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Mental health concerns among young adult populations have increased in recent years, with standard treatment approaches presenting many undue barriers (e.g., time and cost constraints and limited availability of therapists). Single-session interventions (SSIs) have been explored as an alternative, scalable intervention to address these barriers to care. We evaluated the acceptability and feasibility of a SSI in a real-world setting and found promising effects of the SSI on symptoms of depression in a young adult population. Given these findings, we offer support for the SSI as an accessible treatment alternative to perhaps be integrated into tiered care treatment models or settings with limited access to care.
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Background: Multiple sclerosis (MS) is one of the most debilitating neurodegenerative diseases in youth, significantly affecting all life domains. Therefore, a strong association between MS, depression and anxiety symptoms has been established. The objective of the present interventional one-group pretest-posttest study is to assess the feasibility of an online single-session intervention (SSI) based on a cognitive behavioral therapy protocol targeting depressive and anxiety symptoms, psychological mechanisms, fatigue and overall health status. Methods: In this pilot study, 31 patients with MS (Mage = 42 years, SD = 12.2) received the online CBT SSI. The impact of the intervention was assessed using validated instruments two weeks after the intervention and after a two-month follow-up period. Results: Statistically significant effects were observed for the reduction of depression, with B = -7.58, 95% CI (-12.84, -2.31) and p < 0.01, and anxiety, with B = -15.17, 95% CI (-18.31, -12.02) and p < 0.001, at post-test and follow-up screening. Additionally, positive outcomes were seen for irrational beliefs at post-test, with B = -25.86, 95% CI (-46.10, -5.61), along with negative automatic thoughts, with B = -4.47, 95% CI (-10.65, 1.71), which were preserved at follow-up. Despite the health status also improving, no significant changes were observed for dysfunctional attitudes and fatigue. Conclusions: This research proves that the online CBT SSI was efficient for decreasing mild to moderate symptoms of depression and anxiety and reducing the intensity of dysfunctional psychological mechanisms in our sample.
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Autistic youth experience elevated rates of co-occurring internalizing symptoms. Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive, blunting dissemination of intervention and highlighting the need for scalable solutions. One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), however, no study has examined SSIs for depression symptoms in autistic youth. Participants included 40 autistic adolescents ranging in age from 11 to 16 (Mage = 14.22, Nmale = 32). Eligible youth who agreed to participate were randomized to either the active intervention (Project Personality), or an active control designed to mimic supportive therapy. Participants and their caregiver completed questionnaires immediately before, after, and three months post intervention. All participants completed the intervention independently and largely reported enjoying it. The intervention was delivered with 100% fidelity. Findings demonstrated improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. This study was the first to assess a GM-SSI designed to treat depression symptoms in autistic adolescents. Results indicated improvements in perceived control immediately post-intervention and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize benefit. Findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention.
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This study explores a novel approach to enhancing cognitive proficiency by targeting neural mechanisms that facilitate science and math learning, especially mental rotation. The study specifically examines the relationship between upper alpha intensity and mental rotation skills. Although prior neurofeedback research for increasing upper alpha highlights this correlation, mostly with familiar objects, novel chemistry and math learning prompts envisioning unfamiliar objects which question the persistence of this correlation. This study revisits the upper alpha and mental rotation relationship in the context of unfamiliar objects with a single neurofeedback session and examines the efficiency of manual and automatic neurofeedback protocols. Results will provide a basis for integrating neurofeedback protocols into learning applications for enhanced learning. Our study encompassed three cohorts: Group 1 experienced an automatic neurofeedback protocol, Group 2 received a manual neurofeedback protocol, and the control group had no neurofeedback intervention. The experimental phases involved EEG measurement of individual upper alpha (frequency of maximal power + 2 Hz) intensity, mental rotation tasks featuring geometric and unfamiliar molecular stimuli, one neurofeedback session for applicable groups, post-treatment upper alpha level assessments, and a mental rotation retest. The neurofeedback groups exhibited increased levels of upper alpha power, which was correlated with improved response time in mental rotation, regardless of stimulus type, compared to the control group. Both neurofeedback protocols achieved comparable results. This study advocates integrating neurofeedback into learning software for optimal learning experiences, highlighting a single session's efficacy and the substantial neurofeedback protocol's impact in enhancing upper alpha oscillations.
