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Yoga therapy is an emerging integrative health approach that applies the practices and teachings of yoga for individuals with clinical concerns. It is generally offered as individual sessions between a yoga therapist and client or in a small group setting with several clients who share a clinical concern. Here we describe a third model for consideration- the yoga therapy dyad. A dyad includes two clients working simultaneously with a single yoga therapist and differs from both individual and small group sessions in the potential benefits and challenges. The yoga therapy dyad model that is detailed here was implemented as part of a feasibility trial along with group acupuncture therapy for chronic pain in an underserved population. Underserved populations are at risk for pain and reduced access to care. This pilot may inform future research, policy, education, and clinical practice.

Objective Group Well-Child Care (GWCC) has been described as providing an opportunity to enhance well-being for vulnerable families experiencing psychosocial challenges. We sought to explore benefits and challenges to the identification and management of psychosocial concerns in Group Well-Child Care (GWCC) with immigrant Latino families. Methods We conducted a case study of GWCC at an urban academic general pediatric clinic serving predominantly Limited English Proficiency Latino families, combining visit observations, interviews, and surveys with Spanish-speaking mothers participating in GWCC, and interviews with providers delivering GWCC. We used an adapted framework approach to qualitative data analysis. Results A total of 42 mothers and 9 providers participated in the study; a purposefully selected subset of 17 mothers was interviewed, all providers were interviewed. Mothers and providers identified both benefits and drawbacks to the structure and care processes in GWCC. The longer total visit time facilitated screening and education around psychosocial topics such as postpartum depression but made participation challenging for some families. Providers expressed concerns about the effects of shorter one-on-one time on rapport-building; most mothers did not express similar concerns. Mothers valued the opportunity to make social connections and to learn from the lived experiences of their peers. Discussions about psychosocial topics were seen as valuable but required careful navigation in the group setting, especially when fathers were present. Conclusions Participants identified unique benefits and barriers to addressing psychosocial topics in GWCC. Future research should explore the effects of GWCC on psychosocial disclosures and examine ways to enhance benefits while addressing the challenges identified.

Insomnia is a significant public health concern. Cognitive behavioral therapy for insomnia (CBT-i) is considered first-line treatment. The use of telemedicine for CBT-i allows for increased access to providers for patients who are geographically remote as well as to self-directed CBT-i modalities that do not require the involvement of a therapist. Tele-CBT-i modalities include video conferencing with a CBT-i therapist in an individual or group setting or use of Web or mobile application-based CBT-i modules with varying levels of support from a therapist. Multiple studies and meta-analyses support the efficacy of tele-CBT-i when compared with face-to-face CBT-i and placebo.

Purpose Group prenatal care, which integrates medical care with patient education and empowerment in a group setting, has the potential to build social support among pregnant women and reduce the risk of postpartum depression (PPD). Past research on group care’s effects on social support or PPD has produced inconsistent findings. Studies have tended to (1) examine direct effects on social support or PPD and (2) treat group care participation as a dichotomous variable. This study tests the hypothesis that group care has an indirect effect on PPD through its effect on social support. It uses both a dichotomous measure of group care participation and an ordinal measure of social contact with group members. Method This study used survey data from 199 women at two Tennessee health care sites who participated in traditional care (TC) or Supportive Pregnancy Care (SPC), a new group program developed by March of Dimes. Path analysis was employed, estimating standardized path coefficients with propensity score weighted multilevel modeling. Results The study found no evidence of an indirect relationship between SPC and PPD symptoms when modeling the dichotomous measure. Modeling the ordinal measure revealed more favorable PPD outcomes among women reporting high group member contact (compared with TC) and adverse outcomes among women reporting low group member contact. Conclusion SPC may be useful for preventing PPD symptoms among women socially engaged with other group care patients. Given the adverse effect among women who do not engage with other group members, group facilitators should encourage women to interact outside of scheduled sessions.

Purpose: To examine change in gross motor function in children with cerebral palsy (CP) following repeated periods of intensive physiotherapy in real-life group-settings, with expected motor develo...

Shared Medical Appointments (SMAs) are patient-centered care tools designed to administer patient counseling and education, typically delivered individually, in a group setting. SMAs are effective in facilitating peer-learning, resulting in improvement in knowledge and health behavior. This study aimed to implement what we know of as the first ophthalmology SMA done in the United States. We evaluated the implementation feasibility, patient and provider experience, changes in patient knowledge, and provider stress. Five glaucoma patients who expressed issues with adherence during their clinic visit at Boston Medical Center (BMC) who were interested in the SMA were recruited. Patients and staff had a positive experience with the SMA. There was a marked increase in patient glaucoma knowledge and a decrease in average staff member stress level score during the SMA. From all standpoints, including billing and management, we conclude that SMA implementation is feasible in ophthalmology departments in academic settings.

Introduction: Group Medical Visits (GMV) are medical appointments where patients with similar medical conditions are seen in a group setting. Heart Failure (HF) is an ideal fit for the GMV model of healthcare delivery. HF guidelines emphasize the need for a self-care regimen including symptom knowledge, medication adherence, dietary and lifestyle modifications and social support. We conducted an intervention with these elements in a GMV setting to assess feasibility and improvement in quality of life (QoL). Methods: We enrolled a convenience sample of high-risk veterans with HF who required frequent follow up. Veterans participated in a longitudinal GMV for eight sessions lasting two hours each and occurring once a month. A curriculum was prepared a priori, and each session was led by an invited guest facilitator and focused on nutrition, exercise, stress, holistic health among others. Feasibility was assessed through recruitment and retention data. We also collected pre-post medication compliance data and QoL change using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). We gathered feedback after each session. Results: Twelve patients were invited to the program and nine patients attended the first session. The average attendance was 6 participants each week with 4 participants attending all eight sessions. All were men, 22% identified as Black and 8 of 9 participants had preserved ejection fraction and obesity. At baseline, the mean KCCQ was 49.2. At the end of the intervention, the mean change in KCCQ-12 score was +9 (p=0.39). The largest change (+12, p=0.13) was seen on the QoL subscale. No significant improvement was seen in medication compliance. Participants listed community building, peer to peer education, learning about hospital services and continued contact with their provider as highlights of the program. Due to invitation of high-risk individuals, we had one death and seven hospitalizations during the study period. Conclusions: Longitudinal GMVs for high risk patients has a role in HF education and management. It may improve QoL and provider-patient relationship. It is well accepted by the veteran population and has the potential to be routinely integrated into clinical practice.

Shared medical appointments, in which a multidisciplinary team of healthcare providers meets with multiple patients in a group setting, may be an option for treating patients with obesity. To be effective, shared medical appointments need to address patients' nutrition, physical activity, appetite suppression, stress management, and sleep.

INTRODUCTION: It is widely known that the mind and the body, although described medically almost as separate entities, are in fact highly interrelated. This is not, however, always reflected within medical settings where physical interventions are often favoured over more holistic management, even in the case of long-term symptoms and/or pain where there is a strong evidence to favour the use of the latter. Mindfulness is an established and evidence-based intervention which can help people living with pain and physical symptoms. Interventions based on Compassion and Loving-kindness have also shown early promise but have not been fully explored. This study proposes a compassion-focused conceptualisation of persistent pain and reports on an intervention based upon this formulation. METHODS: The study took place within a routine clinical setting. Standardised outcome measures were collected pre- and post-intervention and effect sizes calculated for mean differences on each measure. Written qualitative comments that participants attributed to the group were also collected post-intervention and analysed with a thematic analysis. This was an uncontrolled, unpowered study conducted within a clinical setting which aimed to examine the intervention for any initial evidence of promise and to explore how it would be received by patients. RESULTS: The results of the study indicated that engagement of patients in the intervention was reasonable. Improvements were recorded in pain distress (effect size (ES), 0.47) and intensity (ES, 0.23), anxiety (ES, 0.72), depression (ES, 0.46) and self-efficacy (ES, 0.36). Following the intervention, patients described changes that were grouped into the categories of feeling different, doing things differently and changed attitude. CONCLUSION: This exploratory study has demonstrated that a group-based intervention based on a model of compassion and including mindfulness and loving-kindness exercise has potential as an intervention to be used within routine pain management settings.

Context: Previous research has shown a weak relationship between intended and actual training load in various sports. Due to variety in group and content, this relationship is expected to be even weaker during group rehabilitation. Objective: The goal of this study was to examine the relationship between intended and actual training load during sport-specific rehabilitation in a group setting. Design: Observational study. Setting: Three outdoor rehabilitation sessions. Participants: Nine amateur soccer players recovering from lower limb injury participated in the study (age 22 ± 3 y, height 179 ± 9 cm, body mass 75 ± 13 kg). Main Outcome Measures: We collected physiotherapists’ ratings of intended exertion (RIE) and players’ ratings of perceived exertion (RPE). Furthermore, Zephyr Bioharness 3 equipped with GPS-trackers provided heart rate and distance data. We computed heart rate–based training loads using Edwards’ method and a modified TRIMP. Results: Overall, we found weak correlations (N = 42) between RIE and RPE (r = 0.35), Edwards’ (r = 0.34), TRIMPMOD (r = 0.07), and distance (r = 0.26). Conclusions: In general, physiotherapists tended to underestimate training loads. To check whether intended training loads are met, it is thus recommended to monitor training loads during rehabilitation.

Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

BACKGROUNDInfants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group.OBJECTIVETo design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants.DESIGNAn interventional age-targeted before-after trial with comparison groupSETTINGMonroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee.PATIENTSAll children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert)INTERVENTIONIn August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing.RESULTSThe average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; PPP=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile.CONCLUSIONSThe average monthly testing rate for C. difficile for children C. difficile.Infect Control Hosp Epidemiol 2017;38:542–546

Objectives Physiotherapy is recommended in the management of people with axial Spondyloarthritis (axSpA), with new insights into its preferred content and dosage evolving. This study aimed to describe the use and preferences regarding individual and group physiotherapy among people with axSpA. Methods A cross-sectional survey was conducted among people with axSpA living in the Netherlands (NL) and Switzerland (CH). Results 713 people with axSpA participated (56.7% male, median age 55 years, median ASAS-Hi-score 4.2). Response rates were 45% (n = 206) in NL and 29% in CH (n = 507). 83.3% of participants were or had been using physiotherapy. Individual therapy only was or had been used by 36.7%, a combination of individual plus land- and water-based group therapy was or had been used by 29.1% and group therapy only by 5.3%. Only less than half participants attending individual therapy reported active therapy (like aerobic, muscle strength, flexibility exercises). Although the majority (75.9%) was not aware of the increased cardiovascular risk, participants showed an interest in cardiovascular training, either individually or in a supervised setting. If supervised, a majority, in CH (75.0%) more than in NL (55.7%), prefers supervision by a specialized physiotherapist. Conclusion The majority of people with axSpA uses or used physiotherapy, more often in an individual than in a group setting. The content of individual therapy should be more active; in both therapy settings aerobic exercises should be promoted. Especially, enabling people with axSpA to perform exercises independently would meet their needs and might enhance their daily physical activity.

Background: To meet new requestes among patients with COPD attending a pulmonary rehabilitation programme interactive 3D visualization, 3D technique was developed to enable an increased customization within a group setting. Aims and Objectives: To evaluate patient’s experience of interactive 3D technique used in a pulmonary rehabilitation programme, for patients with COPD. Methods: Patients with COPD were cluster randomized to education by interactive 3D (n=27) or conventional technique (n=16). The programme consisted of an educational part, presented with interactive 3D, or conventional technique in addition to physical training, during 10 weeks (10w). The education contained lectures on anatomy, physiology, COPD symptoms, inhalation-, coughing-, breathing-, and training techniques. At 10 w the level of satisfaction in relation to education was assessed using a numeric rating scale, NRS 0-10. The education was assessed concerning level of factual knowledge at 6 months. A NRS 0-7 was used to assess how stimulating and valuable the education was and the level of motivation to use the knowledge, at 6 months. Results: The level of satisfaction in relation to education was high in both groups, although the lecture in anatomy and physiology 7.0 (IQR 6.75-7.0) was significantly higher (p=0.012) in the 3D technique group. Patients motivation to use the knowledge 9.0 (IQR 8.0-10.0), their stimulation 10.0 (IQR 8.75-10.0) and how valuable 9.0 (IQR 8.0-10.0) the education was high in both groups and there were no differences between the groups. Conclusions: Interactive 3D technique can be used in pulmonary rehabilitation programmes for COPD as an alternative to conventional technique.

Farrell III, JW, Dunn, A, Cantrell, GS, Lantis, DJ, Larson, DJ, and Larson, RD. Effects of group running on the training intensity distribution of collegiate cross-country runners. J Strength Cond Res 35(10): 2862-2869, 2021-Collegiate cross-country training is often conducted and prescribed in a group setting. This may result in the application of an inappropriate training stimulus to athletes due to potentially different physiological responses to the same training prescription. The aim of this investigation was to quantify the training intensity distribution (TID) of a collegiate cross-country team and the associated physiological adaptions. Sixteen subjects, 8 male subjects and 8 female subjects, performed a graded exercise test before and after observational period to determine peak oxygen consumption (V̇o2peak), the speed (S@), heart rate (HR@), and oxygen consumption (V̇o2@) associated with 2 and 4 mmol·L-1 of blood lactate. Training intensity distribution was quantified by assessing time spent in 3 intensity zones calculated as zone 1 (low intensity, HR valuesHR@2); zone 2 (moderate intensity, HR valuesHR@2 andHR@4); and zone 3 (HR valuesHR@4). No statistical differences were observed between male subjects and female subjects for percent of training time spent in zones 1, 2, and 3. No significant interactions were observed between sex and time for performance variables. Male subjects and female subjects improved V̇o2peak, S@4, and V̇o2@4 with male subjects also increasing V̇o2@2. No significant differences were observed between male subjects and female subjects when comparing percent changes for variables. Examining individual data showed that 2 female subjects experienced performance decrements and trained proportionally more in zones 2 and 3 compared with the overall group. The TID and performance decrements of the 2 highlighted subjects suggest that conducting training in a group setting may potentially be detrimental for some collegiate runners.

This study aims to determine whether a functional literacy program using principles from the Cognitive Orientation to daily Occupational Performance approach and Occupational Adaptation theory, and embedded in community-based daily activities, could enhance occupational participation in a sample of sheltered homeless adults. This study used a two-group, controlled design with pre- and post-intervention measures. Intervention was carried out in a group setting in 1.5 hr, twice-weekly sessions over 8 weeks. Intervention addressed literacy skills needed to complete participant identified, desired daily activities. Statistically significant differences were found between intervention and control groups’ perceived functional literacy skills with regard to occupational performance ( Z = −4.075, p < .0001, d = 1.02) and satisfaction ( Z = −4.113, p < .0001, d = 1.40); reading frequency ( Z = −3.594, p < .0001, d = 0.48), reading effectiveness ( Z = −10.673, p < .0001, d = 0.68), level of support ( Z = −10.410, p < .0001, d = 1.81), and reading efficiency ( Z = −10.297, p < .0001, d = 1.83). The intervention enhanced perceived reading and occupational participation in the study’s sample. Further research is needed to replicate and translate results in daily practice.

The Integrative Psychiatry Curriculum (IPC) was developed to train psychiatry residents and fellows to apply an Integrative Medicine (IM) approach for patients presenting with psychiatric disorders. Launched in 2015, IPC includes interactive online courses, in-person experiential sessions, and a clinical component with supervision. Twenty-one residents and fellows have completed the curriculum. The purpose of the IPC is 2-fold: to enhance patient wellness through training residents and fellows in evidence-based whole-person care and to improve physician well-being through enhanced stress management and self-awareness utilizing the practice of mind–body skills within a supportive small group setting. Course participants are trained in a broad range of prevention and treatment options and learn about their evidence base; they then practice incorporating IM into diagnosis and treatment plans through supervised clinical experience. This article describes the development of IPC and its elements. Efforts are underway to further develop and standardize the offerings and increase the portability of the course, making it easier for Psychiatry training programs with limited faculty expertise in IM to provide the curriculum for residents and fellows. To reach the goal of disseminating such a curriculum for integrative psychiatry, further funding and collaboration with multiple residency training programs is needed.

