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We present the results of combined INTEGRAL and XMM–Newton   observations of the supergiant fast X-ray transient (SFXT) IGR J17354−3255. Three XMM–Newton   observations of lengths 33.4, 32.5, and 21.9 ks were undertaken, the first an initial pointing to identify the correct source in the field of view and the latter two performed around periastron. Simultaneous INTEGRAL observations across |${\sim }66\,{\rm {per \, cent}}$| of the orbital cycle were analysed but the source was neither detected by IBIS/ISGRI nor by JEM-X. The XMM–Newton  light curves display a range of moderately bright X-ray activity but there are no particularly strong flares or outbursts in any of the three observations. We show that the spectral shape measured by XMM–Newton  can be fitted by a consistent model throughout the observation, suggesting that the observed flux variations are driven by obscuration from a wind of varying density rather than changes in accretion mode. The simultaneous INTEGRAL data rule out simple extrapolation of the simple power-law model beyond the XMM–Newton  energy range. [ABSTRACT FROM AUTHOR]

Introduction: Painful Diabetic Neuropathy (PDN) is known to negatively affect psychosocial functioning as expressed by enhanced levels of anxiety and depression. Objective: To specify diabetes and pain related fears, hereby identifying potential targets for intervention. Patients: This questionnaire-based cross-sectional study included 154 patients with PDN (mean age 65.7 ± 6.6 years). Methods: Linear regression analyses corrected for age, gender, pain intensity, pain duration and insulin treatment were performed to assess the associations of various fear questionnaires (Hypoglycaemia Fear Survey (HFS), Tampa Scale of Kinesiophobia (TSK), Pain Anxiety Symptom Scale (PASS-20), Falls Efficacy Scale-I (FES-I), Tampa Scale of Fatigue (TSF), Brief Fear of Negative Evaluation Scale (BFNE)) with quality of life (QoL) (Norfolk Quality of Life Questionnaire, Diabetic Neuropathy Version, QOL-DN) and disability (Pain Disability Index, PDI), respectively. Results: All fears were independently associated with QoL and disability (p < 0.001 for all variables). Stepwise backward regression models including all fear questionnaires showed that pain intensity, fear of fatigue, fear of hypoglycaemia and fear of falling were significantly associated with decreased QoL; β = 0.253; p < 0.001; β = 0.134; p = 0.045; β = 0.216; p = 0.003, and β = 0.385; p < 0.001, respectively; R2 = 0.629. Pain intensity and fear of falling were significantly associated with disability; β = 0.283; p < 0.001 and β = 0.540; p < 0.001 respectively; R2 = 0.544. Conclusion: In patients with PDN, pain intensity, fear of falling, fear of hypoglycemia and fear of fatigue were associated with decreased QoL. Pain intensity and fear of falling were associated with disability. Clinical message: Unravelling specific fears enables us to identify targets for behavioural interventions that aim to improve psychosocial well-being in patients with PDN. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to explore physiotherapists' knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for chronification., Method: A qualitative study using in-depth semi-structured interviews was conducted with 13 physiotherapists working in primary care. A purposive sampling method served to seek the broadest perspectives. The knowledge-attitude and practice framework was used as an analytic lens throughout the process. Textual data were analyzed using qualitative content analysis with an inductive approach and constant comparison., Results: Seven main themes emerged from the data; physiotherapists self-estimated knowledge and attitude, role clarity, therapeutic relationship, internal- and external barriers to practice behavior, physiotherapists' practice behaviors, and self-reflection. These findings are presented in an adjusted knowledge-attitude and practice behavior framework., Conclusion: A complex relationship was found between a physiotherapist's knowledge about, attitude, and practice behavior concerning the diagnostic process and interventions for non-specific, non-traumatic, acute, and subacute neck pain. Overall, physiotherapists used a biopsychosocial view of patients with non-specific neck pain. Physiotherapists' practice behaviors was influenced by individual attitudes towards their professional role and therapeutic relationship with the patient, and individual knowledge and skills, personal routines and habits, the feeling of powerlessness to modify patients' external factors, and patients' lack of willingness to a biopsychosocial approach influenced physiotherapists' clinical decisions. In addition, we found self-reflection to have an essential role in developing self-estimated knowledge and change in attitude towards their therapeutic role and therapist-patient relationship., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Painful diabetic neuropathy (PDN) is known to negatively affect psychosocial functioning as expressed by enhanced levels of anxiety and depression. The aim of this study was to specify diabetes and pain-related fears., Methods: This questionnaire-based cross-sectional study included 154 patients with PDN (mean age 65.7 ± 6.6 years). Correlation analyses corrected for age, gender, pain intensity, pain duration and insulin treatment were performed to assess the associations of fear of hypoglycaemia (Hypoglycaemia Fear Survey, HFS), kinesiophobia (Tampa Scale of Kinesiophobia, TSK), fear of pain (Pain Anxiety Symptom Scale, PASS-20), fear of falling (Falls Efficacy Scale-I, FES-I), fear of fatigue (Tampa Scale of Fatigue, TSF) and fear of negative evaluation (Brief Fear of Negative Evaluation Scale, BFNE), with quality of life (QoL) (Norfolk Quality of Life Questionnaire, Diabetic Neuropathy Version, QOL-DN) and disability (Pain Disability Index, PDI), respectively., Results: In univariate analyses, all fears were independently associated with QOL-DN and PDI (p < 0.001 for all variables). Linear regression models including all fears and confounders, showed that pain intensity, pain duration and FES-I were significantly associated with QOL-DN (R 2  = 0.603). Pain intensity, male gender and FES-I were significantly associated with PDI (R 2  = 0.526)., Conclusions: After controlling for confounders, levels of pain intensity, duration of pain and fear of falling were negatively associated with QoL in patients with PDN. Pain intensity, male gender and fear of falling were positively associated with disability. Specifying fears enables us to identify potential targets for behavioural interventions that aim to improve psychosocial well-being in patients with PDN., Significance: This study shows that patients with PDN suffer from various fears, which should enable us to design a treatment strategy that directly targets these fears, hereby improving physical and psychosocial well-being in these patients., (© 2017 European Pain Federation - EFIC®.)

Objectives: Treatment outcome studies ought to assess the fidelity of their treatments, including treatment delivery, but practical guidelines and examples for this are lacking. Based on general recommendations in available literature, this study proposes and illustrates the design and application of a Method of Assessing Treatment Delivery (MATD) in a behavioral medicine trial comparing two treatments for chronic low back pain., Study Design and Setting: In designing MATD, two experts identified several feasible treatment elements. Agreement between the experts in classifying these elements into five categories (essential and unique, essential but not unique, unique but not essential, compatible, prohibited) was assessed. In applying MATD, treatment recordings were evaluated by two independent raters, who coded the (non)-occurrence of MATD elements and who categorized each session as belonging to one of the two treatments., Results: MATDs content validity was supported by adequate agreement between the experts' classifications of the treatment elements. MATDs interrater reliability was good., Conclusion: Comprehensive illustrations of designing and applying MATD may encourage the verification of treatment delivery as a partial reflection of treatment fidelity in forthcoming treatment outcome studies.

Background and Purpose: Before developing new medical facilities or adapting existing facilities in the field of stroke, it is desirable to assess not only the medical, but also the economic consequences of such facilities. Economic evaluation studies differ from other outcome studies in the way that costs are compared with effects. The purpose of this paper is to give an insight into economic evaluation studies in the field of stroke, so that these studies become easier for neurologists to understand and to apply., Summary of the Article: Crucial aspects in economic evaluation research are addressed successively, such as the techniques used and how the results can be influenced by the perspective of the study. The article also considers the inclusion of costs and consequences in economic evaluation research. At the end of this article, special issues in economic evaluation studies are presented such as discounting, sensitivity analysis, incremental analyses and ratios., Conclusions: Although neurologists have no direct responsibility for allocating scarce resources in the field of stroke, they are confronted with the results of these decisions in their everyday work. Because of this, it might be useful to have clear understanding of economic evaluation studies and their caveats., (Copyright 2001 S. Karger AG, Basel)