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Ritmo alfa , Neurorretroalimentación , Humanos , Neurorretroalimentación/métodos , Femenino , Masculino , Ritmo alfa/fisiología , Adulto , Adulto Joven , Electroencefalografía , Aprendizaje/fisiología , Rotación , Imaginación/fisiologíaRESUMEN
Introduction: Mindfulness interventions can improve a broad range of patient outcomes, but traditional mindfulness-based interventions are time and resource intensive. Emerging evidence indicates brief, single-session mindfulness interventions can also improve patient outcomes, and brief mindfulness interventions can be embedded into medical care pathways with minimal disruption. However, the direct impact of a brief mindfulness intervention on patients' pain while waiting in the clinic waiting room remains unexamined. Objective: A series of three, pilot, randomized controlled trials (RCTs) were conducted to examine the impact of a brief, audio-recorded, mindfulness intervention on patients' pain in the clinic waiting room. Method: Study 1 examined an 8-min mindfulness recording delivered before a provider visit; Study 2 examined a 5-min mindfulness recording after a provider visit; and Study 3 examined a 4-min mindfulness recording before a provider visit. Time- and attention-matched control conditions were used in each study. Studies 1 and 2 were conducted in an academic cancer hospital. Study 3 was conducted at a walk-in orthopedic clinic. Pain intensity was measured in each of the three studies. Anxiety and depression symptoms were measured in Studies 2 and 3. Pain unpleasantness was measured in Study 3. Results: A brief (i.e., 4- to 8-min), audio-recorded mindfulness intervention decreased patients' pain intensity in the clinic waiting room, whether delivered before (Study 1 Cohen's d=1.01, Study 3 Cohen's d=0.39) or after (Study 2 Cohen's d=0.89) a provider visit. Mindfulness had a significant effect on anxiety symptoms in both studies in which it was measured. No effect on depression symptoms was observed. Conclusions: Results from these three pilot RCTs indicate brief, audio-recorded, mindfulness interventions may be capable of quickly decreasing clinical symptoms. As such, embedding brief, audio-recorded, mindfulness interventions in clinic waiting rooms may have the potential to improve patient outcomes. The continued investigation of this intervention approach is needed. Clinical Trial Registrations: NCT04477278 and NCT06099964.
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Introduction: Traditional, 8-week, mindfulness-based interventions can effectively treat chronic pain, but require a time and resource investment too burdensome for many patients and providers. The solution to this logistical challenge may be to distill the core, therapeutic elements of an efficacious 8-week, mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), into a 2-h, single-session intervention. Methods: In this study, the authors conducted a waitlist-controlled, randomized clinical trial to assess the impact of a 2-h, single-session adaptation of MORE (i.e., One MORE) on chronic pain patients' (N = 40) pain-related outcomes through 3-month follow-up. Results: Results indicated that One MORE significantly improved chronic pain patients' pain catastrophizing (i.e., primary outcome; F = 9.97, p = 0.002), pain intensity (F = 26.58, p < 0.001), pain interference (F = 39.43, p < 0.001), physical function (F = 16.29, p < 0.001), sleep (F = 16.66, p < 0.001), anxiety (F = 12.54, p < 0.001), and depression (F = 17.48, p < 0.001). One MORE also significantly increased theoretically indicated therapeutic mechanisms through the 3-month follow-up: mindfulness, positive reappraisal, savoring, self-transcendence. Discussion: Study results are promising, and if replicated, would suggest that One MORE is a highly scalable, low-cost (e.g., sustainable), nonpharmacologic treatment for chronic pain. Clinical Trial Registration: NCT05194241.
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Dolor Crónico , Atención Plena , Humanos , Atención Plena/métodos , Dolor Crónico/terapia , Dolor Crónico/psicología , Femenino , Masculino , Persona de Mediana Edad , Estudios de Seguimiento , Adulto , Resultado del Tratamiento , Catastrofización/psicología , Catastrofización/terapia , Manejo del Dolor/métodos , Anciano , Ansiedad/terapia , Ansiedad/psicologíaRESUMEN
BACKGROUND AND OBJECTIVES: Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. MATERIALS AND METHODS: A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. RESULTS: Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). CONCLUSIONS: The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.
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OBJECTIVE: This bibliometric analysis aimed to explore the publication and citation metrics of the research literature on single-session therapy (SST) to understand its current status, trends, and future prospects. METHODS: Seventy-five keywords were validated by subject matter experts. Publications from 1972 through September 2023 were extracted from the bibliometric website Lens.org. Publication trends, citation patterns, prominent journals, and influential authors were examined as part of the bibliometric analysis. Citation network analysis, bibliographic coupling of authors, and coauthorship network analysis were also performed. RESULTS: A total of 301 SST publications, including 18 books, 85 book chapters, and 176 journal articles, were found, published by 493 authors. The citation- and publication-related metrics suggested a growing level of subject matter expertise over time. Initially, single-author publications held more prominence than collaborative work, but this pattern shifted. From 2011 to 2020, scholarly interest surged, resulting in 144 publications during this period. CONCLUSIONS: This bibliometric analysis, the first systematic exploration of the SST knowledge base, can be used to expand and enrich future SST research.
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Bibliometría , Humanos , Psicoterapia/estadística & datos numéricos , Psicoterapia/tendencias , Psicoterapia/métodosRESUMEN
OBJECTIVE: Single-session, catheter-directed thrombolysis (CDT) with adjunctive power pulse spray (PPS) only, without thrombectomy, was evaluated for its safety and effectiveness. We performed a single-center, retrospective analysis of prospectively collected data. METHODS: Patients with high-risk or intermediate-risk pulmonary embolism (PE) who met the inclusion criteria and underwent a single session of CDT-PPS were included in the study. The primary outcomes assessed were technical and clinical success and major adverse events. Secondary outcomes included effectiveness based on pre- and postintervention clinical examination, radiographic findings, and reversal of right ventricular dysfunction at 48 hours and 4 weeks after discharge on echocardiography and computed tomography pulmonary angiography. The length of stay in the intensive care unit and overall admission were also analyzed. A return to premorbid exercise tolerance was evaluated at 12 months after the procedure. RESULTS: Between May 2016 and January 2023, 104 patients at the Wollongong Hospital were diagnosed with high- or intermediate-risk PE and underwent CDT-PPS. Of the 104 patients, 49 (47%) were considered to have high-risk PE and 55 (53%) intermediate-risk PE. Eleven patients (11%) had absolute contraindications and 49 patients (47%) had relative contraindications to systemic thrombolysis. Technical success was achieved in 102 patients (98%). Survival was 99% at 48 hours, 96% at 4 weeks, and 91% at 12 months. At 4 weeks, echocardiography showed 98% of patients had no evidence of right heart dysfunction, and computed tomography pulmonary angiography showed complete resolution of PE in 72%. There were no major adverse events at 48 hours. The median intensive care unit length of stay was 1 day, and the overall length of stay was 6 days. At 12 months, 96% had returned to their premorbid status. CONCLUSIONS: The CDT-PPS technique is fast, safe, and effective in the treatment of high- and intermediate-risk PE, even in patients with a high bleeding risk, and should be considered as first-line management when the skills and resources are available. Further multicenter prospective studies are needed to corroborate these results.
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Embolia Pulmonar , Terapia Trombolítica , Humanos , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Resultado del Tratamiento , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Adulto , Enfermedad Aguda , Tiempo de Internación , Factores de Riesgo , Recuperación de la FunciónRESUMEN
OBJECTIVE: Interventional treatments for acute iliofemoral deep vein thrombosis (DVT) remain controversial after publication of the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) study. Interventions have been shown to reduce post-thrombotic syndrome severity and improve quality of life in DVT patients, but have been accompanied by risk of major bleeding from thrombolytics. We describe thrombus removal using a novel combined basket-rotational thrombectomy device that minimizes the need for thrombolytics or repeat procedures. METHODS: The aim of this prospective, nonrandomized, multicenter, first-in-human study of 19 patients with acute iliofemoral DVT was to evaluate the safety and performance of the Pounce venous thrombectomy system ≤12 months after treatment. The primary performance end point was defined as procedural success through achievement of Society of Interventional Radiology (SIR) grade II lysis in treated vessels with freedom from procedural adverse events. Secondary end points included venous disease severity assessments using the Villalta scale and the Venous Clinical Severity Score, patient quality-of-life measurement using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life questionnaire, and calf circumference measurements taken at baseline, 24 hours, and 1 month. RESULTS: The primary end point of complete or near-complete thrombus removal (Society of Interventional Radiology grade II or III) was achieved in all patients. All study device-related safety end points were met, with no major bleeding or device-related adverse events. Of the 19 patients treated, 16 (84.2%) did not receive thrombolytics during the procedure. Post-thrombotic syndrome (Villalta scale >4) was identified in 17 of 19 patients (89.5%) at baseline, 4 of 13 patients (30.8%) available for follow-up at 6 months, and 2 of 11 patients (18.2%) at 12 months. The median Venous Clinical Severity Score decreased (P < .001) from 8.5 (interquartile range [IQR], 7-10) at baseline to 4 (IQR, 2-4) at 1 month after the procedure and was similar at 6 months (2; IQR, 2-5) and 12 months (2; IQR, 1.5-3) after the procedure. The median Venous Insufficiency Epidemiological and Economic Study-Quality of Life questionnaire score improved (P < .001) by 39 from baseline (57; IQR, 53.5-74) to 1 month (96; IQR, 86-101) after the procedure, and remained high at 6 months (99; IQR, 75-103) and 12 months (98; IQR, 94.5-100). The median calf circumference decreased (P = .089) from 39 cm (IQR, 35-47.8 cm) at baseline to 36 cm (IQR, 32.5-40.5 cm) at 24 hours after the procedure and was 34.5 cm (IQR, 33.2-38.5 cm) at 1 month. CONCLUSIONS: The Pounce device is safe and effective for removal the of thrombus in patients with acute iliofemoral DVT. Initial results demonstrate improvements in venous disease severity and patient quality of life.
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Vena Femoral , Vena Ilíaca , Calidad de Vida , Trombectomía , Trombosis de la Vena , Humanos , Femenino , Trombosis de la Vena/terapia , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/fisiopatología , Masculino , Estudios Prospectivos , Persona de Mediana Edad , Vena Femoral/diagnóstico por imagen , Vena Femoral/cirugía , Vena Femoral/fisiopatología , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Vena Ilíaca/cirugía , Anciano , Resultado del Tratamiento , Trombectomía/instrumentación , Trombectomía/efectos adversos , Adulto , Factores de Tiempo , Diseño de Equipo , Índice de Severidad de la Enfermedad , Síndrome Postrombótico/terapia , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/fisiopatologíaRESUMEN
BACKGROUND: Pregnancy is a time of heightened risk for disordered eating behaviors, which are linked to adverse health outcomes in gestation, delivery, and the postpartum. These adverse outcomes may be partially mediated by greater rates of deviation from recommended weight gain trajectories, especially in those who engage in binge and loss of control (LOC) eating. Food cravings are powerful and highly modifiable triggers of binge and LOC eating in non-pregnant populations with preliminary evidence linking cravings to disordered eating behaviors in pregnancy as well. Acceptance-based approaches have been shown to be feasible and effective in reducing the adverse impact of cravings on behavior. PURPOSE: To test the feasibility, acceptability, and preliminary efficacy of a single-session, self-guided, acceptance-based online workshop targeting food cravings as predictors of binge and LOC eating in pregnancy. METHODS: We will conduct a pilot randomized controlled trial of a single-session, self-guided online acceptance-based workshop targeting food cravings in pregnancy. Pregnant individuals in the second trimester (n ≥ 74) endorsing current food cravings will be randomly assigned to the intervention or an untreated control group. The intervention group will participate in a one-hour workshop that imparts skills grounded in Acceptance and Commitment Therapy, including acceptance, defusion, and present-moment awareness. Both groups will complete comprehensive self-report assessments of primary outcomes and hypothesized mediators and moderators of intervention efficacy at baseline, one-month follow-up, and at full-term. CONCLUSION: Results will inform integration of acceptance-based skills targeting food cravings into routine prenatal care to prevent adverse outcomes associated with disordered eating behaviors in pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT06129461; registered on November 10, 2023.
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Ansia , Trastornos de Alimentación y de la Ingestión de Alimentos , Adulto , Femenino , Humanos , Embarazo , Terapia de Aceptación y Compromiso/métodos , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Intervención basada en la Internet , Proyectos Piloto , Complicaciones del Embarazo/psicología , Segundo Trimestre del Embarazo , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
In this pre-registered study, we evaluated the effects of a single-session, self-guided intervention, leveraging daily micropractice (≤20 seconds/day practice) of self-compassionate touch to enhance self-compassion. We randomly assigned undergraduates (N = 135) to one of two conditions: a single-session intervention in which they were taught self-compassionate touch or a finger-tapping active control. Then, we instructed them to practice for 20 seconds/day for one month. At baseline (T1) and one-month follow-up (T2), participants completed assessments of self-compassion, growth mindset, positive affect, stress, psychopathology, habit formation, and more. In confirmatory, intention-to-treat analyses (N = 135), we found no significant effects on these outcomes. However, in confirmatory, per-protocol analyses (comparing the subsets from each condition who practiced>28 times, N = 45), self-compassionate touch, relative to active control, predicted T1-to-T2 increases in self-compassion (ß = 0.71, p = .025), and reductions in stress (ß = -0.62, p = .047) and psychopathology (ß = -0.61, p = .046). In exploratory intention-to-treat analyses (N = 135), we found the same pattern of effects as in the per-protocol analyses among those who practiced self-compassionate touch more frequently relative to active control. We discuss factors associated with habit formation of daily practice. Daily micropractices have the potential for augmenting single-session interventions and for offering help when more time-intensive approaches may be less accessible. CLINICAL TRIAL REGISTRATION NUMBER: NCT05199779.
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Atención Plena , Autocompasión , Humanos , Atención Plena/métodos , Tacto , Estudiantes , EmpatíaRESUMEN
Objective: This manuscript describes an evidence-based, student-led, single-session group intervention to support emotional wellbeing among graduate students. The present objective is to provide a roadmap for other universities. Participants: Key participants include clinical psychology graduate students (leader and workshop facilitators), faculty supervisor, representatives from receiving departments or schools, and institutional advocates. Methods: The two-hour workshop was based on four core transdiagnostic cognitive behavioral skills, including psychoeducation about emotions, mindful emotional awareness, cognitive flexibility, and behavior change. The workshop was designed and continues to be led by trained graduate students. Results: Key steps and lessons learned are presented for the exploration, preparation, implementation, and sustainment phases. Conclusions: This program has the potential to be flexibly replicated at other universities to assist with graduate student mental health. It provides unique supports for recipients and unique training opportunities for student facilitators.
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Negative body image is a common public health concern among adolescents, globally. The aim of the current study was to evaluate the effectiveness, implementation fidelity, and acceptability of a single session, school-based universal body image intervention in Indonesia. A total of 1926 adolescents (59.4 % girls) and 12 school guidance counsellors (lesson facilitators) from nine state junior secondary schools in Surabaya, East Java took part in a two-arm open parallel cluster randomised controlled trial. In response to the changing circumstances due to the COVID-19 pandemic, half of the lessons were conducted in person and half were delivered online. Results showed that the lesson did not significantly improve adolescent body image or secondary outcomes relative to the control, though there was no evidence of harm. There were no substantive findings regarding intervention effectiveness by gender. The mode of intervention delivery (online vs. in-person) did not significantly influence the main findings. Implementation fidelity varied widely, and the lesson content and pedagogy were largely acceptable, though there was a strong preference for in-person lesson delivery. Findings have implications for researchers aiming to improve adolescent body image in low- and middle-income countries. Lessons learned can inform future school-based efforts to support adolescent body image.