A recent epidemiological study suggested that 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) used for spiritual and recreational reasons is associated with subjective improvement in depression and anxiety. Further exploration of the potential psychotherapeutic effects of 5-MeO-DMT could inform future clinical trials.We examined self-reported improvement in depression and anxiety among people who use 5-MeO-DMT in a group setting with structured procedures guiding dose and administration of 5-MeO-DMT. Such procedures also include activities for the preparation of, and support during/following sessions, which are similar to procedures used in clinical trials of hallucinogen administration. Next, we examined whether depression or anxiety were improved following use, and whether the acute subjective effects (mystical/challenging) or beliefs about the 5-MeO-DMT experience were associated with improvements in these conditions.Respondents (n = 362; MOf those reporting having been diagnosed with depression (41%) or anxiety (48%), most reported these conditions were improved (depression = 80%; anxiety = 79%) following 5-MeO-DMT use, and fewer reported they were unchanged (depression = 17%; anxiety = 19%) or worsened (depression = 3%; anxiety = 2%). Improvement in depression/anxiety conditions were associated with greater intensity of mystical experiences and higher ratings of the spiritual significance and personal meaning of the 5-MeO-DMT experience. There were no associations between depression or anxiety improvement and the intensity of acute challenging physical/psychological effects during the 5-MeO-DMT experience.Future prospective controlled clinical pharmacology studies should examine the safety and efficacy of 5-MeO-DMT administration for relieving depression and anxiety.

Objective: Evaluating the impact of 6 weeks of LIVE online exercise classes in the West of Scotland Adult CF Unit using the Beam platform for people with cystic fibrosis (pwCF). Methods: 63 pwCF enrolled for the classes via Beam. In addition, questionnaires were completed prior to and during shielding to establish motivation and personal objectives with exercise allowing therapists to structure sessions. 28 exercise and 12 education sessions focussing on the health and well-being of the pwCF were delivered. Exercises were adapted to all abilities through a variety of activities eg. yoga, strength and conditioning (S&C), easy exercise and high intensity interval training (HIIT). Results: 26 pwCF attended for 1 or more exercise sessions and 37 attended education sessions. Due to CF cross-infection limitations existing prior to COVID-19, group sessions were previously prohibited. These virtual classes allowed us to be 5× more time efficient with exercise and 12× more efficient when delivering education in a group setting than if they were delivered face-to-face. The post pilot questionnaire showed 64% were exercising on BEAM with their CF physio. The greatest uptake was HIIT (82%) followed by S&C (45%) with other options being equivocal. Motivation (measured using a VAS) increased from 5.75 (SD 2.67) pre-pilot to 7.18 (SD 2.36) post p = 0.189. Levels of perceived fitness also increased from 4.12 to 5.9 post-pilot p = 0.62. Personal fitness goals were fully or partially achieved by 91% of respondents and when asked comments were very positive: “This has been fantastic, especially during a difficult mental and very limiting physical lockdown period.” Conclusion: The implementation of BEAM Live online exercises for pwCF was found to be a satisfactory and convenient way to deliver exercising allowing for optimisation and progression of pwCF perceived exercise tolerance and motivation towards exercise. The sample size was small which may account for the lack of statistical significance.

Background: The National Medical Unified Examination (NMUE) is currently required for graduation, joining postgraduate medical training, and practicing medicine in Syria. Objective: To investigate self-reported study habits that correlate with high performance on the NMUE. Methods: First through 3rd year residents at the three main hospitals in Damascus, Syria, were asked to complete a retrospective cross-sectional survey investigating their study habits and previous scores. Results: Significantly higher score was associated with >15 study h/day and allocating 1–40% of study time for practicing questions. Mean NMUE score was not significantly different in relation to preparation months for examination or for those who reported spending all their time studying alone compared with spending any amount of time in a group setting. Scores of 231–240 on the Syrian scientific high school exam correlated with significantly higher NMUE performance compared with fewer scores, except scores of 221–230. For every 10 point increase in medical school cumulative grades, the NMUE score increased 3.6 (95% confidence interval 2.5–4.8). Conclusion: The NMUE score was significantly affected by hours spent studying per day, number of practice questions completed, percentage of study time allocated for doing questions, Syrian scientific high school exam scores, and the cumulative medical school class grades. It was not significantly affected by preparation months or studying in a group setting. More studies are needed to further describe and investigate the factors that might affect performance in the NMUE.

Mindfulness and acceptance based treatments are being increasingly implemented for a variety of emotional and psychological related problems, including the impact of military and combat related trauma exposure. This article describes a mindfulness skills group as it was implemented on a sub-acute inpatient PTSD Unit at a Department of Veterans Affairs medical center, to demonstrate and explore the role of the mindfulness skills development in a group setting, for Post-Traumatic Stress Disorder and other trauma related problems.

Introduction: The aim of this study was to investigate time-trial (TT) performance in the presence of one competitor and in a group with competitors of various abilities. Methods: In a randomized order, 24 participants performed a 5-km cycling TT individually (IND), with one similarly matched participant (1v1), and in a group of four participants (GRP). For the GRP session, two pairs of matched participants from the 1v1 session were used. Pairs were selected so that TT duration was considered either inferior (INF) or superior (SUP) compared to the other pair of participants. Results: Overall, TT duration (P = 0.86, ηp2 < 0.01) was not different between conditions, while heart rate (HR) was significantly greater in GRP compared to IND (P < 0.01, ηp2 = 0.16). For INF, a large effect size for both mean power (P = 0.07, ηp2 = 0.15) and HR (P = 0.05, ηp2 = 0.16), indicates greatest effort in GRP. Pacing behavior was affected by competition but similar in 1v1 and GRP for SUP, while large effect sizes indicate an increased power output in the initial 750-m for INF in GRP. Additionally, for INF, there was a significant correlation with ego orientation for an increase in TT duration between the GRP session and both the IND (r = 0.43, P = 0.04) and 1v1 (r = 0.54, P = 0.01) sessions. Conclusion: For INF participants, intensity was increased when competing in GRP. Yet, the presence of the SUP competitors resulted in lesser performance improvements for ego oriented INF participants. These findings demonstrate that consideration should be given to the ability of competitors in a group setting to provide adequate motivation. © 2018 Hibbert, Billaut, Varley and Polman.

