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Background: Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. Methods: A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. Results: A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P< .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P<.001); grip strength +33.6% (P<.001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). Conclusion: At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy. [ABSTRACT FROM AUTHOR]

Minimally invasive nonsurgical treatment (MINST) aims to remove an etiology with minimal damage to the healthy periodontium and provide the ideal healing environment. This case series introduces the novel protocol of laser-assisted MINST (LAMINST), combining minimally invasive surgery with a dental laser. A total of 25 patients (32 teeth) with advanced periodontal disease were enrolled and received periodontal treatment by following the LAMINST protocol. Probing depth (PD), recession, clinical attachment level (CAL), bleeding on probing (BOP), plaque presence, and site mobility were evaluated preoperatively and at 6 months. Based on the periodontal evaluations, all cases were diagnosed as stage III grade C periodontitis. Six months after LAMINST, the average PD reduction was 4.44 mm and CAL improved by 4.38 mm. Baseline mobility scores of 1 (6 teeth), 2 (9 teeth), and 3 (3 teeth) decreased to 1 (5 teeth) or 0 (13 teeth). The initial prognoses of 5 (hopeless; 15 teeth), 4 (questionable; 13 teeth), and 3 (poor; 4 teeth), improved to 4 (5 teeth), 3 (12 teeth), 2 (fair; 13 teeth), and 1 (good; 2 teeth). The number of BOP sites reduced from 179 to 12, and the number of plaque sites reduced from 173 to 9. All clinical parameters were improved after LAMINST. The application of LAMINST may overcome the traditional limitations of nonsurgical treatment, such as poor accessibility. [ABSTRACT FROM AUTHOR]

Chronic diseases are usually managed by patients over a lifetime with the help of medication and regular health checkups. Recurring expenses incurred by chronic patients on medicine to manage their chronic illness adversely affect their household income as well as increase household expenditure. Schemes such as the Prime Minister Generic Medicine Scheme (PMBJP) launched by the Government of India aims to decrease out-of-pocket (OOP) expenditure on medicine, especially for chronic patients who have recurring expenditures on medicine. With a focus on PMBJP scheme which provides cheap generic alternatives to chronic patients, this cohort study has been undertaken to investigate if using the Internet to access to these generic medicines online can reduce OOP expenditure on medicine for chronic patients. The study observed that the out-of-pocket expenditure on medicine for branded consumers is significantly higher than the expenditure on medicine for JAM (Jan Aushadhi Medicine) generic medicine consumers. The study urges that a communication intervention providing awareness about alternative access to JAM (Jan Aushadhi Medicine) generic medicines online lead to a significant shift in consumption behavior of chronic patients towards accessing these medicines online. The study found that although the PMBJP scheme has the potential of decreasing OOP expenditure on medicine for chronic patients, the scheme needs to be expanded towards online platforms run by government to ensure ease of access, increased availability which could play an instrumental role in decreasing the OOP expenditure on medicine for chronic patients. [ABSTRACT FROM AUTHOR]

Background: Bioceramic-based root canal sealers are increasingly important in root canal treatment because of their biocompatible properties. This study aimed to evaluate postobturation pain incidence and intensity after root canal obturation with NeoSealer Flo, MTA-Bioseal, and GuttaFlow bioseal calcium silicate-based sealers and AH Plus epoxy resin-based sealer in patients with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis. Methods: A total of 120 participants with single-rooted teeth were included and randomly divided into four groups according to the root canal sealer used (n = 30). The patients were subsequently categorised based on the pulp vitality (vital or nonvital) in each group (n = 15) and all teeth were obturated in a single-visit. The postobturation pain scores were recorded on a visual analogue scale (VAS) at 6 h, 24 h, 48 h, 72 h, 7 d and 30 d. Moreover, analgesic intake was also noted at 24 h and 48 h. The Mann–Whitney U test, Kruskal‒Wallis H test, Friedman test, and Spearman's correlation test were used, and a p value < 0.05 was considered significant. Results: VAS scores were highest for the 6 h > 24 h > 48 h ≈ 72 h ≈ 7 d ≈ 30 d time intervals for both pulp status in each root canal sealer. A significant decrease in the VAS score was observed for all sealers from 6 h to 48 h (p 0.05). Nonvital cases had lower VAS scores at all time intervals. Analgesic intake was greater in the first 24 h (p < 0.05) in vital cases (p < 0.05) and also in females than males. Conclusion: The level of pain experienced after obturation was similar in patients with different pulp status for all the root canal sealers. Analgesic intake was greater in vital cases and females within 24 h. Trial registration: ClinicalTrial.gov, NCT06515756, record date: 2024-07-17, retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies. Objective: This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS. Methods: A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute. Results: The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them. Conclusion: The chronic disease patients' preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients' demand in different regions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of acupuncture in drinkers with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). Methods: We conducted a secondary analysis of a randomized controlled trial across multiple centers, involving 224 drinkers. Patients received either acupuncture or sham acupuncture treatment. The primary outcome was the proportion of responders, defined as participants who had a reduction of 6 points or more from baseline in the National Institute of Health—Chronic Prostatitis Symptom Index (NIH-CPSI) total score at weeks 8 and 32. Secondary outcomes measures included the Global Response Assessment (GRA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF-5). Results: One hundred and twelve drinkers were included in each group (n = 224 in total). The proportion of responders in terms of NIH-CPSI was 58.9% versus 40.3% in the acupuncture group (AG) and sham acupuncture group (SAG), respectively, with a statistically significant difference of 18.6% (p = 0.002) at week 8. Higher proportions of responders with respect to NIH-CPSI (p < 0.001 at week 32) and GRA (p < 0.001 at week 8 and p = 0.01 at week 32) were observed in the AG compared with the SAG. No between-group differences were found in the changes in IPSS at any assessment time point. Changes in IIEF-5 score were significantly higher in the AG than in the SAG at weeks 20 and 32, while the difference was not statistically significant at week 8. Conclusion: Acupuncture appeared to alleviate the symptoms of pain among drinkers with CP/CPPS and improve their quality of life, but had no demonstrable effect on urinary tract symptoms or erectile function among these patients. Trial registration number: NCT03213938 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Introduction: Endovenous ablation may not always be necessary for every patient with chronic venous insufficiency who has an indication for endovenous ablation. This study investigates whether compression stockings and Daflon® can be as effective for some patients with CEAP two in chronic venous insufficiency. Methods: In this study, 137 patients who had endovenous ablation indication received plethysmographical hemodynamic tests and were divided into two groups. Group 1 had normal venous hemodynamics and received compression stockings and Daflon®. Group 2 had abnormal function and received laser ablation. All patients were reevaluated after 6 months. Results: The study showed that there was no statistically significant difference between Groups 1 and 2 in the 6th month measurements after the treatments. Conclusion: As a result, we do not find it appropriate and do not recommend that every patient with complaints of chronic venous insufficiency and an indication for endovenous ablation undergo ablation without evaluating lower extremity venous hemodynamics. [ABSTRACT FROM AUTHOR]

Background: Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context. Methods: An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised. Results: Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45–60 min per session, 2–3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control. Conclusions: Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment modality that is used in the treatment of chronic Achilles tendinopathy (AT). Purposes: To (1) retrospectively assess outcomes after ESWT for both noninsertional AT (NAT) and insertional AT (IAT) at >1-year follow-up and (2) identify potential predictors of outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included patient demographic characteristics, pathological characteristics including the location of AT (NAT or IAT), presence of a Haglund deformity, and severity of tendon degeneration on magnetic resonance imaging (MRI), in addition to treatment characteristics including number of sessions and intensity of ESWT. The Victorian Institute of Sports Assessment–Achilles (VISA-A) and visual analog scale (VAS) pain scores were obtained before ESWT, 6 months after ESWT, and at final follow-up. Failures were also recorded, which were defined as no improvement in VISA-A or VAS scores or need for surgical intervention. Linear regression was performed to identify potential predictors of inferior subjective clinical outcomes and failures. Survival analysis was conducted using Kaplan-Meier curves. Results: The study included 52 patients with IAT and 34 patients with NAT. The mean follow-up in the NAT cohort was 22.3 ± 10.2 months and the mean follow-up in the IAT cohort was 26.8 ± 15.8 months. Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6-month follow-up and at final follow-up (P <.05). Improvements in VISA-A and VAS scores were recorded in the IAT cohort at 6-month follow-up, which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6-month follow-up was 11.8%, which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6-month follow-up was 32.7%, which increased to 59.6% at final follow-up. Predictors of inferior subjective clinical outcomes and failures in the NAT cohort included pre-ESWT subjective clinical score, male sex, presence of a cardiovascular risk factor, and more severe MRI grading of tendinopathy. Predictors of inferior subjective clinical outcomes and failures in the IAT cohort included pre-ESWT subjective clinical score and more severe MRI grading of tendinopathy. Conclusion: Superior subjective clinical outcomes together with a lower failure rate were maintained for >1 year in the NAT cohort compared with the IAT cohort, calling into question the long-term benefit of ESWT for patients with IAT. [ABSTRACT FROM AUTHOR]

Background: Autogenic training (AT) is a structured meditative‐style practice, consisting of a sequence of simple mental exercises intended to induce a relaxed state in patients. There is some emerging evidence to suggest that AT can be effective in treating certain chronic conditions, however, further evidence is required. A service evaluation of AT services at the Royal London Hospital for Integrated Medicine was conducted to evaluate the impact of AT on patients with chronic conditions. Methods: The service evaluation consisted of the completion of validated quantitative outcome measures pre and posttreatment to explore the impact of AT. AT patients were asked to complete the Measure Yourself Medical Outcomes Profile (MYMOP) and Perceived Stress Scale (PSS) at their first hospital appointment (baseline) and then again 8 weeks later following completion of their AT sessions. Pre‐ and posttreatment scores for each outcome measure were analysed in SPSS using the Wilcoxon signed‐rank test. Results: One hundred ninety‐nine patients completed both initial and follow‐up MYMOP forms and were included in the evaluation. The most common presenting complaints for MYMOP symptom 1 were prolonged anxiety/stress and depression (n = 70, 35.2%), chronic pain and migraine headache (n = 44, 22.1%), chronic insomnia and sleep problems (n = 42, 21.1%) and, long‐term exhaustion and fatigue (n = 18, 9%). The change in median score pre‐ and posttreatment for all MYMOP categories (symptoms, activity and well‐being) were statistically highly significant p < 0.001. Anxiety, stress, depression, pain and insomnia were the symptoms that had the largest statistically significant difference between the median score pre‐ and posttreatment. Fifty‐five patients completed the PSS questionnaire at two time points (pre‐ and posttreatment). It showed a highly statistically significant change in PSS median score in patients experiencing stress (p < 0.001). Discussion: The findings of the evaluation indicate that 8 weeks of AT appears to be effective in improving symptoms of concern to patients and enhancing patients' overall well‐being. In particular, AT was found to be beneficial for patients with symptoms of anxiety, stress, depression, pain and insomnia. [ABSTRACT FROM AUTHOR]

Introduction: Chronic back pain is one of the most prevalent conditions and has a large socio-economic impact. The lack of routine use of non-pharmacological options and issues associated with pharmacological treatments underscore high unmet needs in the treatment of back pain. Although blue light phototherapy has proven efficacy in dermatology, limited information is available about its use in back pain. Methods: In this proof-of-concept, randomized controlled trial, a pain relief patch (PRP) delivered blue light at the site of back pain for 30 min during five treatment sessions. The comparator device delivered green light for 5 s but was worn for 30 min. A follow-up visit took place after the last treatment. The primary objective was to demonstrate the superiority of treatment by PRP, compared to the control device, in reducing pain intensity at the end of the treatment period. The post-treatment visual analog scale (VAS) pain intensity score for each group was calculated across the five treatment sessions and compared to the baseline. Secondary objectives included the disability score (Roland-Morris Disability Questionnaire) and safety. Results: The full analysis set included 171 patients. A statistically significant reduction in pain intensity occurred after the use of PRP (p < 0.02), but the study did not meet its primary objective of a superiority trial aimed at demonstrating a 0.6 cm difference in favor of PRP on the VAS scale. There was no significant change in the disability scores. Subgroup analyses were performed to identify the treatment response by patient characteristics such as pain intensity at baseline and skin type. As expected, safety data showed erythema and skin discoloration in the PRP group but not in the control group. Discussion/conclusion: This trial had multiple limitations that need to be addressed in future research. Although the primary objective was not achieved, this proof-of-concept study provides important efficacy and safety data in relation to the use of blue light in the treatment of chronic back pain and key insights that may support further research on similar devices. [ABSTRACT FROM AUTHOR]

Aphasia negatively impacts mental health, disrupting social connections and meaningful life activities. Gratitude interventions for healthy adults positively impact well-being, physical health, and mental health. A systematic review of gratitude interventions for people living with chronic health conditions was conducted to identify current practices and existing gaps and to map the literature for incorporating gratitude interventions into aphasia rehabilitation. A scoping review of the literature published prior to March 2023 was conducted using CINAHL, Google Scholar, PubMed, and ERIC to identify gratitude interventions for adults with chronic health conditions. The search identified 414 studies. Five met the inclusion criteria. Interventions targeting chronic health conditions included alcohol use disorder, chronic heart failure, cancer, and asthma. No empirical studies were identified that used gratitude interventions with people who have aphasia or have had a stroke. Four studies used journaling as the intervention and one used gratitude letters. All interventions used written or verbal expressions of gratitude. Gratitude interventions have been used in limited ways with chronic health conditions. As gratitude interventions are language-based and rely on writing, people with aphasia may need modifications to support accessibility to these interventions which can positively impact mental health and well-being. [ABSTRACT FROM AUTHOR]

Evidence suggests that communication-based aphasia group treatment may increase formal assessment scores and improve features of discourse production. The real-life interactions which occur during group treatment may increase use of grammatically complete and relevant utterances. To examine the effects of communication-based group treatment on production of complete utterances during structured and conversational discourse in adults with chronic aphasia. We analyzed structured and conversational discourse samples from 23 adults with chronic aphasia originally collected by Elman and Bernstein-Ellis (1999a). Bayesian generalized linear mixed-effects models were used to evaluate changes in use of complete utterances and its two components, syntactic completeness and relevance, at treatment exit and 4-6 weeks post-treatment. Results are presented with reference to the region of practical equivalence (ROPE, i.e., the range of effect sizes small enough to ignore) and in terms of the probability, derived from Bayesian model posterior distributions, that the effect in question exceeded, fell within, or fell below the ROPE. At the group level, syntactic completeness improved in structured discourse, but syntactic completeness, relevance, and complete utterances did not change during conversational discourse. Individual response to treatment varied and participants with mild aphasia and without concomitant apraxia of speech were more likely to demonstrate post-treatment change in complete utterances. Use of syntactically complete utterances during structured discourse increased at treatment exit and follow-up. Participants, especially those with severe aphasia and apraxia of speech, may have changed in ways not revealed by the complete utterance measure. [ABSTRACT FROM AUTHOR]

Introduction: Central Serous Chorioretinopathy (CSC), a leading cause of vision loss, presents diverse treatment challenges based on its acute or chronic manifestation. Areas covered: In acute CSC, treatment typically involves observation, reserving intervention for cases where optimal vision is crucial for professional activities. Emerging evidence advocates the use of half-dose or half-fluence Photodynamic Therapy (PDT), directed by Indocyanine Green Angiography (ICGA) or Fluorescein Angiography (FA), to hasten subretinal fluid (SRF) resolution, improve vision, and minimize recurrence. Chronic CSC, on the other hand, increasingly favors half-dose PDT, a recommendation strengthened by studies such as the PLACE trial. CSC complicated by Choroidal Neovascularization (CNV) necessitates management through intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections and/or half-dose PDT. In cases of polypoidal choroidal vasculopathy (PCV), a combination of anti-VEGF therapy with PDT proves beneficial. For scenarios where standard treatments are impractical, Eplerenone emerges as the primary oral medication. Methods: A literature search of all original articles was performed using the major online databases. The following keywords 'Central Serous Chorioretinopathy' and 'Treatment,' were searched in combination with 'Photodynamic therapy,' 'Focal Laser Photocoagulation,' 'Subthreshold Micropulse Laser' and 'Systemic treatments.' Expert opinion: Managing CSC requires a patient-centered approach. In acute CSC, careful monitoring and lifestyle modifications may suffice, while in chronic CSC, PDT is a primary therapeutic option. [ABSTRACT FROM AUTHOR]

Background: To describe the treatment of patients with great saphenous vein (GSV) incompetence and varicose veins (VVs), utilizing an Automated Microfoam Preparation System (AMPS, Varixio®, VB Devices, Barcelona, Spain). Methods: Adults between January and June 2021 were included. The AMPS system was used for foam preparation. Sclerotherapy treatment followed international recommendations. The primary endpoint was GSV closure rate after 36 months. Results: 164 patients were enrolled. During the 7-day follow-up period, all GSVs showed complete closure, which was maintained at the 1-year mark. No major complications were reported. A cumulative complete GSV recanalization rate of 6.1% and a partial recanalization rate of 26.8% after 36 months were noted. Some patients (9.7%) required additional treatment. A higher BMI was associated with complete recanalization. Conclusion: The AMPS offers an easy-to-use and standardized procedure, potentially enhancing treatment outcomes if compared with manual preparation. Caution is advised when treating obese patients. [ABSTRACT FROM AUTHOR]

Background: Literature supports including occupational therapists on primary care teams. Few occupational therapists practice in this setting. The health care community needs more information regarding the benefits of occupational therapists on the team. Method: We completed an 18-month pilot integrating an occupational therapist in a primary care team, tracking conditions treated by the occupational therapist, visit duration, reimbursement, and level of primary care providers’ (PCP) satisfaction. We then evaluated outcomes via a retrospective chart review. Results: Visits were brief, averaging 35 min. Longer visits did not improve outcomes. Occupational therapists were reimbursed by Medicare (47%), commercial (47%), both (6%). PCPs referred numerous conditions, and > 50% related to musculoskeletal pain. Most of the patients, 84%, reported partial (30%) or complete (54%) improvement; 60% required one-time treatment; and 40% were referred for further treatment on-site or outside the department for additional or specialty treatment. After the pilot, most of the PCPs felt an occupational therapist on the team was absolutely essential (n = 14; 61%), or very important (n = 7; 30%). Conclusion: Embedded occupational therapy treatment resulted in symptom improvement in 84% of patients across a variety of conditions, and brief visits were effective. Occupational therapist services were reimbursed across insurance plans. After working with an occupational therapist, 91% of the PCPs viewed the occupational therapist as a very important or essential team member. [ABSTRACT FROM AUTHOR]

Background and Objectives There are a growing number of early-phase (i.e. Stage I, NIH Stage Model) interventions targeted at family care dyads navigating chronic health conditions in older adults. Currently, the benefits of these interventions are often evaluated for older adults and their family care partners separately, even when controlling for interdependence. Without understanding the benefits (and potential harms) for dyads as a whole, understanding of program impact is incomplete. Moreover, few health behavior interventions involving dyads include relational measures to ensure no unintended consequences for the dyad or account for within-dyad pretest risk level. Research Design and Methods We used secondary data from a quasi-experimental trial involving 39 couples in which 1 member of the dyad was living with Parkinson's disease as an exemplar demonstration of 3 proposed approaches: an above-zero approach, a pretest risk status approach, and an expanded pattern analysis matrix approach. Results Approaches provided evidence for dyadic benefits of the intervention compared to the wait-list comparison condition, but carried different assumptions that did not always categorize dyads similarly. Discussion and Implications Implications of using each approach and selecting different benchmarks for defining success are discussed. The descriptive approaches proposed, provide a rationale for more intentional evaluation of small-sample, early-phase dyadic interventions. [ABSTRACT FROM AUTHOR]

Background and purpose: Little is known about the applicability, utilization, and effectiveness of mind–body interventions (MBIs) for conditions that are not predominantly pain, neoplastic, or psychiatric, particularly in pediatric patients. This scoping review describes research pertaining to such interventions in youth with nonpain, noncancer, and nonpsychiatric predominant chronic medical conditions. Methods: Searches of EBSCO CINAHL, Elsevier Scopus, Ovid for MEDLINE, and Ovid PsycInfo were conducted to investigate MBIs in youth under 18 years of age with nonpain, noncancer, and nonpsychiatric predominant chronic medical conditions. Articles published between 2010 and 2020 were included. Abstracts were screened by three authors for inclusion, and disagreements were resolved by a designated author. Selected full-text articles were divided among all authors for review of study quality, intervention feasibility and acceptability, and effectiveness. Results: The search yielded 1010 titles with 15 meeting the final inclusion criteria, studying a total of 641 youth. Participants ranged in age from 6 to 19 years (included studies had data on participants <18 years reported separately); 61.5% were female (n = 394) and 38.5% were male (n = 247). The two most common conditions studied were asthma and irritable bowel syndrome, with yoga being the most popular intervention. Overall, MBIs showed promising preliminary evidence for improving symptoms and quality of life in youth with chronic medical conditions. Conclusion: MBIs have been successfully delivered and show promise in symptom palliation and quality of life improvement for youth with a variety of chronic medical conditions. More data from high-quality randomized controlled trials are needed to further characterize the effectiveness of specific modalities for specific conditions. [ABSTRACT FROM AUTHOR]

Objectives: Periodontitis is one of the most common chronic inflammatory diseases. It causes changes in the biting abilities of individuals. However, periodontal treatment has positive effects on masticatory function. The aim of this study is to determine the effect of periodontitis and periodontal treatment on masticatory abilities by measuring masseter and temporal muscle thicknesses with ultrasonography before and after periodontal treatment in chronic periodontitis patients. Methods: The patients included in the study were determined by clinical and radiological examination. The thickness of the masseter and temporal muscles of the patients were measured by ultrasonography. Periodontal measurements and treatments of the patients were completed by a single physician. IBM SPSS 20.0 (IBM Corp., Armonk, NY) statistical program was used for statistical analysis. Results: A statistically significant difference was found between the values of periodontal measurements before and after treatment (p<0.05). In the ultrasonography measurements of the thickness of masseter and anterior temporal muscles, a statistically significant increase was observed in both rest and contraction values at all time intervals (p<0.05). Muscle thicknesses of male patients were higher than female patients. Conclusions: Periodontitis negatively affects the masticatory performance of individuals. Chronic periodontitis patients should be referred for periodontal treatment without wasting time. [ABSTRACT FROM AUTHOR]