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Imagen Corporal , Pandemias , Femenino , Adolescente , Humanos , Masculino , Indonesia , Imagen Corporal/psicología , Instituciones AcadémicasRESUMEN
OBJECTIVE: The objective of this study was to analyze the hemorrhagic risk of melanoma brain metastases after Gamma Knife radiosurgery (GKRS). METHODS: A prospective institutional database was retrospectively queried to identify patients who underwent GKRS for melanoma brain metastases between 1990 and 2021. Lesional hemorrhage was defined as definite or possible based on radiologists' readings, and severity was graded according to Common Terminology Criteria for Adverse Events. RESULTS: Two hundred ninety-one patients with 1083 lesions treated in 419 sessions were identified. The mean (± SD) patient age was 60 ± 15 years, and 61% were male. The median follow-up period for overall survival (OS) was 11 (range 0-214) months with 581 patient-years. Definite/possible lesional hemorrhages occurred in 13% of lesions, with grade 3 hemorrhages observed in 4% of lesions. Surgical intervention was required in 2% of cases (5% of patients), and all resected lesions were pathologically consistent with melanoma. A decreased risk of definite/possible lesional hemorrhage was associated with a later time period between 2015 and 2021 (OR 0.45, 95% CI 0.266-0.75, p = 0.0021), increased marginal dose (OR 0.91, 95% CI 0.83-0.99, p = 0.037), antiplatelet use post-GKRS (OR 0.195, 95% CI 0.083-0.46, p < 0.001), and whole-brain radiotherapy (WBRT; OR 0.53, 95% CI 0.344-0.82, p = 0.0042). After 2015, more patients received anticoagulation, B-Raf proto-oncogene inhibitors, and immune checkpoint inhibitors, and fewer received bevacizumab (p < 0.001). The cumulative risk of lesional hemorrhage was 17%-20% at 36 months from GKRS, with 95%-96% of cases occurring within 12 months. The median patient OS was 11 (95% CI 9-13) months, and multivariate Cox regression analysis revealed that antiplatelet agents (hazard ratio [HR] 0.66, 95% CI 0.45-0.96, p = 0.031) and immune checkpoint inhibitors (HR 0.35, 95% CI 0.26-0.48, p < 0.001) were associated with longer OS, while WBRT (HR 1.36, 95% CI 1.02-1.81, p = 0.037) and definite/possible hemorrhage (HR 1.39, 95% CI 1.04-1.85, p = 0.024) were associated with shorter OS. CONCLUSIONS: The definite hemorrhage risk of melanoma brain metastases after GKRS was 17% in the first 3 years and 95% of the lesional hemorrhage occurred within the 1st year. Surgical intervention was needed in 5% of patients. Antiplatelet agents and immune checkpoint inhibitors were associated with improved OS, while definite/possible hemorrhage was associated with worse OS.
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Neoplasias Encefálicas , Melanoma , Radiocirugia , Humanos , Masculino , Persona de Mediana Edad , Anciano , Femenino , Radiocirugia/efectos adversos , Resultado del Tratamiento , Estudios Retrospectivos , Melanoma/patología , Inhibidores de Puntos de Control Inmunológico , Inhibidores de Agregación Plaquetaria , Estudios Prospectivos , Neoplasias Encefálicas/cirugía , Hemorragia/etiología , Estudios de SeguimientoRESUMEN
CASE HISTORY: Medical records from a single referral hospital (Animal Referral Hospital, Sinnamon Park, Australia) of dogs treated with modified triple tibial osteotomy (TTO) for management of cranial cruciate ligament (CrCL) disease from June 2017 to June 2020 were reviewed. Modifications to the originally described TTO procedure included a modified wedge angle calculation and performing the tibial osteotomies without the use of pre-drilled guide holes. CLINICAL FINDINGS: A total of 253 dogs met the inclusion criteria. Two dogs were excluded, leaving 251 dogs that had undergone 309 procedures for assessment, and data from these, including complications, were reviewed. Complete, partial competent, and partial incompetent rupture of the cranial cruciate ligament was identified in 202/309 (65.4%), 79/309 (25.6%), and 28/309 (9.1%) stifles, respectively. Medial meniscal injury was identified in 207/309 (67.0%) stifles at the time of initial surgery. TREATMENT AND OUTCOME: Fifty-eight dogs had bilateral procedures, including both single-session and staged surgeries, and 48 of these were