Background. Ongoing physical activity is important for maintaining the functional level of individuals with chronic stroke. Video games in a group setting might be a cost-effective way for providing mobility and preventing physical inactivity. Purpose. This study explores the experiences and perceptions of individuals with chronic stroke who participated in a novel community-based video-game group intervention and their therapists. Method. A qualitative study, nested in a randomized controlled trial, was conducted using semistructured interviews with eight individuals with chronic stroke (four men and four women) ages 29 to 69 and a focus group of their three occupational therapists, following a video-game intervention. Data were analyzed using content analysis. Findings. Three main categories were identified by the study participants: (a) using video games, (b) the group/team experience, and (c) intervention outcomes/evolving understandings following the intervention. Implications. Playing video games was perceived not as treatment but as a motivating tool to facilitate whole-body movement. Therefore, this intervention might be suitable to be used in the community for ongoing intervention.

Chronic tic disorders may have a huge influence on quality of life. Habit reversal training (HRT) and exposure response prevention (ERP) are effective treatments. In a blinded assessed, open trial, this study evaluates the effectiveness of a newly developed Scandinavian tic treating manual designed to treat adolescents with a chronic tic disorder, combining HRT and ERP. The study compared the efficacy of treatment based on the same manual delivered either individually or in groups. The study was an open randomized controlled clinical trial in which adolescents were randomized to either individual or group therapy. Both therapies included nine sessions. The parents were offered group-based psycho-education. The exclusion criteria were chosen to design a study that would be close to clinical practice. This is the first Scandinavian study that examines the effectiveness of a treatment manual combining HRT and ERP delivered in an individual and group setting. The study showed a significant reduction of the Total Tic score on the Yale Global Tic Severity Scale both in the individual (effect size 1.21) and group setting (effect size 1.38). A total of 66.7% of participants were considered responders. There was no statistical significant difference between the individual and group setting apart from the functional impairment score. The reductions were comparable with those shown in other studies. The participants applied both HRT and ERP, and the majority (36/59) reported an increased post-treatment experience of control. The newly designed Scandinavian manual was equally effective in the individual and group setting with effect sizes comparable with those shown in other studies.

Background Motivation towards an exercise program is higher in a small group setting in comparison to individual therapy. Due to attentional problems, group exercises are difficult for people with Alzheimer disease (AD). This study evaluates the feasibility of a music-supported video-based group exercise program in older adults suffering from AD. Methods Five participants with moderate AD were recruited from a nursing home. A progressive physical exercise program using a video-based training with musical accompaniment was performed and digitally recorded to investigate the adherence and performed accuracy of the exercises. Results The overall participation during the exercises was 84.1%. The quality of the performance was for all exercises above the cut-off scores. Conclusion A music-supported video-based group exercise program is feasible in persons with AD. The participants were motivated and the expectations towards the program increased over time. Music seemed an important factor for attention in participants with AD.

The Bergen 4-day concentrated exposure treatment (cET) for obsessive-compulsive disorder (OCD) has proven highly acceptable; with practically no drop-out and a 6 month remission rate of nearly 70%. The aim of the present study was to evaluate long term gains of the approach, and to compare the results to findings from our recent meta-analysis. Sixty-nine of 95 patients consecutively referred to an outpatient clinic in the specialist health care, were offered the Bergen 4-day treatment. Among the 65 who initiated treatment, 60.0% were classified with “severe” to “extreme” OCD. None of the patients dropped-out during treatment. Independent Yale-Brown Obsessive-Compulsive Scale interviews were conducted post-treatment, and at 3- and 12-month follow-up. Using the international consensus criteria, 83.1% responded to treatment at 12-month follow-up, and 67.7% of patients were classified as recovered. Significant changes were also seen in depression, as measured by Patient Health Questionnaire-9, and in generalized anxiety, as measured by Generalized Anxiety Disorder-7 scale. A total of 89% of the patients rated the treatment as very good and 100% would recommend the treatment to a friend. Compared to results in a recent meta-analysis, the Bergen 4-day treatment is favorable in respect to attrition, response and 12-month recovery. In sum the Bergen 4-day treatment is a feasible way to deliver treatment for OCD, and the effects are stable at 12-month follow-up. Implications for dissemination are discussed. © 2018 Hansen, Hagen, Öst, Solem and Kvale. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Rationale and Objectives Professionalism can be challenging to teach during residency training. We undertook this study to evaluate the impact of a case-based, reflective practice (RP) curriculum on the attitudes of radiology residents about professionalism. Materials and Methods We developed a case-based radiology-specific RP curriculum focused on topics related to professionalism and ethics. This year-long curriculum was comprised of six individual sessions and was attended by radiology residents. We assessed the program using the Penn State College of Medicine Professionalism Questionnaire, a validated instrument designed to assess attitudes toward professionalism, with anonymous responses collected before and after completion of the 1-year curriculum. We also obtained feedback on individual sessions. Results Our curriculum affected the professional attitudes of residents in 7 of 36 sample items on the professionalism questionnaire ( P Conclusions A case-based, RP curriculum centered about professionalism offers a unique practical approach to expose residents to the concepts of professionalism and ethics in a small group setting. Based on a widely used validated survey instrument, our results indicate that this method raises resident awareness about professionalism and impacts the way in which residents think about this topic and their eventual career.

