Tag: Therapy

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Effects of Patient Portal Message Framing on Treatment Preferences and Expectations for Degenerative Meniscus Tears: Randomized Exploratory Cross-Sectional Survey Study

<strong>Background:</strong> Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations. <strong>Objective:</strong> This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan. <strong>Methods:</strong> A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups. <strong>Results:</strong> Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (<i>χ</i><sup>2</sup><sub>2</sub>=6.1; <i>P</i>=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; <i>P</i>=.02). Expectations for physical therapy success differed significantly (<i>χ</i><sup>2</sup><sub>4</sub>=12.3; <i>P</i>=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (<i>χ</i><sup>2</sup><sub>6</sub>=6.7; <i>P</i>=.35) but did differ significantly by initial treatment preference (<i>P</i>=.03) and was the lowest among respondents preferring steroid injection. <strong>Conclusions:</strong> In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs. <strong>Trial Registration:</strong>
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RESCUE- expected usefulness and willingness to participate in a trauma-informed group intervention for coping with traumatic work experiences in the emergency medical services

Emergency Medical Services personnel (EMS) are confronted with potentially highly stressful and traumatic occupational experiences, placing them at high-risk for mental disorders. Avoidant coping mechanisms, internalized and occupational stigma not only impede disclosure of and processing the incident-related stress but also weaken the overall resilience of the EMS. Effective interventions are needed that operate both at the individual and group level. The aim of this study was to investigate the expected usefulness and willingness to participate in a trauma-informed intervention (Facts derived from Narrative Exposure Therapy, NETfacts). A total of 256 German EMS (67.19% men, 32.81% women) participated in the online survey. We assessed the expected usefulness and willingness to participate in NETfacts, critical incident-related stress (EMS Critical Incident Inventory EMS-CII), burnout symptoms (Professional Quality of Life ProQOL), age and work experience. Overall, about half of the EMS expected NETfacts to be at least somewhat useful, and reported a generally willingness to participate. Expected usefulness was neither associated with critical incident-related stress nor burnout symptoms. Younger participants (<35 years) showed a generally higher willingness to participate than older participants. However, the willingness is across both age groups positively associated with higher levels of critical incident-related stress. Nevertheless, burnout symptoms and the willingness are negatively associated among participants age 35 and older, while remaining stable among their younger colleagues. Early, trauma-informed and age-sensitive prevention programs are needed to mitigate the adverse effects of critical incidents among EMS. Our study presents EMS preferred circumstances to enhance employees’ uptake of such a program.
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Communication-Based Teaching on Childhood Obesity and the Planetary Health Diet in Medical Education: Proof-of-Concept Study Comparing 4 Information Sources

Background: Childhood obesity constitutes a complex medical and psychosocial challenge that requires both nutritional knowledge and sensitive, relationship-oriented doctor-patient communication. The Planetary Health Diet links individual health promotion with environmental sustainability and represents a relevant framework for contemporary medical education. Objective: This proof-of-concept study investigated how different information sources influence medical students’ acquisition, structuring, and application of knowledge on childhood obesity and the Planetary Health Diet within a communication-based teaching setting, including the exploratory use of artificial intelligence–based tools. Methods: A total of 359 second-year medical students participated in a mandatory communication seminar during the 2023‐2024 academic year. Following a precourse knowledge assessment and a brief theoretical introduction, students worked on a standardized counseling scenario addressing childhood obesity. In small groups, students used only 1 assigned information source (ChatGPT, Google Search, scientific papers, or instructional videos) to prepare a counseling approach. Group outcomes were assessed using a predefined scoring system based on a sample solution, complemented by thematic content analysis. Results: All information sources enabled students to acquire relevant knowledge on childhood obesity and the Planetary Health Diet. However, groups differed with regard to the depth, differentiation, and structuring of their responses. The ChatGPT group achieved the highest conformity scores with the sample solution and provided the most additional information, followed by the Google and video groups, while the paper group achieved the lowest scores. Prior to the course, students reported limited knowledge of the Planetary Health Diet and little practical experience in counseling children with obesity and their families. Conclusions: Communication-based teaching formats provide an effective framework for introducing medical students to complex topics such as childhood obesity and sustainability-related nutrition early in their training. Easily accessible digital tools, including artificial intelligence–based systems, may facilitate knowledge acquisition and elaboration; however, their use requires explicit didactic framing, critical source evaluation, and reflection on the complexity of chronic conditions to support responsible and realistic learning outcomes in future physicians.
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Ketamine With Dialectical Behavioural Therapy (DBT) for Suicidality in Individuals With Treatment-Resistant Depression and Borderline Personality Disorder (KET-DBT)

Conditions: Borderline Personality Disorder (BPD); Treatment-Resistant Major Depressive Disorder; Treatment-resistant Bipolar Depression; Major Depressive Disorder (MDD); Bipolar Disorder (BD); Bipolar Disorder I or II; Suicidal Ideation

Interventions: Drug: Ketamine Hydrochloride; Drug: Midazolam Hydrochloride; Behavioral: Dialectical Behavioral Therapy (DBT)

Sponsors: Joshua Rosenblat

Not yet recruiting
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Case Report: Prism for PTSD in severe traumatic brain injury with psychiatric comorbidities: two cases

BackgroundTraumatic brain injury (TBI) with post-traumatic stress disorder (PTSD) is treatment-resistant, with conventional psychotherapy showing limited efficacy due to neurocognitive impairments.Case SummaryWe report two patients with severe TBI and psychiatric comorbidities treated with Prism neurofeedback.Case 144-year-old female, 35 years post-childhood TBI, with agoraphobia and hyperacusis, achieved 42% PTSD reduction and substantial functional gains (social reintegration, independent driving) sustained through 4-month follow-up.Case 240-year-old male, 3.5 years post-adult TBI with bipolar II disorder and severe PTSD (PCL-5 = 62), achieved 90% PTSD reduction with complete remission sustained at 1-month follow-up, enabling return to work and family system transformation. Both patients developed personalized regulatory strategies and maintained gains without relapse.ConclusionsPrism neurofeedback demonstrates clinically meaningful outcomes in severe TBI-PTSD where traditional psychotherapy shows limited efficacy. The intervention’s circumvention of cognitive processing demands may explain the favorable outcomes. Controlled trials are warranted.