available for analyses. The modifications to the TTO procedure described herein resulted in a median wedge angle of 21° and a median post-operative tibial plateau angle of 5.8°. Tibial compression testing following surgery indicated elimination of cranial tibial thrust in all stifles in this series. The most common intra-operative complication was tibial tuberosity fracture (15/309; 4.9%). Minor post-operative complications occurred in 37/309 (12.0%) procedures, with infection being the most common (27/309; 8.7%). Major post-operative complications occurred in 9/309 (2.9%) procedures. The intra- and post-operative complication rates for dogs undergoing bilateral single-session TTO were both 8.3% (2/24). The intra- and post-operative complication rates for dogs undergoing bilateral staged TTO were both 4.2% (1/24). The low number of complications for both the bilateral single-session and bilateral staged TTO groups precluded statistical analysis. All complications resolved uneventfully as determined by the attending surgeon. CLINICAL RELEVANCE: The modified TTO technique described here was safe and effective for the management of canine CrCL disease in the dogs included in the case series. Findings of this study suggest that, with careful case selection, the modified TTO may be performed as a bilateral single-session procedure in dogs with concurrent bilateral cranial cruciate ligament disease. Future studies analysing the effects of these modifications on stifle biomechanics would be beneficial. ABBREVIATIONS: CrCL: Cranial cruciate ligament; SSI: Surgical site infection; TPA: Tibial plateau angle; TPLO: Tibial plateau levelling osteotomy; TTA: Tibial tuberosity advancement; TTO: Triple tibial osteotomy.
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Ligamento Cruzado Anterior , Enfermedades de los Perros , Perros , Animales , Ligamento Cruzado Anterior/cirugía , Estudios Retrospectivos , Rodilla de Cuadrúpedos/cirugía , Tibia/cirugía , Osteotomía/veterinaria , Osteotomía/métodos , Enfermedades de los Perros/cirugía , Rotura/cirugía , Rotura/veterinariaRESUMEN
Background: Single-session interventions have the potential to address young people's mental health needs at scale, but their effects are heterogeneous. We tested whether the mindset + supportive context hypothesis could help explain when intervention effects persist or fade over time. The hypothesis posits that interventions are more effective in environments that support the intervention message. We tested this hypothesis using the synergistic mindsets intervention, a preventative treatment for stress-related mental health symptoms that helps students appraise stress as a potential asset in the classroom (e.g., increasing oxygenated blood flow) rather than debilitating. In an introductory college course, we examined whether intervention-consistent messages from instructors sustained changes in appraisals over time, as well as impacts on students' predisposition to try demanding academic tasks that could enhance learning. Methods: We randomly assigned 1675 students in the course to receive the synergistic mindsets intervention (or a control activity) at the beginning of the semester, and subsequently, to receive intervention-supportive messages from their instructor (or neutral messages) four times throughout the term. We collected weekly measures of students' appraisals of stress in the course and their predisposition to take on academic challenges. Trial-registration: OSF.io; DOI: 10.17605/osf.io/fchyn. Results: A conservative Bayesian analysis indicated that receiving both the intervention and supportive messages led to the greatest increases in positive stress appraisals (0.35 SD; 1.00 posterior probability) and challenge-seeking predisposition (2.33 percentage points; 0.94 posterior probability), averaged over the course of the semester. In addition, intervention effects grew larger throughout the semester when complemented by supportive instructor messages, whereas without these messages, intervention effects shrank somewhat over time. Conclusions: This study shows, for the first time, that supportive cues in local contexts can be the difference in whether a single-session intervention's effects fade over time or persist and even amplify.
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Attentional biases toward threatening faces have repeatedly been studied in the context of social anxiety, with etiological theories suggesting exacerbated biases as a possible cause for the latter. To counteract these postulated effects, research has focused on the concept of attentional bias manipulation (ABM), in which spatial contingencies between succeeding stimuli are traditionally employed in training paradigms designed to deliberately shift automatic attention processes away from threat-related stimuli. The ABM research field has been faced with various methodological challenges, such as inconsistent results, low reliabilities of dependent variables and a high susceptibility to moderating factors. We aimed to combine several recent approaches to address these issues. Drawing upon theories of value-driven attention, we explored reward-based contingencies in a Dot Probe task to improve the training's efficacy, combined with neurophysiological measures for greater reliability compared to reaction times, while evaluating the moderating effect of explicitness in the instruction. In a healthy sample (N = 60) and within a single session, we found a general attentional bias toward angry faces present across all conditions as indicated by the N2pc, which was, however, marked by large intrinsic lateralization effects, with submeasures exhibiting opposing polarities. This prompted us to explore an alternative, intrahemispheric calculation method. The new N2pc variant showed the attentional bias to have disappeared at the end of the training session within the explicit instruction group. Reliabilities of the main dependent variables were varied from excellent to questionable, which, together with the exploratory nature of the analysis, leaves this result as preliminary.
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OBJECTIVE: The purpose of this study was to determine whether a single session of trans-cranial direct current stimulation (tDCS) of the cerebellum and M1 has any advantages over one another or sham stimulation in terms of balance, gait and lower limb function. METHODS: A total of 66 patients who had experienced their first ever stroke were recruited into three groups for this double-blinded, parallel, randomized, sham-controlled trial: cerebellar stimulation group (CbSG), M1 stimulation group (MSG) and sham stimulation group (SSG). A single session of anodal tDCS with an intensity of 2 mA for a duration of 20 min was administered in addition to gait and balance training based on virtual reality using an Xbox 360 with Kinect. Balance, gait, cognition and risk of fall were assessed using outcome measures before intervention (T0), immediately after intervention (T1) and an hour after intervention (T2). RESULTS: Across group analysis of all outcome measures showed statistically non-significant results (p > .05) except for Six Minute Walk Test (p value T0 = .003, p value T1 = .025, p value T2 = .016). The training effect difference showed a significant difference in balance, gait and cognition, as well as cerebral and cerebellar stimulation, in comparison to sham stimulation (p < .05). The risk of falls remained unaffected by any stimulation (p > .05). CONCLUSIONS: In addition to Xbox Kinect-based rehabilitation training, a single session of anodal tDCS to the M1 or cerebellum may be beneficial for improving lower limb function, balance and gait performance.
Asunto(s)
Corteza Motora , Accidente Cerebrovascular , Estimulación Transcraneal de Corriente Directa , Humanos , Estimulación Transcraneal de Corriente Directa/métodos , Método Doble Ciego , Accidente Cerebrovascular/terapia , Cerebelo/fisiologíaRESUMEN
BACKGROUND: Common mental disorders (CMDs) impose significant socioeconomic impacts on the global community. Nevertheless, over 50% of individuals with CMDs do not receive proper treatment, indicating that the current treatment modalities do not adequately tackle this issue. Since single-session therapy (SST) is a potential method for reducing the treatment gap, it is crucial to evaluate its effectiveness. Therefore, this systematic review aimed to evaluate the effectiveness of SST on CMD symptoms in adults. METHODS: This systematic review included randomised and non-randomised studies assessing the clinical effectiveness of SST on CMD symptoms in adults. English-written, peer-reviewed studies or dissertations were included, while grey literature was excluded. MEDLINE, Embase, PsycINFO, and Cochrane's CENTRAL were searched on December 13, 2022, from their inception dates. The risk of bias in the included studies was evaluated using RoB 2 and ROBINS-I. A narrative synthesis was performed. This systematic review was registered in the PROSPERO database on July 6, 2022 (CRD42022343925). RESULTS: Six randomised and three non-randomised studies were included after screening 2,130 records. Three non-randomised studies with a "critical" or "serious" risk of bias were excluded from the synthesis. Therefore, six randomised trials involving 298 participants were included in the synthesis. Four out of six studies had a "high" risk of bias. The participants had non-severe symptoms at baseline, and three intervention types (behavioural activation, DBT, and solution-focused psychotherapy) were evaluated. Five of six studies showed positive results for depression, with only one reporting a positive result for anxiety. CONCLUSIONS: SST may be effective in improving CMD symptoms in adults, particularly depression. However, there is a limit to deriving definite conclusions due to a high risk of bias in included studies, insufficient sample size and research volume. Further research exploring the characteristics of clients who can benefit from SST is required to facilitate its widespread use.