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Objectives: To determine whether there is a relationship between body mass index (BMI) and success or accuracy rate of BUS for the diagnosis of appendicitis. Methods: Patients 4 years of age and older presenting to the emergency department with suspected appendicitis were eligible.Enrollment was by convenience sampling. After informed consent, BUS wasperformed by trained emergency physicians who had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose appendicitis. Subject outcomes were ascertained by a combination of medical recordreview and telephone follow-up.  Calculated BMI for adults and children were divided into 4 categories(underweight, normal, overweight, obese) according to Centers for Disease Control and Prevention classifications.Results: A total of 125 subjects consented for the study, and 116 of them had adequate image data for final analysis.  Seventy (60%) of the subjects werechildren.  Prevalence of appendicitis was 39%.  Fifty-two (45%) of the BUS studies were diagnostic (successful). Overall accuracy rate was 75%.  Analysis by Chi-square test or Mann Whitney U did not find any significant correlation between BMI category and BUS success. Similarly, there was no significant correlation between BMI category and BUS accuracy.  Same conclusion was reached when children and adults were analyzed separately, or when subjects were dichotomized into underweight/ normal and overweight/ obesecategories.  Conclusion: BMI category alone is a poor predictor of appendix BUS success or accuracy.

This study investigated symptom change trajectory for patients with persistent somatic symptoms (PSS) during psychotherapy and the association of these patterns with pre-treatment characteristics and long-term outcome. Growth mixture modeling was used to identify trajectory curves in a sample of N = 210 outpatients diagnosed with PSS and treated either with conventional cognitive behavioral therapy (CBT) or CBT enriched with emotion regulation training (ENCERT). We identified three subgroups of patients with similar symptom change patterns over the course of treatment (a "no change," "strong response," and "slow change" subgroup). Higher initial anxiety symptoms were significantly associated with the no change and strong response subgroups; symptom-related disability in daily routine with no changes. Patients with a strong response had the highest proportion of reliable improvement at termination and at six-month-follow-up. Our results indicate that, instead of one common change pattern, patients with PSS respond differently to treatment. Due to the high association of symptom curves with long-term outcome, the identification and prediction of an individual's trajectory could provide important information for clinicians to identify non-responding patients that are at risk for failure. Selecting personalized treatment interventions could increase the effectiveness of psychotherapy. Trial registration: ClinicalTrials.gov identifier: NCT01908855.. [ABSTRACT FROM AUTHOR]

Objectives: Differing methodologies that identify dramatic change in psychotherapy have been thought to be capturing similar phenomena. We compared three methods—percentage improvement-50% (PI-50), rapid response (RR), and sudden gains (SG)—to identify similarities and differences between these approaches. Methods: Using a large database (n = 11,764) from a western university counseling center, we examined client characteristics (including initial severity and number of sessions in a course of treatment) and treatment outcomes (including overall change and meeting clinically significant criteria) using the Outcome Questionnaire-45. Results: Approximately 47% of clients (n = 5516) met criteria for one or more of the dramatic change definitions examined. Only 498 clients (3.7%) met criteria for all three methods, while 1349 (11.5%) met criteria for only one; RR identified the most clients (41.9%) and SG identified the fewest (4.9%). All definitions were associated with higher rates of clinically significant change at termination. Compared to those who recovered gradually, dramatic changers showed higher initial severity and more overall change. RR showed fewer sessions and PI-50 and SG showed more sessions than those who recovered gradually. Conclusions: Given these differences, consensus needs to be reached in the literature regarding the definition of dramatic change. We call for further theory development and research to help formulate a definition that can be simply applied and that more fully and parsimoniously captures the phenomenon of dramatic change. [ABSTRACT FROM AUTHOR]