued to show that substance use disorders (SUDs) can be treated effectively with evidence-based treatment, there continues to be gaps in access, and utilization remains low. Alternative SUD treatment methods, including telemedicine, are increasingly being explored to reach patients where traditional in-person treatment approaches are inaccessible. This cross-sectional study aimed to explore SUD treatment retention, specifically comparing telemedicine-delivered opioid use disorder (OUD) treatment with a traditional in-person treatment delivery approach. Patients at Cahaba Medical Care, an FQHC in Birmingham, AL with a diagnosis of OUD and undergoing buprenorphine/naloxone or buprenorphine treatment were categorized into two groups: treatment and control. The dependent variable, retention to SUD treatment, was assessed at four different time periods over 12 months to determine patient SUD consultation appointment attendance. Multiple linear regression was used to examine the relationship between SUD treatment retention and delivery mode. Correlations were obtained to assess associations between frequency of urine drug screens performed and SUD treatment retention. As the number of the urine drug screens patients received increased by 1, the number of SUD treatment program consultations patients attended increased by 0.69 (P < 0.001). There was no significant difference in SUD treatment retention between traditional in-person and telemedicine delivered approaches, however. The findings of this study suggest that a telemedicine-delivered treatment program equals retention effectiveness when compared with in-person delivery. This suggests that leveraging telemedicine to treat patients with SUD could be an effective alternative for those unable to access treatment or who are less likely to attend or complete traditional in-person treatment sessions.

Financial toxicity, coping strategies, and quality of life among Chinese patients with hematologic malignancies: a cross-sectional study.

Financial toxicity is used to describe the financial hardship experienced by cancer patients. Financial toxicity may cause negative consequences to patients, whereas little is known in Chinese context. This study aimed to explore the level of financial toxicity, coping strategies, and quality of life among Chinese patients with hematologic malignancies. We conducted a prospective, observational study among 274 Chinese patients with hematologic malignancies from November 2021 to August 2022 in Sun Yat-sen University Cancer Center. Clinical data were extracted from electronic clinical records. Data on financial toxicity, coping strategies, and quality of life were collected using PRO measures. Chi-square or independent t test and multivariate logistic regression were performed to explore the associated factors of financial toxicity and quality of life, respectively. Effects of financial toxicity on coping strategies were examined using Chi-square. The mean age of the participants was 50.2 (± 14.6) years. Male participants accounted for 57.3%. About half of the participants reported high financial toxicity. An average median of ¥200,000 on total medical expenditures since the diagnosis was reported. The average median monthly out-of-pocket health expenditure relating to cancer treatment was ¥20,000 (range ¥632-¥172,500) after reimbursement. Reduce daily living expenses (64.9%), borrowing money (55.7%), and choosing cheaper regimens (19.6%) were the commonly used strategies to cope with financial burden. Financial toxicity was negatively associated with quality of life (β = 0.071, P = 0.001). Financial toxicity was not uncommon in patients with hematological malignancies. Reducing daily living expenses, abandoning treatment sessions, and borrowing money were the strategies commonly adopted by participants to defray cancer costs. Additionally, participants with high level of financial toxicity tended to have worse quality of life. Therefore, actions from healthcare providers, policy-makers, and other stakeholders should be taken to help cancer patients mitigate their financial toxicity.

The efficacy of core stability exercises versus conventional physiotherapy in lower back pain

Context: Practice guidelines recommend various types of general exercise and core stability exercises with electrotherapeutic modalities for chronic back pain but it remains the primary cause of absenteeism and disability. Chronic low back pain causes activity limitation in persons younger than 45 years. Core stability exercise is becoming increasingly popular for low back pain. Aims: To find out the effectiveness of core stability exercises on Pain and Disability in patients with chronic low back pain Settings and Design: A comparative study was done in the Physiotherapy OPD of Mahatma Gandhi Medical College &amp; Hospital Jaipur. Methods and Material: 40 subjects suffering from low back pain as per the inclusion and exclusion criteria were enrolled. The subjects were divided into two Group A (core stability) and Group B (General exercises). Before the treatment session, the pain and disability of the patients in each group were assessed with the help of the VAS scale and ODI scale respectively. After 15 days they were again assessed and the improvement levels were calculated. Statistical analysis used: Paired t-test was used to analyze significant changes between pre-test &amp; post-test measurements. Results: Statistical analysis made with the quantitative data revealed a statistically significant difference between the Core stability group &amp; General exercises group on pain &amp; disability level. Group A (core stability) improved in VAS and ODI compared to Group B (General exercises) with P values of 0.018 and 0.021 respectively. Conclusions: The findings reveal that core stability exercises are more effective than General exercises in chronic low back pain patients.

Increasing the Duration of On-Task Behavior in Children with Borderline Intellectual Functioning through Shaping Techniques

This study aims to investigate and apply behavior modification principles, specifically using shaping techniques, to increase the duration of on-task behavior in children with Borderline Intellectual Functioning (BIF). The techniques used include antecedent control, reinforcement through token economy, and providing prompts to the participant. This study uses a single-subject design conducted over a total of 22 intervention sessions. The participant in this study is an 8-year and 7-month-old boy with BIF. The results of the study indicate an increase in the average duration of on-task behavior from 19 minutes in the initial measurement (pre-test) to 64 minutes in the final measurement (post-test) and 54 minutes in the follow-up measurement. It can be concluded that behavior modification principles, specifically using shaping techniques, can help to improve on-task behavior duration in children with Borderline Intellectual Functioning.