Introduction: In this paper, we use the Rainbow Model of Integrated Care (RMIC) framework to evaluate the effectiveness of integrated care in terms of enhancing the outcomes of chronic conditions such as diabetes mellitus type 2 (DMT2), cardiovascular diseases (CVD), chronic respiratory diseases (CRD), or their combinations. Methods: The data extracted from randomized controlled trials (RCT) of integrated care interventions for DMT2, CVD, and CRD (follow-up ≥ 3 months) in 11 databases were analysed using random-effects meta-analysis. Results: A total of 54 eligible studies covering 12,976 participants, with a mean follow-up of 54 weeks, were included. In moderate-quality evidence, integrated care interventions reduced mortality for CVD, adverse events for CVD and DMT2, and improved quality of life for CVD and DMT2, physical and mental functioning, self-management, and blood pressure control. Conclusion: Integrated care can reduce all-cause mortality, adverse events, and improve quality of life, physical and mental functioning, self-management and blood pressure control in chronic disease patients. However, available evidence for some outcomes (e.g., all-cause hospital admissions) remains uncertain. [ABSTRACT FROM AUTHOR]

The article focuses on the use of compression therapy in managing varicose veins, highlighting its efficacy in improving symptoms, reducing leg swelling, and enhancing quality of life for patients with chronic venous disease. Topics discussed include the indications for compression therapy, its role in different stages of varicose veins, and recommendations for its use before and after venous interventions.

Objective: Evaluate feasibility and impact of a multimodal integrative therapeutic intervention in patients presenting with chronic symptoms attributed to a postinfectious syndrome. Design: This was a prospective longitudinal single-center pilot study conducted from January 2019 to December 2020. Setting/Location: University of Maryland Lyme Program, Baltimore Maryland. Subjects: Persons presenting for Lyme evaluation for symptoms attributed to Lyme disease. Interventions: Participants attended two 1-h individual instructional sessions consisting of Ayurveda-based dietary intervention and breath-coordinated mind-body practice to be used for home practice. Outcome measures: Standard measures of impact were obtained at baseline, 1, 3, 6, and 12 months using the following validated survey instruments: Perceived Stress Scale (PSS), PROMIS Global Health v1.2 (GH), and PROMIS 29 v2.0 survey. Results: From 216 patients presenting for Lyme evaluation, 19 participants enrolled with 84% completing the study (N = 16). Baseline PROMIS GH scores consisting of general Physical Health (GPH) and general Mental Health (GMH) scores were lower in the study population than in the general U.S. population. PROMIS 29 scores were higher for fatigue, anxiety, and pain than those in the general U.S. population. Over 12-month period, improvement in both the GPH and GMH was 6.09 (confidence interval [95% CI] = 2.71-9.46; p < 0.001) and 4.65 (95% CI = 1.50-7.80; p = 0.004), respectively. PROMIS 29 scores showed the greatest improvement in fatigue at -7.91 (95% CI=-12.34 to -3.48; p < 0.001), pain interference -5.08 (95% CI=-9.20 to -0.96; p = 0.016), and ability to participate in social roles and activities 7.48 (95% CI = 3.21-11.75; p = 0.001) and least with depression -1.82 (95% CI=-4.74 to 1.10; p = 0.223). Employment status had significant effects on almost all outcome scores. Postinfectious state was associated with improvement in anxiety and PSS scores. Conclusions: Amultimodal Ayurvedic and breath-coordinated mind--body therapeutic intervention is feasible and a potential nonpharmacologic therapeutic option for persons presentingwith pain, stress, fatigue, physical dysfunction, and sleep disturbance attributed to a postinfectious syndrome. Further research is needed to determine efficacy in this population and in other groups with similar symptom complexes due to postinfectious syndromes. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the efficacy of spironolactone in the treatment of chronic central serous chorioretinopathy (CSC) and identify imaging characteristics that can predict the benefit of spironolactone treatment. Methods. Patients with chronic CSC were treated with spironolactone (20 mg/tid) and followed for 6 months. The primary outcome measure was complete resolution of the subretinal fluid (SRF), and the best-corrected visual acuity (BCVA), the SRF area, the central macular thickness (CMT), the subfoveal choroidal thickness (SFCT), and the density of the choriocapillaris vessel and adverse events were secondary outcome measures. Patients who presented complete resolution of SRF were included in the responder group and the other patients who had moderate or no resolution were included in the nonresponder group. Imaging characteristic comparisons between the responder and nonresponder groups were performed with regression analyses to identify factors that are predictive of a good response to treatment. Results. Forty-two eyes of 42 patients with a mean age of 46.06 ± 6.66 years were included. A total of 57.1% of the patients achieved a complete resolution of SRF. The mean SRF area, CMT, and SFCT decreased significantly (all P < 0.05) throughout the follow-up period and BCVA improved slightly (P > 0.05). The vascular density of the choriocapillaris of the fellow eyes did not vary significantly during treatment. Logistic regression analysis revealed that SFCT (P = 0.002) and the intact ellipsoid zone (P = 0.001) were correlated with disease resolution. A relatively higher baseline SFCT was a predictive factor associated with a good response to treatment according to multivariate analysis. Conclusions. This study suggested that oral spironolactone could be an effective and safe therapy for chronic CSC patients. Eyes with a higher baseline SFCT and intact ellipsoid zone could have a good response. These parameters are an important prognostic marker. [ABSTRACT FROM AUTHOR]

Background and objectives: Chronic headaches are a frequent cause of pain and disability. The purpose of this randomized trial was to examine whether transcranial direct current stimulation (tDCS) applied to the primary motor cortex, reduces pain and increases daily function in individuals suffering from primary chronic headache. Materials and methods: A prospective, randomized, controlled trial, where participants and assessors were blinded, investigated the effect of active tDCS vs. sham tDCS in chronic headache sufferers. Forty subjects between 18 and 70 years of age, with a diagnosis of primary chronic headache were randomized to either active tDCS or sham tDCS treatment groups. All patients received eight treatments over four consecutive weeks. Anodal stimulation (2 mA) directed at the primary motor cortex (M1), was applied for 30 min in the active tDCS group. Participants in the sham tDCS group received 30 s of M1 stimulation at the start and end of the 30-minute procedure; for the remaining 29 min, they did not receive any stimulation. Outcome measures based on data collected at baseline, after eight treatments and three months later included changes in daily function, pain levels, and medication. Results: Significant improvements in both daily function and pain levels were observed in participants treated with active tDCS, compared to sham tDCS. Effects lasted up to 12 weeks post-treatment. Medication use remained unchanged in both groups throughout the trial with no serious adverse effects reported. Conclusion: These results suggest that tDCS has the potential to improve daily function and reduce pain in patients suffering from chronic headaches. Larger randomized, controlled trials are needed to confirm these findings. Trial registration: The study was approved by the local ethics committee (2018/ 2514) and by the Norwegian Centre for Research Data (54483). [ABSTRACT FROM AUTHOR]

