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The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen's d = 0.45, 95% CI = 0.27-0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.

Motivated by the observation that dynamo is a conversion mechanism between kinetic and magnetic energy, we develop a new approach to unravel dynamo mechanism based on local (in space, scale, and time) energy budget describing dissipation and scale-by-scale energy transfers. Our approach is based upon a new filtering approach that can be used effectively for any type of meshes, including unstructured ones. The corresponding formalism is very general and applies to any geometry or boundary conditions. We further discuss the interpretation of these energy transfers in the context of fast dynamo and anomalous dissipation. We apply it to the results from direct numerical simulations of the von Kármán Sodium setup (referred to as VKS) using a finite element code, showing dynamo action for two types of impellers (steel or soft iron) in the magnetic field growth and saturation phases. Although the two types of dynamo hardly differ from the mean-field theory point of view (the velocity fields are the same in both cases), the locality of our formalism allows us to trace the origin of the differences between these two types of dynamo: for steel impellers, the dynamo is due to the transfer of velocity energy both in the bulk and in the vicinity of the impellers, whereas for soft iron impellers, the dynamo effect mainly comes from the rotation of the blades. We finally discuss possible signatures of precursors to anomalous dissipation and fast dynamo, which could become relevant in the inviscid limit. [ABSTRACT FROM AUTHOR]

Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months. The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects.