Clinical Characterization of Juvenile Fibromyalgia in a Multicenter Cohort of Adolescents Enrolled in a Randomized Clinical Trial

Arthritis Care & Research · 2022-12-20 · 11 citations

OBJECTIVE: Juvenile fibromyalgia (JFM) is a complex chronic pain condition that remains poorly understood. The study aimed to expand the clinical characterization of JFM in a large representative sample of adolescents with JFM and identify psychological factors that predict pain interference. METHODS: Participants were 203 adolescents (ages 12-17 years) who completed baseline assessments for the multisite Fibromyalgia Integrative Training for Teens (FIT Teens) randomized control trial. Participants completed the Pain and Symptom Assessment Tool, which includes a Widespread Pain Index (WPI; 0-18 pain locations) and Symptom Severity checklist of associated somatic symptoms (SS; 0-12) based on the 2010 American College of Rheumatology criteria for fibromyalgia. Participants also completed self-report measures of pain intensity, functional impairment, and psychological functioning. RESULTS: Participants endorsed a median of 11 painful body sites (WPI score) and had a median SS score of 9. Fatigue and nonrestorative sleep were prominent features and rated as moderate to severe by 85% of participants. Additionally, neurologic, autonomic, gastroenterologic, and psychological symptoms were frequently endorsed. The WPI score was significantly correlated with pain intensity and catastrophizing, while SS scores were associated with pain intensity and all domains of physical and psychological functioning. Depressive symptoms, fatigue, and pain catastrophizing predicted severity of pain impairment. CONCLUSION: JFM is characterized by chronic widespread pain with fatigue, nonrestorative sleep, and other somatic symptoms. However, how diffusely pain is distributed appears less important to clinical outcomes and impairment than other somatic and psychological factors, highlighting the need for a broader approach to the assessment and treatment of JFM.

Characterizing Juvenile Fibromyalgia in a Large Cohort of Adolescents

Journal of Pain · 2022-05-01

What do psychologists most value in their state organizations? The Connecticut Psychological Association (CPA) perspective.

Professional Psychology Research and Practice · 2022-04-07 · 1 citations

Randomized clinical trial of Fibromyalgia Integrative Training (FIT teens) for adolescents with juvenile fibromyalgia – Study design and protocol

Contemporary Clinical Trials · 2021-02-21 · 22 citations

Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity

JMIR mhealth and uhealth · 2021-05-18 · 38 citations

The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future.

Abstract 9303: Delay in Coronary Artery Bypass Grafting for ST Elevated Acute Myocardial Infarction Patients is Associated With Beneficial Outcomes: Further Evidence and Opportunities

Circulation · 2021-11-16

Introduction: Coronary artery bypass grafting (CABG) surgery for patients with acute ST Elevated Acute Myocardial Infarction (STEMI) in the first 24 hrs of admission is associated with greater hospital morbidity and mortality. Delaying CABG >24 hrs may provide opportunities to improve patient outcomes. This study replicates and extends recent research and considers practice implications. Hypothesis: Patients with STEMI undergoing non-elective CABG surgery <24 hrs after admission will have worse outcomes than patients receiving later non-elective or elective CABG surgery. Methods: Patients age >= 30 yrs undergoing CABG <7 days of admission from the National Inpatient Sample 2016-2017 were examined. Non-elective and elective CABG was compared with 4 subgroups examined: Non-elective admission, STEMI diagnosis, CABG <24 hrs (Group A); CABG in 2-3 days (Group B); CABG in 4-7 days (Group C) and elective admission, CABG <7 days (Group D). Outcomes included postoperative complications (bleeding, cardiac, renal, respiratory), in-hospital mortality, post-operative and total hospital length of stay (LOS), and total hospital cost. Results: Patients with STEMI (n=2793, age=65.9±9.7 yrs) non-electively hospitalized (group A=47.2%, B=25.7% and C=27.0%) and elective admissions without STEMI (n=28096, mean=63.8 ±10.8 yrs, group D) were analyzed. Complication rates did not consistently differ for groups A, B, and C, however group A rates were significantly higher than group D. Group A had the highest mortality (6.06%) — significantly greater than groups B (3.62%) and C (3.32%) — with all non-elective groups greater than the elective group D (1.01%). Group A had significantly longer postoperative and total LOS. Total median hospitalization cost was lowest for elective group D ($135,446) but not significantly different between groups A ($191,344) and B ($203,944). Conclusions: STEMI cases typically need urgent intervention and CABG surgery can be critical for management. Delaying non-elective CABG >24 hours after admission is associated with better outcomes. Elective CABG has the best outcomes. More pre-surgical time provides opportunities to better prepare patients and caregivers with tailored coaching and content which can further improve outcomes.

