Outpatient Training Research Articles

Outpatient exercise training for chronic lung disease - for whom, how and why?

There is a legal entitlement to participate in outpatient exercise groups in accordance with the German Social Code (Book IX) which regulates and facilitates prescriptions for patients with chronic respiratory diseases. A medical examination with specific inclusion and exclusion criteria prior to admission to an exercise group ensures safe participation.Traditional outpatient exercise groups are conducted in face-to-face groups for 60 to 90 minutes, once a week, with structured warm-up, main and cool-down phases. In addition, since the coronavirus pandemic, the introduction of online exercise groups via videoconferencing has enabled flexible participation (even without a prescription). To date, more than 11,000 German patients have participated in online exercise groups since 2021.Scientific evidence confirms the significant benefits of regular exercise, such as improved physical performance and reduced breathlessness. The psychosocial benefits and the promotion of self-efficacy are additionally supported by the supervision of a specialized trainer. Regular exercise (e.g. in outpatient exercise groups) is an inexpensive and very effective form of therapy to improve the quality of life of people with chronic respiratory diseases.

What does current diabetes and endocrine speciality outpatient training look like and what will change? Observations from a single training region in England

Introduction: Diabetes and endocrine speciality training in the UK has traditionally been lasted five years but moved to a four- year model in 2021 with the introduction of the Internal Medical Training (IMT)3 year programme. Here we aim to review the case mix of outpatients seen by a single diabetes and endocrinology Specialty Registrar (SpR) during clinical training and offer insights into the range of patients seen. We will also review the NHS ePortfolio entries for Diabetes and Endocrinology and for General Internal Medicine to establish how many self-entered forms, assessments (completed and expired) and summary assessments are typically undertaken before certification of completion of training (CCT). Methods: A diabetes and endocrinology registrar (JD) kept an anonymised log of all outpatient consultations from starting speciality training as an ST3 in August 2017 up until his CCT was awarded in May 2023. Duration of training was extended because JD was a less than full time trainee (LFTT), with a period of shared parental leave. Non-patient-identifiable data included diagnosis or presenting complaint of patient seen, type of clinic and date of clinic between August 2017 and May 2023. Following CCT, NHS ePortfolio data were reviewed to establish NHS ePortfolio entries, including the number of requested assessments and number of completions. Results: For the last 18 months of training, approximately 40% of JD’s working time was spent on general medicine and 60% on diabetes and endocrinology. Over the total time of training from 2017 to 2023 JD had a total of 4,150 consultations in outpatient clinics. There were 1,347 consultations in the endocrine clinic and 2,803 consultations in the diabetes clinic. There were 472 ePortfolio entries: 158 of these were self-entered, 284 requested assessments completed and 30 summary or progression assessments. 130 requested assessments expired before completion, giving a response rate of 68.5%. Conclusion: Observations from a single training region in England show that five years of diabetes and endocrinology registrar training provided a broad mix and depth of outpatient experience. The greater number of patients seen in diabetes clinic represents the requirement for service delivery in the area and subspecialist interest being developed. The change to four years’ speciality training is likely to represent around 800 fewer consultations as a speciality trainee in diabetes and endocrinology. The reduction in training opportunities could be addressed through having more protected time for specialist teaching clinics, particularly pump and technology clinics. A large amount of evidence from both the trainee and assessors is required in NHS ePortfolio to achieve CCT in diabetes and endocrinology and general internal medicine. Although the data come only from one trainee and one region, they can provide a point of reference for future analysis of the effect of four years’ speciality specific training on the breadth of training and a stimulus for other trainees and other region to reflect and analyse their rota and data.