Background Liquid embolic agents and polyvinyl alcohol (PVA) particles have been used for the embolization of the middle meningeal artery (MMA) for the treatment of chronic subdural hematomas. However, the vascular penetration and distribution of these embolic agents have not yet been compared. The current study compares distribution of a liquid embolic agent (Squid) to PVA particles (Contour) in an in vitro model of the MMA. Methods MMA models were embolized with Contour PVA particles 45-150 µm, Contour PVA particles 150-250 µm, and Squid-18 liquid embolic agent (n=5 each). The models were scanned and every vascular segment with embolic agent was manually marked on the images. Embolized vascular length as a percentage of control, average embolized vascular diameter, and embolization time were compared between the groups. Results The 150-250 µm Contour particles primarily accumulated close to the microcatheter tip, yielding proximal branch occlusions. The 45-150 µm Contour particles achieved a more distal distribution, but in a patchy segmental pattern. However, the models embolized with Squid-18 had a consistently distal, near-complete and homogenous distribution. Embolized vascular length was significantly higher (76±13% vs 5±3%, P=0.0007) and average embolized vessel diameter was significantly smaller (405±25 µm vs 775±225 µm, P=0.0006) with Squid than with Contour. Embolization time with Squid was also lower (2.8±2.4 min vs 6.4±2.7 min, P=0.09). Conclusions Squid-18 liquid results in a considerably more consistent, distal and homogeneous pattern of embolysate distribution than Contour PVA particles in an anatomical model of the MMA tree. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the integrated efficacy of completely simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine in chronic periodontitis. Method and materials: This was a split-mouth randomized controlled trial including 19 patients with moderate to severe chronic periodontitis. After calculus removal, the test side received simultaneous ultrasonic scaling and subgingival irrigation with 0.12% chlorhexidine, and the control side received simultaneous ultrasonic scaling and subgingival irrigation with distilled water. A newly designed ultrasonic scaler tip with a liquid outlet on the terminal was used. Clinical parameters were assessed, and gingival crevicular fluid was collected before treatment at baseline and 1.5, 3, and 6 months after baseline. Results: On follow-up, both sides showed significant reductions in clinical parameters and concentration of inflammatory mediators in gingival crevicular fluid. Adjunct application of CHX resulted in an additional periodontal pocket reduction (0.27 to 0.29 mm, P < .05) compared to the control side, in sites with initial probing depth of 4 to 5 mm. Within the initial probing depth ≥ 6 mm, the additional probing depth reduction was 0.44 to 0.60 mm (P < .05), with clinical attachment loss, concentration of interleukin-6, and concentration of matrix metalloproteinase-8 being 0.32 to 0.38 mm, 2.64 to 3.40 µg/L, and 19.78 to 22.39 ng/L, respectively (all P < .05). Conclusion: In this study, treatment outcomes of chronic periodontitis could be improved by treating the root surface with simultaneous ultrasonic scaling and chlorhexidine irrigation. The adjunctive use of 0.12% chlorhexidine with a newly designed ultrasonic scaler tip in the treatment of moderate to severe chronic periodontitis demonstrated significant clinical benefits and decrease in inflammatory mediator when compared with scaling and root planing plus placebo. [ABSTRACT FROM AUTHOR]

Background: Strength endurance in lower back region is the most important factor for chronic low - back pain. There are several treatments for strengthening low back muscle. Strength and endurance that have proven benefit in CLBP patients; however, there are very few studies that focus on lumbar stabilization exercises. Purpose: The intention of this study was to improve the strength and endurance more effectively than usual programs by performing lumbar stabilization exercises. Materials And Methods: This Quasi-Experimental study had 40 participants with persistent LBP, aged 25 to 50, divided into lumbar stability (n=20) and lumbar strengthening (n=20) groups. sEMG measured strength endurance, NPRS scale measured pain, before and after intervention. Results: Lumbar stabilization exercises (Group A) were significantly more effective than static stretching and strengthening exercises (Group B) in treating persistent low back pain, with p<0.001 in outcome measures. Conclusion: Lumbar stabilization exercises have been demonstrated to be more effective than conventional therapies in patients with CLBP. [ABSTRACT FROM AUTHOR]

Background: endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. Methods: all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions. Results: 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively. Conclusions: EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Stroke is a leading cause of permanent disability in developing nations. Motor impairment in stroke contributes to limitations in activities of daily life, participation in community, and overall quality of life. Recovery following stroke is challenged by poor lower-limb muscle performance interfering with balance, gait, and functional tasks. Objective: The objective of this study was to investigate the effect of Russian current over the quadriceps muscle in 10-m walk performance and Brunnstrom stages of lower-extremity recovery in chronic stroke survivors. Materials and Methods: The Institutional Review Board approval was obtained for this pilot study, and a total of 36 chronic stroke survivors were recruited from the outpatient department of Alva's College of Physiotherapy and Research Center, Moodubidire, Karnataka. Consent was obtained from the voluntary participants, and they were randomly assigned to one of the two groups; intervention and the control groups. Participants in the intervention group received Russian current over the quadriceps muscle in addition to the conventional rehabilitation, whereas the control group participants received only conventional rehabilitation. The study duration was 6 weeks. The outcomes measured were 10-m walk test and Brunnstrom stages of lower-extremity recovery. Results: Statistical analysis was performed with SPSS statistical software. The Kolmogorov-Smirnov test was performed for normality. The paired t-test, within-group analysis, demonstrated a significant increase in the 10-m walk test (P < 002) and Brunnstrom stage of lower extremity (P < 0.043) for the intervention group. The independent t-test demonstrated a highly significant (P = 0.001) value for the intervention group than the control group. Conclusion: Statistical results conclude that Russian current is effective in improving 10-m walk performance and Brunnstrom stages of motor recovery of lower limb in chronic stroke survivors. [ABSTRACT FROM AUTHOR]

We investigated the follow-up (3- and 6-month) intervention effects of two ACT-interventions for parents of children with chronic and developmental conditions. Parents (N=110) were randomly assigned to the supported iACT (n=57) or to the Self-help ACT (n=53). At 3-month follow-up, symptoms of burnout decreased more in the supported iACT group, whereas, unexpectedly, psychological flexibility decreased in both groups. However, at the 6-month follow-up, the iACT group reported decreased symptoms and increased psychological flexibility skills. Online and self-help ACT interventions may be beneficial to this population and decrease their risk of psychopathology. [ABSTRACT FROM AUTHOR]

Ten patients with a diagnosis of generalized chronic periodontitis underwent nonsurgical periodontal therapy performed with the exclusive use of ultrasonic instrumentation and air polishing with erythritol powder. For each patient, four pockets with probing depths (PDs) of 4 to 10 mm were selected as experimental sites, and air polishing was performed either before (Group A) or after (Group B) ultrasonic scaling. PDs and clinical attachment levels significantly improved over a 12-month observation period. No significant difference was observed between the use of air polishing before or after ultrasonic instrumentation. The present clinical protocols could represent a suitable treatment for cause-related periodontal therapy. [ABSTRACT FROM AUTHOR]