Objective This study aimed to establish learning profiles for noninvasive transcutaneous Doppler ultrasound. Materials and methods Four trainees attended a 2-h lecture, followed by a 15-min demonstration on a volunteer and a 30-min hands-on workshop in a small group setting. Then, they underwent hands-on practice on 50 participants without supervision. The skill acquisitions in terms of signal magnitude, signal quality, and measurement time of the trainees were evaluated through 50 assessments, and were compared with that of a trainer with extensive experience on the use of an ultrasonic cardiac output monitor acting as a ‘gold standard’. The learning profile for each individual trainee was analyzed using the cumulative sum graphical method. Results Four trainees performed ultrasonic cardiac output monitor on 50 participants. All trainees attained proficiency after 18–36 assessments to achieve aortic signal magnitude and quality comparable with the trainer. It requires a minimum of nine assessments to obtain three aortic scans within 5 min with 95% success rates. Only half of the trainees achieved competence in pulmonary scans and the minimum number of assessments required was 36. A minimum of 22 assessments were required for three pulmonary scans within 10 min with 95% success rates. Conclusion A substantial period of learning needs to be undertaken to achieve proficiency on the use of noninvasive transcutaneous Doppler ultrasound. Cumulative sum analysis is a useful tool for ongoing quality assessment during medical education and training in practical procedures on an individual basis.

Introduction: Decreased vaccination rates in children have played a role in the deaths of several children in the United States over the last decade. Interventions to date have been ineffective at changing vaccination patterns. No studies have evaluated a conciliatory patient-centered approach where parent concerns were acknowledged and addressed in a group setting. Methods: Vaccine-averse parents with incompletely vaccinated children were recruited from a family medicine practice. These parents attended three group visit sessions centered on vaccine safety and efficacy. Pre and post surveys were given at each session. The children’s vaccination records were examined in the year prior and the year following the groups. One year after the group visits, parents were interviewed about their attitudes toward vaccination. Results: There were no significant attitude changes in parents attending the group visits. In the year following the visits, the percentage of recommended vaccines that children had received did not increase. Interviews with parents revealed a broad range of concerns about vaccines and a widespread desire for a longer-term study designed to address these concerns. Conclusions: Surveys and vaccination records revealed no significant change in attitudes or behavior after three group visit sessions, consistent with other research on interventions with vaccine-averse parents. The phone interviews demonstrated a desire for further research into long-term effects of vaccines, with most parents stating that they would consider changing their beliefs if the research was free from commercial bias, addressed their concerns, and was extended out over a long period of time.

Riccardo Dalle Grave,Massimiliano Sartirana,Marwan El Ghoch,Simona Calugi Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy Abstract: Multistep cognitive behavioral therapy for obesity (CBT-OB) is a treatment that may be delivered at three levels of care (outpatient, day hospital, and residential). In a stepped-care approach, CBT-OB associates the traditional procedures of weight-loss lifestyle modification, ie, physical activity and dietary recommendations, with specific cognitive behavioral strategies that have been indicated by recent research to influence weight loss and maintenance by addressing specific cognitive processes. The treatment program as a whole is delivered in six modules. These are introduced according to the individual patient’s needs in a flexible and personalized fashion. A recent randomized controlled trial has found that 88 patients suffering from morbid obesity treated with multistep residential CBT-OB achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between months 6 and 12. The treatment has also shown promising long-term results in the management of obesity associated with binge-eating disorder. If these encouraging findings are confirmed by the two ongoing outpatient studies (one delivered individually and one in a group setting), this will provide evidence-based support for the potential of multistep CBT-OB to provide a more effective alternative to standard weight-loss lifestyle-modification programs. Keywords: obesity, cognitive behavioral therapy, lifestyle modification, weight loss, weight maintenance, outcome

In the 1990s, the Japanese population aged 65 and over increased to more than 14%, and Japan became an “aging society.” Now, one in five people are 65 or over (23.4%, and one in ten people are 75 or over (1.6%, meaning that Japanese society is aging substantially. The serious problems that acute hospitals now face involve complications of diseases that are typified by deliriu, and their prevention. Patients with delirium have a higher risk of falling and dying, and delirium has a negative influence on treatment and nursing as well as on a patient’s vital prognosis. However, delirium is a mental state that is often overlooked. Thus, it is very important to develop the observation skills of staff and establish a nursing care system that does not overlook delirium. In this study, we conducted group interviews involving the clinical nurses who care for patients with delirium on a routine basis at Kansai Medical University Takii Hospital, Japan. Their spontaneous utterances about delirium were analyzed using the DEMATEL method, and these utterances were divided into two groups: “causes of delirium” and “delirious patients’ behavior.” From each group, keywords and phrases were chosen and analyzed. Consequently, this study will demonstrate how these clinical nurses feel about delirium and delirious patients.

The aims of the present study were to evaluate the acceptability and long term gains of a highly concentrated exposure and response prevention (ERP) for obsessive compulsive disorder (OCD). Treatment was individually tailored and delivered in a group format over four consecutive days in an outpatient OCD treatment unit, part of the ordinary specialist health care. A total of 35 patients accepted the offer of treatment; 23 of the patients were classified with severe to extreme OCD, and 74% of the sample had previously received treatment for their OCD (20% of these with ERP). The results showed that more than 90% of the patients expressed a high degree of satisfaction with the concentrated ERP. At six months follow-up 27 (77%) were classified as recovered and a significant improvement was seen in depressive symptoms as well. The majority of the sample also showed improvement with regard to employment status 12 months after treatment. The results indicate that this highly concentrated treatment may be a feasible format of delivering ERP.