Muscle Makers: Evaluating a 10-Week Strength and Nutrition Programme's Impact on Sarcopenia

Abstract Background Sarcopenia is a progressive skeletal muscle disorder characterized by loss of muscle mass and strength, leading to adverse outcomes like physical disability, poor quality of life, and death. The European Working Group on Sarcopenia in Older People (EWGSOP) identifies sarcopenia using criteria including low muscle strength, quantity, quality, and performance. This highlights the importance of early detection and intervention strategies, such as the physiotherapy-led Muscle Makers programme —a 10-week outpatient Progressive Resistance Training (PRT) program with fortnightly Clinical Nutrition input. This data collection aimed to evaluate the programme's effectiveness over a 6-month period. Methods Data was collected on all participants who attended Muscle Makers (one 1-hour session/week) between September 2023 and February 2024. Analysis included participants with both pre- and post-10-week programme outcome measures completed. Data was collected and analysed using MS Excel. Outcome Measures (OCMsused: Timed Up and Go (TUG) and 5-time sit to stand (5TST).Inclusion: Participants with both pre- and post-OCMscompletedExclusion: Participants without pre/post OCMsNon-normally distributed data was log-transformed prior to statistical testing.Results: Number of participants fitting inclusion criteria: 44 (Male: 20, Female: 24)Average age: 80.6 yearsAverage sarcopenia score (SARC F): 4.04 (probable sarcopenia)Average number of falls in the past 12 months: 1.56Average number of classes attended: 8.12 Data Results Conclusion The participants in the Muscle Makers programme achieved significant improvements in both the 5TST and TUG tests, demonstrating enhanced lower body strength, balance, and overall functional mobility. These improvements suggest that the 10-week strength and nutrition intervention effectively mitigates the effects of sarcopenia, highlighting the potential of targeted exercise and nutritional strategies in managing and potentially reversing the progression of this condition.

Oncology pharmacy staffing survey across practice settings in the United States.

This study was developed to provide a resource for staffing model metrics for oncology pharmacies at healthcare organizations. The Hematology/Oncology Pharmacy Association Practice Outcomes and Professional Benchmarking Committee (POPBC) Oncology Pharmacy Staffing Model Task Force designed and distributed a survey to collect baseline data and staffing metrics for oncology pharmacies. The survey was first tested by four POPBC volunteers. The Staffing Model Survey was distributed in multiple phases between September 2021 and January 2022. The task force focused on several different domains including facilities, general metrics, outpatient infusion services, inpatient and outpatient services, informatics/technology, and training and residency programs. Descriptive statistics were used to evaluate the data. A total of 67 responses were received from 68 surveys distributed (98.5%). Of the responders, the majority were from academic medical centers (AMCs) (n = 37, 55%) and community-based centers (CBCs) (n = 21, 31.3%). AMCs reported servicing more inpatient facilities than CBCs (2.1 vs 1.2). For all respondents, 20% tracked in-patient turn-around time compared with 39% of ambulatory sites. Patient education was tracked in all responding settings: 31% for inpatient and 27% for ambulatory. Most sites reported that pharmacy personnel were responsible for cleanroom cleaning (63%) or shared responsibility with an environmental service (37%). Of the 32 sites with ambulatory services, 19 sites were open on Saturday and 15 sites were open on Sundays. Sixty-eight percent of information technology respondents (n = 28) indicated that they use Epic/Beacon (EPIC Oncology Module) as their electronic health record. For the respondents, 89% used closed-system-transfer devices when compounding, 15% used gravimetric technology, and 11% used robotic technology. Oncology pharmacy operations and staffing models are unique to each pharmacy and practice setting. The results of the pharmacy staffing model survey provide an insight into operations across the country and highlight a need for staffing model benchmarking and metrics.

Outpatient Training During Hospice and Palliative Medicine Fellowship: A National Survey

ContextOutpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training. ObjectivesCharacterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education. MethodsA cross-sectional survey of US adult HPM fellowship program directors (PDs) or their designee conducted between March and July, 2023. ResultsOf 161 programs, 85 participated (53% response rate) with representation across all US regions. HPM fellows spend a median of 4.8 weeks in outpatient PC compared to 24 weeks inpatient PC and 10.5 weeks in hospice settings. Over half (51%) of fellows saw outpatients from primarily one disease type with limited exposure to patients with other serious illnesses. Across programs, fellows’ clinic structure, interdisciplinary team composition, and didactic experiences varied. On a 5-point rating scale, PDs reported significantly lower quality outpatient versus inpatient training (mean rating: 3.58 vs. 4.62, P<0.001) and perceived fellows as less prepared for independent outpatient practice upon graduation (mean: 4.06 vs. 4.73, P<0.001). ConclusionOur survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform.

Neurofeedback and meditation technology in outpatient offender treatment: a feasibility and usability pilot study.