Context: Chronic ankle instability is documented to be followed by a recurrence of giving away episodes due to impairments in mechanical support. The application of ankle Kinesiotaping (KT) as a therapeutic intervention has been increasingly raised among athletes and physiotherapists. Objectives: This study aimed to investigate the impacts of ankle KT on the lower-limb kinematics, kinetics, dynamic balance, and muscle activity of college athletes with chronic ankle instability. Design: A crossover study design. Participants: Twenty-eight college athletes with chronic ankle sprain (11 females and 17 males, 23.46 [2.65] y, 175.36 [11.49] cm, 70.12 [14.11] kg) participated in this study. Setting: The participants executed 3 single-leg drop landings under nontaped and ankle Kinesio-taped conditions. Ankle, knee, and hip kinematics, kinetics, and dynamic balance status and the lateral gastrocnemius, medial gastrocnemius, tibialis anterior, and peroneus longus muscle activity were recorded and analyzed. Results: The application of ankle KT decreased ankle joint range of motion (P =.039) and angular velocities (P =.044) in the sagittal plane, ground reaction force rate of loading (P =.019), and mediolateral time to stability (P =.035). The lateral gastrocnemius (0.002) and peroneus longus (0.046) activity amplitudes also experienced a significant decrease after initial ground contact when the participants' ankles were taped, while the application of ankle KT resulted in an increase in the peroneus longus (0.014) activity amplitudes before initial ground contact. Conclusions: Ankle lateral supports provided by KT potentially decreases mechanical stresses applied to the lower limbs, aids in dynamic balance, and lowers calf muscle energy consumption; therefore, it could be offered as a suitable supportive means for acute usage in athletes with chronic ankle instability. [ABSTRACT FROM AUTHOR]

Background: Trigger finger is one of the most common causes of pain and dysfunction. The aim of our study was to compare the effectiveness of shock wave therapy versus local corticosteroid injection in the treatment of trigger finger in diabetic patients. Results: The two groups were matched on age, HbA1c, VAS score, and grip force at week zero. There was statistically significant improvement in both groups after treatment. In comparing the two groups after 6 weeks of starting treatment either by shockwave therapy or by local corticosteroid injection, there was a statistically significant improvement in group 1 as regards VAS pain score (p = 0.012), clinical signs (finger extension and locking) (p = 0.018), hand grip dynamometer (p < 0.001), and musculoskeletal ultrasound findings in comparison to group 2. Conclusion: Trigger finger is a common complication of DM. Shockwave therapy was able to reduce pain and improve hand functional level and quality of life. Shockwave is an effective, safe, non-invasive method for conservative management of trigger finger. [ABSTRACT FROM AUTHOR]

To evaluate the status of a 7‐month phase 3 study conducted to test the effect of intramuscular injections of VM202 (ENGENSIS), a plasmid DNA encoding human hepatocyte growth factor, into the calf muscles of chronic nonhealing diabetic foot ulcers with concomitant peripheral artery disease. The phase 3 study, originally aimed to recruit 300 subjects, was discontinued because of slow patient recruitment. An unprespecified interim analysis was performed for the 44 subjects enrolled to assess the status and determine the future direction. Statistical analyses were carried out for the Intent‐to‐Treat (ITT) population and separately for subjects with neuroischemic ulcers, using a t‐test and Fisher's exact test. A logistic regression analysis was also conducted. VM202 was safe and potentially should have benefits. In the ITT population (N = 44), there was a positive trend toward closure in the VM202 group from 3 to 6 months but with no statistical significance. Levels of ulcer volume or area were found to be highly skewed between the placebo and VM202 groups. Forty subjects, excluding four outliers in both arms, showed significant wound‐closing effects at month 6 (P =.0457). In 23 patients with neuroischemic ulcers, the percentage of subjects reaching complete ulcer closure was significantly higher in the VM202 group at months 3, 4, and 5 (P =.0391,.0391, and.0361). When two outliers were excluded, a significant difference was evident in months 3, 4, 5, and 6 (P =.03 for all points). A potentially clinically meaningful 0.15 increase in Ankle‐Brachial Index was observed in the VM202 group at day 210 in the ITT population (P =.0776). Intramuscular injections of VM202 plasmid DNA to calf muscle may have promise in the treatment of chronic neuroischemic diabetic foot ulcers (DFUs). Given the safety profile and potential healing effects, continuing a larger DFU study is warranted with modifications of the current protocol and expansion of enrolling sites. [ABSTRACT FROM AUTHOR]

Background: Healthy Lifetime, a theoretically driven, personalized health coaching program delivered electronically, including face-to-face videoconferencing, was developed to intervene in early aging to stave off functional decline and minimize the onset/exacerbation of chronic conditions. Objective: To determine the efficacy of a theoretically driven, personalized health coaching program in participants 50 years and older with one or more chronic conditions using a randomized, controlled, pragmatic clinical trial methodology. Methods: Participants were randomly assigned to the HL (n = 59) or a usual care (n = 63) group. The HL group received health coaching from a trained nurse over eight weeks. Outcomes were measured at baseline, eight weeks, and 20 weeks (after the 12-week no-treatment phase). Regression modeling with fixed-effect repeated measures was used to account for the longitudinal data collection. Results: For the HL group, health habits increased at 8 weeks (3.1 units; SE = 1.0; p =.0005; effect size =.15). This difference was sustained at 20 weeks (2.4 units, SE = 0.2; p =.0005). Independent self-care agency improved at 8 weeks in individuals with high blood pressure (13.5 units; SE = 4.37; p =.0023; effect size =.3). However, that difference was not sustained at 20 weeks (p =.47). No significant improvements were shown in the usual care group at 8 weeks or 20 weeks. Conclusions: HL participants significantly improved their health habits at 8 weeks and sustained this improvement at week 20 (after a 12-week no-treatment phase) vs. the usual care group. Changing health habits alone has been shown to reduce all-cause morbidity and mortality in chronic disease. The high-functioning, community-dwelling older adults with chronic diseases we studied is an important target population for primary care practices to intervene early in aging to stave off the complications of chronic disease and functional decline. Trial registration: ClinicalTrials.gov (record NCT05070923, 07/10/2021). [ABSTRACT FROM AUTHOR]

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Background: Effective emotional regulation is recognized as essential to a good mental health of people with chronic diseases, and Mind–body and Art Therapies (MBATs) could have a positive effect on emotional regulation skills in this population. Thus, we aimed to evaluate the effect of MBATs on emotional regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) questionnaire. Methods: A convergent mixed approach nested in a pragmatic superiority two arms parallel randomized controlled trial was conducted. French speaking adults with one or more chronic somatic illnesses and not suffering from a chronic psychiatric disorder unrelated to one of their chronic somatic illness were included. At inclusion, non-directive interviews were conducted, followed by an initial DERS assessment. The same combination of evaluation was implemented after 6 months of activity (T1). After inclusion, each participant was randomized within either the intervention group (G1) or the control group (G2) following a controlled wait-list design by use of a pregenerated randomization list. Staff and patient were blinded to this list until the initial evaluation was completed, after which the trial was conducted in an open-label fashion. Participants chose 2 mediations: one creativity-focused (art-therapy, writing workshop, theatre of life, vocal workshop) and one mind–body-focused (mindfulness meditation, Pilates, shiatsu, ayurvedic massages). G1 started their mediations immediately after inclusion, while G2 started 6 months later. Primary outcome was the change in means at 6 months in the overall DERS score compared between each group. Non-directive interviews were carried out at the inclusion and after 6 months of MBATs. A continuous inductive analysis was carried out on gathered material in G1 to explore the participants' experiences regarding their disease and their perceived changes associated to the intervention. Results: A total of 150 patients was randomized (75 per groups) at the end of the study. At T1, 133 patients filled out the final questionnaire (67 in G1 vs 66 in G2) and 112 interviews were analysed (54 in G1 vs 58 in G2). All 150 patients were analysed (intention to treat) using a multiple imputation approach. The mean DERS score at T0 was equal to 82.8 ± 21.1 and 85.0 ± 20.2 in G1 and G2 respectively. On average, at T1, the score decreased in the G1 (Δ = -4.8, SD = 21.3) and in G2 (Δ = -0.11, SD = 17.8). The difference in decrease, however, was not statistically significant (p = 0.13). Qualitative analysis underlined some MBATs benefits on emotional regulation, especially on regulation strategies. No harms related to the intervention has been observed. Conclusions: This study only partially supports benefits on MBAT on emotional regulation skills enhancement in patients with chronic disease receiving MBATs, as measured by the DERS scale. Trial registration: The protocol was registered on Clinical Trials (NCT02911207). [ABSTRACT FROM AUTHOR]