Children who experience ongoing abuse, violence and homelessness often develop social, emotional, health and behavioural problems which are frequently manifested in trauma-based behaviours including self harming and suicidal behaviours, aggressive and criminal behaviours, and drug and alcohol problems. These children often do not engage with traditional therapeutic services. Their persistent fear associated with fleeing the violence and their subsequent transient living situations prevents them from engaging with professionals.An innovative therapeutic program using animals in an activity based group setting was implemented by a family violence housing and support agency to engage these children. As part of its commitment to improving responses to children this agency funded a preliminary, independent evaluation of the program.The objective of this evaluation was to obtain feedback from the children who had attended the group on their experiences of the animal therapy group. This paper reports on the children’s views of the benefits of the group.“. . . .and when we’re holding the animals, makes you feel more calmer and stuff” (13-year-old girl)

Public health emergency preparedness officials use several modes of education and training programs to improve their response capability, including tabletop exercises. Tabletop exercises allow participants to role-play during a health emergency in an experiential practice environment and evaluate performance using existing benchmarks. Although tabletop exercises are routinely used in public health to identify gaps in emergency planning, quantitative measures of the impact of participating in an exercise are less common. To this end, we have designed a state-of-the-art simulation-driven hybrid tabletop exercise which is informed by local leadership interests and options, and tied into a research platform that enables rigorous assessment and improvements. The exercise and assessment were used by the state of Arizona during the 2009 H1N1 influenza outbreak. The simulation allows participants to respond to a hypothetical pandemic influenza scenario and make iterative policy decisions in a group setting. The exercise provided a valuable forum reviewing and assessing emergency plans for schools to prepare for, respond to, and recover from an influenza pandemic. After the exercise, participants reported a significantly increased level of confidence in performing core public health functional capabilities around the five main topic areas.

Objective Assess pharmacy student's perceptions of small group ( n =10) versus large group discussion during recitation ( n =>80) and perceived learning benefits based on access to patient cases. Methods Respondents selected responses on a 5-point Likert scale regarding their access to patient cases prior to recitation. Respondents ranked their preference for small versus large group discussion based on the setting in which patient cases were reviewed. Respondents were able to express their thoughts in writing for five items. Results One-hundred seventeen second professional year Doctor of Pharmacy students participated. Small group discussions in separate rooms and reviewing patient cases as a group in the separate room was least preferred by respondents regardless of if they received patients cases prior to ( p p p =0.0094). Respondents favored small group discussions in an auditorium and reviewing patient cases as a whole class if they received patient cases during recitation ( p Conclusions Preference for small or large group recitation discussions was dependent on when respondents received patient cases. Faculty may coordinate the group setting in recitation based on pharmacy students' access to course material.

Pain Pain experienced by an individual can be modulated by social, cognitive, and emotional factors. In a group setting, can an individual experiencing pain affect other, pain-free individuals' behaviors and responses? Smith et al. explored this question in mice. They examined the responses of “bystander” animals housed in the same room, but not in the same cage, as animals experiencing hyperalgesia—a heightened sensitivity to pain—from tissue damage or withdrawal of opiates. The “bystander” animals also displayed hyperalgesia, which was mediated by olfactory cues. Sci. Adv. 10.1126/sciadv.1600855 (2016).

Aim To provide a group exercise programme to suit the variety of needs of all hospice In-patients, day therapy patients and community patients to enable them to exercise together as a group. Background A group exercise session not only has physical benefits for patients, the social aspect of exercising together is extremely beneficial for patients in a hospice setting (Talbot Rice et al., 2014). Taking into account physical ability, medical conditions, needs and limitations of each individual person makes providing a group exercise a challenge. Method Two hospice staff members trained as Tripudio Movement Instructors. The programme combines gentle stretching and strengthening in an aerobic exercise programme. It can be adapted to suit the individual needs of all patients, is done seated or standing and at any intensity level dependent on the individuals fitness level, physical ability and condition. Most importantly the sessions are fun. Results The table below demonstrates the results of a 6 week programme held for one hour a week for ladies aged between 36yrs and 83yrs with lymphoedema. Following the program’s success, the classes were adapted further to suit all day therapy, community and in- patients. Conclusion Tripudio is an effective group exercise programme which can be adapted to enable patients with a variety of life-limiting conditions, symptoms and physical abilities to exercise together in a group setting.

This study measured the feasibility of completing a randomized control trial on an 8-week seated yoga program for older adults with osteoarthritis. Part of the feasibility of this program was to determine whether participants would continue the yoga practice at home using a guide book after the 8-week program. Findings demonstrated that once participants were not in a group setting for the yoga, they did not continue with yoga practice. This outcome demonstrates the need for group programs for older adults to promote adherence to movement-based programs. (Trial registration: ClinicalTrials.Gov: NCT02113410).