Although Cognitive Behavioral Therapy (CBT) is the most often used intervention in forensic treatment, its effectivity is not consistently supported. Interventions incorporating knowledge from neuroscience could provide for more successful intervention methods. The current pilot study set out to assess the feasibility and usability of the study protocol of a 4-week neuromeditation training in adult forensic outpatients with impulse control problems. The neuromeditation training, which prompts awareness and control over brain states of restlessness with EEG neurofeedback, was offered in addition to treatment as usual (predominantly CBT). Eight patients completed the neuromeditation training under guidance of their therapists. Despite some emerging obstacles, overall, the training was rated sufficiently usable and feasible by patients and their therapists. The provided suggestions for improvement can be used to implement the intervention in treatment and set up future trials to study the effectiveness of neuromeditation in offender treatment.

Impact of Ambulatory Blocks on Pulmonary Critical Care Fellow Outpatient Training Experience.

The Accreditation Council for Graduate Medical Education requires Pulmonary and Critical Care Medicine (PCCM) fellows spend a minimum of 7% of their time in the outpatient setting over 3 years of training. In a multi-institutional survey, only 47% of PCCM fellows rated their ambulatory training as adequate. Internal medicine residencies previously adopted the "x + y" scheduling model, which separates inpatient ("x") and outpatient ("y") rotations to provide focused ambulatory experiences, to address similar concerns. To observe the effects of dedicated ambulatory blocks at a single academic PCCM fellowship on fellow exposure to outpatient pulmonary medicine, and on fellow and faculty perceptions of education. In the 2021-2022 academic year, PCCM fellows of all class years in a single academic fellowship program in the northeast United States rotated through four 2-week ambulatory blocks that included longitudinal clinics, themed subspecialty clinics, and a dedicated educational half-day for small group learning. Before the intervention, fellow ambulatory clinics were scheduled longitudinally one-half day per week during inpatient and research blocks. Both fellows and faculty were surveyed before and after the intervention; fellows were also interviewed via focus groups at the conclusion of the intervention. The degree of subspecialty clinic exposure was compared before and after intervention. There was an increase in the quantity and variety of pulmonary subspecialty clinics per fellow when compared with preintervention years (P < 0.01). After intervention, we observed increased fellow satisfaction with ambulatory education, perceived preparedness for independent practice, and satisfaction with subspecialty clinic exposure (P < 0.05). Faculty satisfaction with fellow ambulatory pulmonary education also increased (P < 0.05). Thematic analysis from focus groups highlighted focused topical learning, exposure to the breadth of pulmonary medicine, career development, interaction with engaged faculty experts, and enhanced interprofessional competence. The ambulatory block structure provides a potential model to expand PCCM fellow outpatient pulmonary training through increased exposure to ambulatory pulmonology and dedicated ambulatory teaching. Important features of the ambulatory block structure include separation of outpatient clinics from competing responsibilities, expansion of fellow pulmonary exposure, opportunities for deliberate practice, and faculty engagement in fellow education.

Group social skill training for children on the autism spectrum: an exploratory study of a short-term program in a Chinese outpatient clinic

Objectives Group Social Skill Training (GSST) is a recommended approach for enhancing the social skills of children on the autism spectrum, and it enables therapists to address diverse needs within a single session. However, Chinese families encounter challenges in accessing professional and high-quality GSST training and support services. Notably, outpatient clinic training programs in China often have relatively short durations, yet studies on the effectiveness of short-term GSST for Chinese children are scarce. Methods This study used clinical demonstrations with five children on the autism spectrum aged between 4- to 7-year-olds. The study investigated whether a short-term GSST program effectively improved three social behaviors: initiating a conversation, asking for help, and comforting others. Results The findings revealed three out of the five children’s target social behaviors met the mastery criteria, while the remaining two did not fully meet the criteria still demonstrated clinical improvements. Conclusions This exploratory study showed promising results for supporting the effectiveness of an early short-term GSST program for families of children with autism in China. The findings were discussed in terms of training strategies, and recommendations were proposed for both practical application and future research.