Objectives: In this study, we present the complication data of patients we treated for chronic venous insufficiency (CVI) with cyanoacrylate adhesive closure (CAC) therapy for 2 years. Methods: Complications of 382 CAC procedures performed by the same surgeon were reviewed retrospectively. Results: Independent of patients, depending on the payment system of the state; two hundred twenty-three (58.4%) of 382 procedures were performed using the Venex system, and the Variclose system was used in 159 (41.6%) patients. A phlebitis-like reaction occurred in 46 (12%) patients, induration in 18 (4.7%) patients, hyperpigmentation in five (1.3%) patients, abscesses in four (1%) patients, cellulitis in three (0.8%) patients, and granuloma in one (0.3%) patient. In addition, as serious complications, deep vein thrombosis (DVT) developed in three patients and pulmonary embolism in one of these patients. Interestingly, temporary blindness was also observed in one patient. Conclusions: Although CAC therapy is a reliable method, its complications should not be ignored. Its use by experienced surgeons reduces the risk of complications. [ABSTRACT FROM AUTHOR]

Anal fissure is one of the most prevalent diagnosis in patients with anorectal symptoms. Depending on the chronicity, treatment choices vary, from topical and conservative management to operative ones. PRP is a blood‐derived product with a three to five‐fold platelet count and can be used for restorative purposes. The objective of this study is to assess the therapeutic effect of intralesional PRP in acute and chronic anal fissures and comparing it with the classic topical approach. We included 94 patients with acute and chronic anal fissures and divided them into intervention and control groups. Control patients were treated only with topical compounds, and the intervention group received one dose of intralesional autologous PRP plus the same classic treatment. We assessed patients 2 weeks, 1 month, and 6 months later. The mean pain score in the intervention group was significantly lower than control groups in all visits (p‐value <0.001). During the follow‐ups, the bleeding rate was significantly lower in the intervention group, so in the sixth month, the bleeding was 4% in the intervention group against 32% of the control (p‐value <0.001). The healing rate assessed by examination was 96% in the intervention group against 66% in the control in the sixth month (p‐value <0.001). Although there may be no significant difference in healing rate between groups in the acute anal fissure, the PRP group is significantly superior in the chronic setting. We concluded that in anal fissure treatment, PRP plus topical products are significantly superior to alone topical treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis. Design: Prospective, three-arm randomised controlled trial. Setting: Rehabilitation department of an academic hospital. Subjects: Patients with chronic subacromial bursitis. Interventions: Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group. Main outcome measures: The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient's evaluation of treatment effect, and symptom recurrence. Results: Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient's evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient's evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001). Conclusion: Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of age group (infants and non-infants) and demographics on survival in pediatrics with tracheotomy. Materials and Methods: Sex, age at the time of the tracheotomy, nationality, parental consanguinity, primary disease, date of discharge from the intensive care unit, and date of death were obtained from the medical records. The study population was categorized by nationality, parental consanguinity, and age group for survival analysis. Results: The study included 140 pediatric patients who underwent a tracheotomy. The median age of the patients at the time of the tracheotomy was 1.23 years. The median follow-up after tracheotomy was 5.4 months. Consanguinity was present in 70.4% of the parents. Primary diseases were grouped as neurologic (37.1%), neuromuscular (29.3%), metabolic (12.1%), cardiopulmonary (8.6%), traumatic (6.4%), and syndromic (6.4%). Neuromuscular diseases were more common in infants, while neurologic and metabolic diseases were more common in non-infants. Eighteen patients were weaned and four patients were decannulated. The overall mortality rate was 70%. The median overall survival was 214 days. Infants (147 days) had a shorter survival than non-infants (286 days). Parental consanguinity and nationality did not affect survival. Conclusion: In this study, among pediatric patients, infants are associated with a poor prognosis in survival. Neurologic and neuromuscular diseases may be thought to increase mortality among primary diseases. According to our study, it can be suggested that infants who cannot be decannulated due to neuromuscular diseases and are discharged with a tracheostomy are the group that should receive most attention regarding mortality among pediatrics with a tracheostomy. [ABSTRACT FROM AUTHOR]

Objectives and Background: Chronic cluster headache (CCH) is a rare but severely debilitating primary headache condition. A growing amount of evidence suggests that occipital nerve stimulation (ONS) can offer effective treatment in patients with severe CCH for whom conventional medical therapy does not have a sufficient effect. The paresthesia evoked by conventional (tonic) stimulation can be bothersome and may thus limit therapy. Burst ONS produces paresthesia‐free stimulation, but the amount of evidence on the efficacy of burst ONS as a treatment for intractable CCH is scarce. Methods: In this case series, we report 15 patients with CCH treated with ONS at Aarhus University Hospital, Denmark, from 2013 to 2020. Nine of these received burst stimulation either as primary treatment or as a supplement to tonic stimulation. The results were assessed in terms of the frequency of headache attacks per week and their intensity on the Numeric Rating Scale, as well as the Patient Global Impression of Change (PGIC) with ONS treatment. Results: At a median (range) follow‐up of 38 (16–96) months, 12 of the 15 patients (80%) reported a reduction in attack frequency of ≥50% (a reduction from a median of 35 to 1 attack/week, p < 0.001). Seven of these patients were treated with burst ONS. A significant reduction was also seen in maximum pain intensity. Overall, 10 patients stated a clinically important improvement in their headache condition following ONS treatment, rated on the PGIC scale. A total of 16 adverse events (nine of which were in the same patient) were registered. Conclusion: Occipital nerve stimulation significantly reduced the number of weekly headache attacks and their intensity. Burst ONS seems to function well alone or as a supplement to conventional tonic ONS as a preventive treatment for CCH; however, larger prospective studies are needed to determine whether the effect can be confirmed and whether the efficacy of the two stimulation paradigms is even. [ABSTRACT FROM AUTHOR]

Context: Tai Chi is a physical activity modality which is widely practiced over the world. The effectiveness of Tai Chi on postural control and balance has been described in older population, but until recently there are no studies that include patients with chronic ankle instability. Objectives: The aim of this study was to evaluate the effectiveness of 12 weeks of Tai Chi intervention on dynamic balance and self-reported instability in patients with chronic ankle instability. Study Design: A randomized controlled trial was carried out. Setting: University physical therapy facility. Participants: Fifty-two participants were allocated to an intervention group (n = 26) based on Tai Chi training or a control group (n = 26) who received no intervention. Intervention: The participants completed 12 weeks of Tai Chi intervention (1 h session/2 times per week) or no intervention in the control group. Main OutcomeMeasures: Outcome measures included postural control and self-reported instability feeling assessed by the Star Excursion Balance Test and the Cumberland Ankle Instability Tool, respectively. Results: There was observed significant improvement in all Star Excursion Balance Test reach distances (anterior [F = 6.26, P < .01]; posteromedial [F = 9.58, P < .01], and posterolateral [F = 8.42, P < .01]) in the Tai Chi group with no change in the control group (P < .01). The intervention group demonstrated significant improvement on self-reported instability feeling assessed by the Cumberland Ankle Instability Tool questionnaire (F = 21.36, P < .01). Conclusion: The obtained results suggested that 12 weeks of Tai Chi intervention have positive effects on postural control and self-reported instability feeling in patients with chronic ankle instability. [ABSTRACT FROM AUTHOR]