Investigating key predictors of persistent low back pain: A focus on psychological stress

Applied Nursing Research · 2021-02-11 · 10 citations

Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity (Preprint)

2020-10-15

<sec> <title>UNSTRUCTURED</title> The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future. </sec>

A Systematic Review of Biological Mechanisms and Chronic Pain Outcomes During Stress Reduction Interventions

Biological Research For Nursing · 2020-03-16 · 11 citations

BACKGROUND: Nonpharmacologic stress reduction interventions provide an opportunity to modify chronic pain trajectories; however, the biological mechanisms underlying these interventions are poorly understood. OBJECTIVES: To examine clinical literature published in 2012-2018 with the goals of (1) identifying which biological mechanisms or biomarkers are currently being measured in nonpharmacologic stress reduction intervention studies for individuals with chronic pain and (2) evaluating the evidence to determine whether these stress reduction interventions lead to changes in (a) pain outcomes and/or (b) measured biomarkers. DATA SOURCES: Scientific articles in the electronic databases PubMed/Medline, Cumulative Index of Nursing and Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. STUDY SELECTION: Randomized controlled trials and quasi-experimental studies that recruited subjects with a chronic pain condition, examined a relationship between a nonpharmacologic stress reduction intervention and pain-related outcome(s), and included measurement of a biomarker. RESULTS: The 13 articles that met inclusion criteria spanned four nonpharmacologic stress reduction categories: mindfulness-based stress reduction, physical exercise, manual therapies, and biofeedback. Methods for studying biomarkers included measuring biological samples, neurological function, and autonomic control. Although all studies investigated both biological measures and pain outcomes, only three demonstrated an association between the biomarker(s) and pain-related outcomes. CONCLUSIONS: The results of this review highlight the complex nature of stress-pain relationships and the lack of rigorous clinical research identifying specific stress-related biological factors that modulate pain outcomes. Stress reduction interventions remain a favorable method for symptom management in patients living with chronic pain, but consistency in study measures and design is needed for robust evaluation.

Complementary Parent Components for Pediatric Pain Families: Innovations in Treatment

Children · 2020-01-01 · 11 citations

For families with a child with chronic pain, the home environment is the context in which adaptive or maladaptive illness behaviors are developed. Supporting families to effectively cope with their child’s chronic pain is a critical need. This work analyzes intervention approaches from emerging treatment programs to support families coping with pediatric pain that diverge from traditional treatment models by specifically targeting parents. Two novel parent intervention programs are presented that consider caregiver needs in both outpatient and inpatient pain treatment settings: Parents as Coping Coaches and Putting Parents FIRST. These programs are evaluated through comparing parental training components across different stages of treatment. Additionally, the efficacy of Putting Parents FIRST in promoting maintenance of children’s functional gains achieved in intensive interdisciplinary pain treatment is presented, and compared to previous results of the efficacy of Putting Parents FIRST. Specifically, outcomes of 36 children whose parents received the intervention in Putting Parents FIRST were compared to a matched control sample of children whose parents did not receive the parent intervention. Similar to the findings from Parents as Coping Coaches, results indicated that patients whose parents received the intervention maintained/improved program gains in disability, coping, and pain significantly more than patients whose parents did not receive the intervention. Implications for parent-focused intervention development efforts targeting parent and youth functioning in the context of pediatric chronic pain are considered.