The Effects of Exercise Training on Functional Capacity and Quality of Life in Patients with Rheumatoid Arthritis: A Systematic Review.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four databases, selecting clinical trials that included community or outpatient exercise training programs in patients with RA. The primary outcome was functional capacity assessed by peak VO2 or the 6 min walking test, and the secondary outcome was QoL assessed by questionnaires. Seven studies were finally included, identifying a total number of 448 patients. The results of the present systematic review show a statistically significant increase in peak VO2 after exercise training in four out of seven studies. In fact, the improvement was significantly higher in two out of these four studies compared to the controls. Six out of seven studies provided data on the patients' QoL, with five of them managing to show statistically significant improvement after exercise training, especially in pain, fatigue, vitality, and symptoms of anxiety and depression. This systematic review demonstrates the beneficial effects of exercise training on functional capacity and QoL in patients with RA.

Voiding camp: A successful and unique bladder rehabilitation program for children with urinary incontinence

Standard urotherapy is a well-established treatment for children with incontinence, although it is often challenging for both child and parents, and not always successful. As an alternative, several in- and outpatient bladder training programs have shown positive results on achieving continence. However, the disadvantage is the hospital environment, which can be more stressful for the child, and also quite expensive for society. The aim was to evaluate the outcome on achieving continence following a voiding camp, where standard urotherapy was applied during a one-week stay at a regular summer youth camp, outside the hospital. Retrospective analysis of 105 children with urinary incontinence, followed in an expert centre for urinary incontinence for at least one year. Data at 7 different time points, before, during and until 6 months after voiding camp were collected. Even though all children had regular follow-up in an expert centre for urinary incontinence for at least one year before participating voiding camp, only 15% of the children reached the recommended amount of daily fluid intake (1.5L/day). Once minimal daily fluid intake was re-established during the voiding camp, an immediate increase in the maximum voided volume (MVV), and a decrease in the number of wet days and wet nights per week was noted. This effect on a higher MVV remained even 3 months after voiding camp. Although sufficient daily fluid intake is a well-established part of standard urotherapy, up until now there was no data that proved the positive impact of sufficient daily fluid intake on bladder volume training and achieving continence in children. Voiding camp, as an unique bladder rehabilitation program for children with incontinence, is a successful alternative treatment option. Optimizing the daily fluid intake during voiding camp had a major positive impact on bladder volume training and achieving continence in children.

Post-COVID rehabilitation for IMT outpatient training: a quality improvement project demonstrating the benefit of protected clinic time

Post-COVID rehabilitation for IMT outpatient training: a quality improvement project demonstrating the benefit of protected clinic time

Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy

Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.

To Use or Not to Use: Exploring Therapists' Experiences with Pre-Treatment EMA-Based Personalized Feedback in the TheraNet Project.

Using idiographic network models in psychotherapy has been a growing area of interest. However, little is known about the perceived clinical utility of network models. The present study aims to explore therapists' experiences with network model-based feedback within the context of the TheraNet Project. In total, 18 therapists who had received network-based feedback for at least 1 patient at least 2 months prior were invited to retrospective focus groups. The focus group questions related to how participation in the study influenced the therapeutic relationship, how the networks were used, and what might improve their clinical utility. The transcribed focus groups were analyzed descriptively using qualitative content analysis. Most therapists mentioned using the feedback to support their existingtheir case concept, while fewer therapists discussed the feedback directly with the patients. Several barriers to using the feedback were discussed, as well as various suggestions for how to make it more clinically useful. Many therapists reported skepticism with regards to research in the outpatient training center in general, though they were also all pleasantly surprised by being involved, having their opinions heard, and showing a readiness to adapt research to their needs/abilities. This study highlights the gap between researchers' and therapists' perceptions about what useful feedback should look like. The TheraNet therapists' interest in adapting the feedback and building more informative feedback systems signals a general openness to the implementation of clinically relevant research. We provide suggestions for future implementations of network-based feedback systems in the outpatient clinical training center setting.

Exercise training: which impact on COPD patients?