From a societal perspective long-term clinical trials or follow-up studies should preferably not only include an evaluation of the health effect for the patient, but also an economic evaluation. In order to yield comprehensive medical and nonmedical resource use data, we at least partly depend on respondents' recall for collecting these costing data. A patient cost diary was developed in order to estimate total resource use, expenses, and lost production due to illness and treatment. We applied the cost diary in two randomized clinical trials evaluating the cost-effectiveness of behavioral rehabilitation in 205 fibromyalgia and chronic low back pain patients. The use of the diary was evaluated, studying the feasibility, the influence of the period of data collection on the results, and some aspects of validity. Eighty-five percent of the patients completed at least one diary and in total 68% of the diaries were returned. Although the results for the three alternative periods of data collection (keeping the diary 1 week every month, 2 weeks every 2 months, or a full year) were not significantly different, they were only moderately correlated. Finally, self-reported specialist care contacts were generally in agreement with data from an insurance company. However, for physiotherapy contacts there were differences between the self-reported and insurance data. This study shows how the cost diary might be used successfully in cost-effectiveness studies.

This study examined the supplemental value of a cognitive coping skills training when added to an operant-behavioral treatment for chronic low-back pain patients. The complete treatment package (OPCO) was compared with an operant program + group discussion (OPDI) and a waiting-list control (WLC). After the WL period, the WLC patients received a less protocolized operant program usually provided in Dutch rehabilitation centers (OPUS). Regression analyses showed that, compared with WLC, both OPCO and OPDI led to less negative affect, higher activity tolerance, less pain behavior, and higher pain coping and pain control. At posttreatment, OPCO led to better pain coping and pain control than OPDI. Calculation of improvement rates revealed that OPCO and OPDI had significantly more improved patients than OPUS on all the dependent variables. The discussion includes findings regarding treatment credibility, compliance, and contamination bias.

Objective: In this 3 year randomized clinical trial the cost effectiveness of a 6 week educational/cognitive intervention (ECO) is compared with an educational discussion intervention (EDI) and a waiting list condition (WLC)., Methods: A total of 131 patients with fibromyalgia were randomly allocated to the ECO, EDI, or WLC intervention. The ECO and EDI groups were followed for 12 months, whereas the WLC group was followed for 6 weeks. Direct health care and nonhealth care costs, and the indirect costs associated with lost production due to illness, were calculated. The effects were measured in terms of utilities, using rating scale and standard gamble methods., Results: Treatment costs were estimated to be US $980 per patient for both ECO and EDI. The total direct health care costs of ECO treatment were US $1623 higher than those for EDI. This difference was significant. Indirect costs for the 2 groups were not significantly different. At 6 weeks there was a significant difference in rating scale utilities between the 3 groups, caused by a significantly greater improvement in the EDI group compared to the WLC group. However, no significant differences in either rating scale or standard gamble utilities were found between the ECO and EDI groups immediately after treatment, or at the 6 or 12 month followups., Conclusion: The economic evaluation showed that the addition of a cognitive component to the educational intervention led to significantly higher health care costs and no additional improvement in quality of life compared to the educational intervention alone. This conclusion is robust through a range of plausible values used in a sensitivity analysis.

Objective: This randomized controlled clinical trial evaluates the effectiveness of outpatient group cognitive/educational treatment for patients with the fibromyalgia (FM) syndrome. We hypothesized that the combination of group education with cognitive treatment aimed at developing pain coping skills would be more effective than group education alone., Methods: 131 patients with FM were randomly assigned to 3 conditions: an experimental condition, which was the combined cognitive/educational intervention (ECO); an attention control condition consisting of group education plus group discussion (EDI); and a waiting list control (WLC). For the treatment conditions ECO and EDI, assessments were made 2 weeks before treatment, at start of treatment, at post-treatment, and at 6 and 12 mo followup. WLC patients received only 3 assessments., Results: There were no pretreatment differences between the groups, or between dropouts and patients who remained in the study. At post-treatment, and compared with the WLC, the ECO patients improved in knowledge about FM (p = 0.007) and pain coping (p < 0.001). EDI patients improved on pain coping (p = 0.005) and pain control (p = 0.002). EDI patients reported significantly less fear than ECO patients (p = 0.005). There were no other differential effects between ECO and EDI at post-treatment or 6 mo or 12 mo followup. Based on the reliability of change index for clinical significance, the relative short term success rates are 6.4 and 18.4% for ECO and EDI, respectively., Conclusion: The surplus value of a highly structured, 12 session group cognitive treatment added to group education cannot be supported by our study. In EDI, fear reduction might have enhanced pain coping and pain control, while poor compliance, the difficulty of homework assignments, and lack of individual support may have limited the effectiveness of ECO.