AimTo compare a newly developed avoidability assessment tool (AAT) to existing Hallas assessments1 for a set of paediatric ADR cases.MethodThe new AAT was employed to assess 249 case reports of ADRs causing admission to hospital. The case reports contained a description of the ADR, details of suspected and concurrent medication and past medical history. Each case report was independently assessed and an avoidability category assigned. For ADRs categorised as either ‘possibly' or ‘definitely avoidable' a rationale was recorded. A second reviewer independently assessed a purposive sample (10%) for validation and quality assurance purposes.The final outcome was then compared to the Hallas assessments (1) previously completed as part of another study, which was carried out in a consensus group setting. Both tools used categorical scores with the same four point ordinal scale ‘definitely avoidable', ‘possibly avoidable', ‘not avoidable' and ‘unassessable'.ResultsAssessment of the 249 ADR case reports using the new AAT found that 19.3% were either possibly or definitely avoidable. This figure increased to almost 32% for the non-oncology cases (129/249) and decreased to 5.8% for the oncology cases (120/249). This was similar to the Hallas results (1), where overall, 22% of ADRs were deemed either possibly or definitely avoidable.Percentage exact agreement (%EA) was 90% overall; when subcategorised into oncology and non-oncology cases the %EA was found to be 94.2% and 86% respectively. Percentage extreme disagreement (%ED) was 0.8%. The kappa score was 0.71 (95% CI 0.60–0.82) for all cases, 0.54 (95% CI 0.40–0.68) for the oncology cases and 0.73 (95% CI 0.58–0.88) for the non-oncology cases. In total there were 25/249 cases with disagreement. %EA agreement from the validation check was 72%.ConclusionAssessment with the new AAT showed that approximately 19% of all cases were either possibly or definitely avoidable. This was comparable to the Hallas assessments (1). The sub-categorisation of the analysis into oncology and non-oncology cases showed a change in the number of avoidable cases. The avoidability rate increased to almost 32% for the non-oncology cases and decreased to 5.8% for the oncology cases. The reason for this marked difference may be explained by the nature of the oncology ADRs. The most common oncology reactions were neutropenia, thrombocytopenia and anaemia; these are often expected and largely 'not avoidable' given the benefit risk ratio.The AAT was designed specifically for use in paediatrics following difficulty using other tools including Hallas (1). The AAT refers to guidelines and patient history rather than to abstract concepts such as “present-day knowledge of good medical practice” and “effort exceeding the obligatory demands” as per Hallas (1). Further work to identify potentially avoidable ADRs and strategies to prevent them is needed.

The purpose of this study was to evaluate differences in gross motor performance of children 3-5 years of age with motor delays when assessed individually compared to assessment in a group setting among peers with typical development (TD).Twenty children with motor delays and 42 children with TD were recruited from a preschool program. A within-subject repeated measures design was used; each child with delay was tested both in an individual setting and in a group setting with two to four peers with TD. Testing sessions were completed 4-8 days apart. Ten different motor skills from the Peabody Developmental Motor Scales-2 were administered. Performance of each item was videotaped and scored by a blinded researcher.Overall gross motor performance was significantly different (p.05) between the two settings, with 14 of 20 children demonstrating better performance in the group setting. In particular, children performed better on locomotion items (p.05).The higher scores for locomotion in the group setting may be due to the influence of competition, motivation, or modeling. Assessing a child in a group setting is recommended as part of the evaluation process.

Many hospitals provide breastfeeding support groups to new mothers. How effective is the support and education providing in promoting breastfeeding success? The following is preliminary data from an on-going study to evaluate the effectiveness of a Mother’s Breastfeeding Support Group conducted at Johns Hopkins Hospital as part of their Baby Friendly Initiative.

Tests measuring visuospatial abilities have shown that these abilities increase during adolescence. Unfortunately, the Block Design test and other such tests are complicated and time-consuming to administer, making them unsuitable for use with large groups of restless adolescents. The results of the Design Organization Test (DOT), a quick pen-and-paper test, have been shown to correlate with those of the Block Design test. A group of 198 healthy adolescents (110 male and 88 female) aged 12 to 19 years old participated in this study. A slightly modified version of the DOT has been used in which we shortened the administration time to avoid a ceiling effect in the score. Scores show a linear increase with age (on average 2.0 points per year, r = .61) independent of sex. Scores did not differ between individual setting and group setting. Thus, the DOT is a simple and effective way to assess visuospatial ability in large groups, such as in schools, and it can be easily administered year after year to follow the development of students.

Objective: To assess long-term quit rates of a comprehensive smoking cessation group programme and identify factors that may influence outcomes. Design: Data from 199 patients who participated in the programme from June 2009 through June 2010 were evaluated regarding smoking history, nicotine dependence and attitudes toward smoking and quitting. Setting: The programme is offered at hospitals, worksites and multiple community locations. Methods: All participants were offered eight weekly group counselling sessions and cessation medication. Participants completed a programme evaluation at the end of the last session to assess smoking status and evaluate the course. Patients were contacted at three and 12 months post-programme to obtain their smoking status. Results: Over half (58%) of participants attended the majority of the eight group therapy sessions and most took pharmacotherapy for smoking cessation (173, 87%). Most (148, 76%) had successfully quit smoking at the end of the eighth session; 131 (67%) and 81 (56%) remained tobacco free at the three- and 12-month assessments respectively. Conclusion: This carefully planned programme with detailed materials and procedures provides a non-judgemental, supportive environment that fosters participant adherence in implementing the behaviours that are necessary to achieve total and enduring smoking abstinence.

The Department of Veterans Affairs (VA) recently has adopted the Safety Planning Intervention (SPI; Stanley & Brown, 2011), a brief collaborative intervention, for use with veterans who are at high risk of suicide. The SPI is a hierarchical list of strategies for veterans to use in coping with a suicidal crisis. Its developers recommended that it be used with individual psychiatric inpatients working toward discharge, but its utility in a group format has not previously been addressed. This article describes the facilitation of a safety planning group with psychiatric inpatients at a large urban VA medical center. It depicts each step in the safety plan and offers case examples, anecdotal support, and specific considerations for its use in groups. Directions for further research are also discussed.