Introduction: Exercise training reactivates the aerobic pathway through physical exercise, thereby improving dyspnea and breaking deconditioning spiral in chronic obstructive pulmonary disease (COPD) patients. Method: 60 COPD patients were selected to benefit from a four-week outpatient exercise training and muscle strengthening program, at a rate of 3 sessions per week, after excluding the following cases: patients who have contraindications to exercise training; severe patients or those receiving long-term oxygen therapy. The program combined exercise training on a bicycle ergometer for 45 min, muscle strengthening of the lower limbs and nutritional monitoring. Nutritional management included a diet based on nutritional status and the prescription of oral food supplements for malnourished COPD patients. Parameters assessed before and after training were bioimpedance analysis (BIA),6MWT, quadriceps isometric voluntary contraction (MVC) and dynamic endurance, and the quality-of-life questionnaire (Q11). Result: Forty COPD patients (36 men and 4 women) aged 67.22 (± 10) years were able to complete the program. Amid them, 36 were non-smokers. Ten patients (GOLD I), 14 patients (GOLD II), 16 patients (GOLD III), no patients (GOLD IV). Dyspnea was stage 2 (± 1) m MRC. After training, quadriceps muscle function ((MVC) and endurance) improved significantly (p &lt; 0.0001). The improvement in distance covered during 6MWT was also significant (p &lt; 0.0001). A significant improvement in quality of life after training was noted on the total score of the Q11 questionnaire. No significant improvement in body composition after training in COPD patients. Conclusion: this study has confirmed the beneficial effects of training mainly on muscle function, effort capacity and quality of life in COPD patients.

35 Pairwise Concurrence Rates Between Standalone and Embedded Performance Validity Tests

Objective:Determine the classification concordance between a standalone performance validity test (PVT) and embedded PVTs from multiple cognitive domains.Participants and Methods:Participants were 106 patients (49.1% female; 69% white) that underwent neuropsychological evaluation at an outpatient university doctoral clinical psychology training and research clinic (M/SD: age = 32.38/11.95; education = 13.7/2.75). A comprehensive neuropsychological battery included the Medical Symptom Validity Test (MSVT) and embedded PVTs from different cognitive domains: attention - Wechsler Adult Intelligence Scale - Fourth Edition Reliable Digit Span and Digit Span age-corrected scaled score (DS ACSS); memory - California Verbal Learning Test, 3rd Edition (CVLT-3) Forced-Choice Recognition (FCR), executive functions -Wisconsin Card Sorting Test (WCST) Failure to Maintain Set (FMS); visual-spatial/construction -Rey Complex Figure Test (RCFT) Copy raw score; language - Boston Diagnostic Aphasia Examination Complex Ideation Material (CIM); and motor functions - Finger Tapping Test (FTT). All participants were administered the MSVT but not all participants were administered all seven embedded PVTs. Credible/noncredible classification concordance rates and kappa correlations (i.e., percentage of agreement) were computed for each pairwise PVT combination.Results:Twenty-two percent (n = 23) of the sample failed at least one PVT, with 17.0% (n = 18) failing at least two. DS ACSS was the embedded PVT with the highest MSVT concordance rate at 92.4% and a fair kappa coefficient of .39; WCST FMS had the lowest concordance with MSVT at 82.9% and a slight kappa coefficient of .19. The highest concordance among embedded PVTs from different cognitive domains was CVLT-3 FCR and RCFT Copy raw score at 89.7% with a fair kappa coefficient of .35; the lowest agreement among embedded PVTs was WCST FMS and FTT at 74.0% with a kappa coefficient of -.02. More conservative kappa coefficients among all pair-wise embedded PVT combinations from different cognitive domains ranged from -.02 to .36. For all standalone and embedded PVT pairwise concordance rates, only two fell below the recommended minimum agreement of 80%: FCR vs. FMS = 79.3% and FMS vs. FTT = 74.0%.Conclusions:Embedded PVTs across various cognitive domains have high agreement with a standalone PVT to aid in classifying noncredible performance, in the 83-92% range. Embedded PVTs from different cognitive domains also have mostly high agreement classification rates amongst themselves in aiding to determine noncredible performance, in the 74-90% range, with the lowest agreement rate between executive function and motor tests at 74%. More conservative kappa-based agreements between PVT pair-wise combinations were fairly consistent with other studies, with most being in the fair range. Finally, these findings indicate about a 17% base rate of noncredible cognitive performance in an outpatient university-based clinic.

General practitioner residents’ experiences and perceptions of outpatient training in primary care settings in China: a qualitative study

ObjectivesThe implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions...