Background: In recent years, we have witnessed an evolving landscape in the management of chronic pancreatitis (CP). Endoscopy plays a pivotal role in CP management. Because the management of CP is problematic, we aimed to review and evaluate the role of endoscopy in the management of CP. Methods: This study was carried out in patients with painful chronic calcific pancreatitis who were admitted to the Department of Gastroenterology at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. This was an observational prospective study. We included 67 patients with painful chronic calcific pancreatitis and pancreatic duct abnormalities (stones, strictures, or ductal variations) in our study. These patients had to access exocrine and endocrine status before any therapeutic measures. All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic measure. After ERCP, the patients were followed up for 2 years to assess improvement in pain (visual analog scale score reduction), endocrine status (HBA1C reduction), or exocrine status (Fecal elastase reduction). Results: 67 patients were included in the study. Among them males were 32 (47.8%), females were 35(52.5%) and the age distribution studied were as in the age group of 15-30 years, patients were 23 (34.3%), in 30-45 years, there was 20 (29.9%), in age group of 45-60 year, patients were 20 (29.9%), and in the age group of 60-75 years, the patients were 4 (6%). Etiology was sought in all patients; alcohol-related CP was seen in three patients (4.5%), genetic in 11 (16.4%), IgG4 in one (1.5%), pancreatic divisum in 6 (9.0%), hyperparathyroidism in on1e (1.5%), and idiopathic in 45 (67.2%). All patients underwent ERCP for their symptoms to reduce ductal pressure, which is postulated as one of the hypotheses for pain in CP. Pancreatic duct (PD) clearance was attempted in all patients (complete in 42 [62.7%], partial in 17 [25.4%], and failed in 8 [11.9%]). These patients were followed for a period of two years after endotherapy, and the important predictors for pain reduction were single PD stones, disease in the head and body, and non-stricturing disease. Conclusion: Endotherapy offers a high rate of success in selected patients, clearance being better in distal disease and CP without PD strictures, suggesting early disease usually gets cleared very easily. [ABSTRACT FROM AUTHOR]

Introduction: This participatory action research was conducted by the collaborative health-related team in a district, in Thailand. The community network jointly developed a care model for diabetic patients in primary care using the Chronic Care Model (CCM) and evaluated the effectiveness of implemented model. Methods: Data was collected between October 2021 and March 2022 and involved 2 groups: 1) a community network of 25 people including representatives of the community hospital, primary care hospital, Sub-district administrative organization, community leaders, community representatives, representatives of diabetic patients, and representatives of caregivers of diabetic patients, and 2) 41 people with type 2 diabetes and 41 of their family caregivers. The research was conducted in 4 stages: planning, action, observation, and reflection. Results: Both quantitative and qualitative data were collected, and the overall average knowledge scores of diabetic patients, family caregivers, and community representatives significantly increased from before (6.07 ± 2.11, 7.07 ± 1.98, P =.024, 5.74 ± 1.88, 7.37 ± 2.25, P <.001, 7.47 ± 2.44, 8.99 ± 1.72, P =.010) respectively. For satisfaction, diabetic patients were most satisfied with family caregiver support, while the community network representatives were most satisfied with their participation in planning a model for diabetic patients in primary care. After model implementation, the blood sugar-controlled patients (HbA1c < 7 mg%) significantly increased (0 and 9.76%, P =.045), although the fasting blood sugar (FBS) of diabetic patients did not improve. Conclusion: The development and implementation of diabetes care based on CCM, promoted community participation and involvement in diabetes care. This model mainly affected diabetic patients who could control their HbA1c level and the satisfaction of the community network. [ABSTRACT FROM AUTHOR]

Background: Dysfunction of the endothelium is a key precursor of cardiovascular disease. Endothelial function, as assessed via the flow-mediated dilation test, is attenuated with chronic disease (e.g., type 2 diabetes mellitus, hypertension). Exercise training may mitigate this dysfunction and promote better vascular health. Objective: The main objective of this umbrella review was to determine the impact of exercise training on flow-mediated dilation in healthy adults and those with chronic disease. Methods: Studies were included if they conducted a systematic review and/or meta-analysis on flow-mediated dilation responses to exercise interventions in adults. Sources were searched in January 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. National Institutes of Health quality assessment tools were used. The results were presented narratively. Results: Twenty-seven systematic reviews, including 19 meta-analyses, (total: 5464 unique participants, 2181 reported unique female individuals) met the inclusion criteria. The average overall quality of included reviews was 8.8/11. The quality of studies within each included review varied from low to moderate using a variety of quality assessment scales. Reviews were conducted in healthy adults (n = 9, meta-analyses = 6), as well as those with type 2 diabetes (n = 5, meta-analyses = 4), cardiovascular conditions [i.e., conditions that impact the cardiovascular system, but excluding samples of only type 2 diabetes] (n = 11, meta-analyses = 7), and other chronic conditions (n = 2, meta-analyses = 2). Overall, the included reviews provided evidence that the type of training to optimally improve FMD may vary based on disease condition. Specifically, the evidence suggests that healthy adults benefitted most from higher intensity aerobic training and/or more frequent low-to-moderate resistance training. In addition, adults with type 2 diabetes benefitted most from low-intensity resistance or aerobic exercise training, whereas those with cardiovascular conditions should consider engaging in high-intensity aerobic training to improve endothelial function. Conclusions: This information may help guide the design of specific exercise programs or recommendations for adults with chronic conditions. [ABSTRACT FROM AUTHOR]

Background/Purpose This study aimed to evaluate how a two-week program using the in-phase mode of a balance adjustment system (the BASYS) affected postural control in participants with chronic ankle instability (CAI). It was hypothesized that the in-phase mode on the BASYS would lead to improved postural control compared with training on a balance disc. Study Design Randomized control trial. Methods Twenty participants with CAI were recruited. The participants were divided into two intervention groups: the BASYS (n = 10) and Balance Disc (BD; cushion type, n = 10). All participants underwent six supervised training sessions over a two-week period. Static postural control during single leg standing with closed eyes was assessed for the CAI limb. We collected COP data while participants balanced on the BASYS. The test was performed for 30 sec, and the total trajectory length and 95% ellipse area were calculated. In the assessment of dynamic postural stability, Y-Balance tests-anterior, posteromedial, and posterolateral directions were measured on the CAI limb for all participants and normalized to the individual's leg length. Participants were recorded at three instances: pretraining (Pre), post-training 1 (Post1: after the first training), and post-training 2 (Post2: after the last training). Results There was an effect on time in the COP total trajectory length of the BASYS group, which was significantly decreased for Post 1 and Post 2 than for the Pre (p = 0.001, 0.0001). Group differences and time-by-group interactions were not observed for either of the Y-balance test reach distances. Conclusions The study's primary finding was that two weeks of intervention in the in-phase mode on the BASYS improved static postural control in participants with CAI. Level of Evidence Level I, randomized control trial [ABSTRACT FROM AUTHOR]