Characteristics and Outcomes of Individuals Self-Selecting Yoga versus Physical Therapy for the Treatment of Chronic Low Back Pain

Chronic low back pain (cLBP) is a significant public health problem that is difficult and costly to treat. Determining whether a patient with cLBP will benefit from a particular treatment approach is challenging, since little is understood about the patient characteristics that predict improved treatment outcomes. Understanding these characteristics could reduce treatment failures and costs of care. This study was designed to explore the demographic, clinical and treatment- related characteristics of individuals self-selecting yoga versus physical therapy (PT) for treatment of cLBP. A growing body of research demonstrates that yoga reduces pain and improves function in persons with cLBP. However, questions remain about how people selecting yoga as a treatment for cLBP differ from persons selecting standard therapies, like PT, and whether pre-treatment differences influence treatment outcomes. A convenience sample of 53 adults ≥ age 18 with cLBP ≥ 3 months enrolling in either a 6 week modified Integral yoga program (n = 27) or a 6 week program of individualized PT (n = 26) participated in the study. Data were collected at baseline and at 6 and 12 weeks after completion of treatment. Study variables included disability (Roland Morris Disability Questionnaire), depression (Beck Depression Inventory-II), health status (RAND Short-Form 36-Item Health Survey 1.0 Questionnaire), fear of movement (Tampa Scale of Kinesiophobia), pain self-efficacy, pain bothersomeness, pain medication use, reasons for treatment choice and satisfaction with care. Group differences were compared using non-parametric statistics. The findings revealed no significant differences between the groups in duration of cLBP (9.02 ± 9.29 years), worst pain in the past 6 months (8.05 ± 1.93 on a 0-10 pain bothersomeness scale), age (50.69 ± 15.56 years), gender (66% female) or education (16 ± 3.05 years). However, PT participants were more likely to be nonwhite, earning ≤ $30,000/yr and selecting PT based on healthcare provider referral or insurance coverage. Yoga participants were more likely to be gainfully employed, earning ≥$70,000/yr and selecting yoga based on personal research. Neither group was depressed at baseline, but PT participants were significantly more disabled, had lower health status, greater pain and twice the pain medication use compared to yoga participants at baseline. At the conclusion of 6 weeks of treatment, both groups had significant improvements in disability and health status with fewer days in pain. PT participants who showed significantly greater pain symptoms at baseline had greater reductions in pain at 6 and 12 weeks compared to yoga participants. At 12 weeks the groups had equivalent pain levels, demonstrating persistent treatment benefits with few adverse effects and high satisfaction with care. Cost was cited as a reason for early termination of treatment for PT participants but was not an issue for yoga participants. The improved outcomes and group differences support the effectiveness of both treatments in reducing pain and disability. The similarities between the groups at 12 weeks and differences in total cost of care suggest the need for further research to examine the long-term costs and benefits of yoga versus PT for treatment of cLBP

Heterozygous Variants in KMT2E Cause a Spectrum of Neurodevelopmental Disorders and Epilepsy.

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities

The Emergency Medicine Physician Workforce: Projections for 2030.

STUDY OBJECTIVE: The goals of this study were to determine the current and projected supply in 2030 of contributors to emergency care, including emergency residency-trained and board-certified physicians, other physicians, nurse practitioners, and physician assistants. In addition, this study was designed to determine the current and projected demand for residency-trained, board-certified emergency physicians. METHODS: To forecast future workforce supply and demand, sources of existing data were used, assumptions based on past and potential future trends were determined, and a sensitivity analysis was conducted to determine how the final forecast would be subject to variance in the baseline inputs and assumptions. Methods included: (1) estimates of the baseline workforce supply of physicians, nurse practitioners, and physician assistants; (2) estimates of future changes in the raw numbers of persons entering and leaving that workforce; (3) estimates of the productivity of the workforce; and (4) estimates of the demand for emergency care services. The methodology assumes supply equals demand in the base year and estimates the change between the base year and 2030; it then compares supply and demand in 2030 under different scenarios. RESULTS: The task force consensus was that the most likely future scenario is described by: 2% annual graduate medical education growth, 3% annual emergency physician attrition, 20% encounters seen by a nurse practitioner or physician assistant, and 11% increase in emergency department visits relative to 2018. This scenario would result in a surplus of 7,845 emergency physicians in 2030. CONCLUSION: The specialty of emergency medicine is facing the likely oversupply of emergency physicians in 2030. The factors leading to this include the increasing supply of and changing demand for emergency physicians. An organized, collective approach to a balanced workforce by the specialty of emergency medicine is imperative