Change in Peak Oxygen Uptake Predicted by the Moderate 1-km Treadmill Walking Test After Walking Training in Outpatients With Cardiovascular Disease.

The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O 2peak ) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program. Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O 2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O 2peakEST ). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O 2peak determination (V˙O 2peakMEAS ). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT. Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O 2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O 2peakMEAS and V˙O 2peakEST . Compared with CPX results, the 1km-TWT underestimated the V˙O 2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05). The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O 2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs.

Efficacy of social cognition and interaction training in outpatients with schizophrenia spectrum disorders: randomized controlled trial.

Given the relationship between social cognition and functional outcome in schizophrenia, a number of social cognitive interventions have been developed, including Social Cognition Interaction Training (SCIT), a group-based, comprehensive, manualized intervention. In the current trial, we examined SCIT efficacy as well as potential moderators of treatment effects. Fifty-one outpatients were randomized to SCIT or a wait-list-control (WLC), with assessments of social cognition, neurocognition, self-report, symptoms, and functioning conducted at baseline and end of the active phase. Relative to WLC, we did not find significant improvements for SCIT on neurocognition, social cognition, self-report, or symptoms, though there was a trend-level, medium effect favoring the SCIT condition on interpersonal and instrumental role function. Post-hoc analyses indicated that baseline neurocognition did not impact degree of social cognitive or functional change. Shorter duration of illness was significantly associated with better post-training neurocognition and self-esteem and, at trend-level with better symptoms and social functioning. We discuss the importance of outcome measure selection and the need for continued evaluation of potential treatment moderators in order to better match people to existing treatments. Clinical trial registration: Clinicaltrials.gov, Identifier NCT00587561.

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients.

Introduction: Outpatient exercise training has been shown to be beneficial for solid organ transplant recipients. Little is known about the effects of inpatient rehabilitation programs for recipients with a more complicated postoperative course. Research Question: This study was designed to (1) describe the changes in functional outcomes after an inpatient rehabilitation program, and (2) determine whether the changes in lower body strength and quadriceps strength are associated with changes in functional exercise capacity. Design: This was a single-arm prospective longitudinal study. The recipients participated in an inpatient rehabilitation program twice a day, 7 days a week for 3 to 4 weeks. Outcome Measures Included: 2-Minute Walking Test, Timed Up and Go, Berg Balance Scale, 30-Second Sit to Stand, biceps and quadriceps strength, Functional Independence Measure, SF-36, and Canadian Occupational Performance Measure. Results: Twenty-eight patients (54% female, mean age = 55 [11]) completed the study. Participants were mostly liver (42%) and lung recipients (35%). There were statistically significant improvements in all outcomes after the intervention. There was no relationship between changes in functional exercise capacity and quadriceps strength or lower body strength. Conclusion: An inpatient rehabilitation program may improve several functional outcomes and health-related quality of life in transplant recipients with a complicated postoperative course.

Status quo of urological residency training in Germany-a strengths, weaknesses, opportunities, and threats (SWOT) analysis

Urological residency training is adecisive step on the urological career path. The aim of this review is to develop strategies and approaches to actively shape, improve and further develop urological residency training. With the help of astrengths, weaknesses, opportunities, and threats (SWOT) analysis, the status quo of urological residency training in Germany is analyzed in astructured manner. Strengths of urological residency training incorporate the attractiveness of the specialty itself, and the residency training curriculum in urology ("Weiterbildungscurriculum Urologie", WECU), including the networking of inpatient and outpatient training and accompanying internal and external further training. The German Society of Residents in Urology (GeSRU) also provides anetworking platform for residents. Weaknesses include country-specific differences and alack of checkpoints during residency training. Opportunities for urological continuing education arise from freelance work, digitalization, and technical and medical progress. In contrast, the aftermath of the coronavirus disease 2019 (COVID19) pandemic, with still limited staff and surgical capacities, an increased psychosocial workload, and the rising number of outpatient treatments in urology pose threats for urological residency programs. With the help of aSWOT analysis, factors for the further development of urological residency training can be identified. In order to provide high-quality residency training in the future, strengths and opportunities should be consolidated and weaknesses and threats should be addressed at an early stage.