A validation of the Oswestry Spinal Risk Index

Purpose The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). Methods We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. Results Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). Conclusions Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSC

A randomized controlled trial of Kundalini yoga in mild cognitive impairment

Background: Global population aging will result in increasing rates of cognitive decline and dementia. Thus, effective, low-cost, and low side-effect interventions for the treatment and prevention of cognitive decline are urgently needed. Our study is the first to investigate the effects of Kundalini yoga (KY) training on mild cognitive impairment (MCI). Methods: Older participants (≥55 years of age) with MCI were randomized to either a 12-week KY intervention or memory enhancement training (MET; gold-standard, active control). Cognitive (i.e. memory and executive functioning) and mood (i.e. depression, apathy, and resilience) assessments were administered at baseline, 12 weeks and 24 weeks. Results: At baseline, 81 participants had no significant baseline group differences in clinical or demographic characteristics. At 12 weeks and 24 weeks, both KY and MET groups showed significant improvement in memory; however, only KY showed significant improvement in executive functioning. Only the KY group showed significant improvement in depressive symptoms and resilience at week 12. Conclusion: KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience. This observation should be confirmed in future clinical trials of yoga intervention for treatment and prevention of cognitive decline (NCT01983930).Harris A. Eyre, Prabha Siddarth, Bianca Acevedo, Kathleen Van Dyk, Pattharee Paholpak, Linda Ercoli, Natalie St. Cyr, Hongyu Yang, Dharma S. Khalsa and Helen Lavretsk

Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany

BACKGROUND: High prevalence rates of psychological distress in medical training and later professional life indicate a need for prevention. Different types of intervention were shown to have good effects, but little is known about the relative efficacy of different types of stress management interventions, and methodological limitations have been reported. In order to overcome some of these limitations, the present study aimed at evaluating the effect of a specifically developed mindfulness-based stress prevention training for medical students (MediMind) on measures of distress, coping and psychological morbidity. METHODS: We report on a prospective randomized controlled trial with three study conditions: experimental treatment (MediMind), standard treatment (Autogenic Training) and a control group without treatment. The sample consisted of medical or dental students in the second or eighth semester. They completed self-report questionnaires at baseline, after the training and at one year follow-up. Distress (Trier Inventory for the Assessment of Chronic Stress, TICS) was assessed as the primary outcome and coping (Brief COPE) as a co-primary outcome. Effects on the psychological morbidity (Brief Symptom Inventory, BSI) as a secondary outcome were expected one year after the trainings. RESULTS: Initially, N = 183 students were randomly allocated to the study groups. At one year follow-up N = 80 could be included into the per-protocol analysis: MediMind (n =31), Autogenic Training (n = 32) and control group (n = 17). A selective drop-out for students who suffered more often from psychological symptoms was detected (p = .020). MANCOVA’s on TICS and Brief COPE revealed no significant interaction effects. On the BSI, a significant overall interaction effect became apparent (p = .002, η2partial = .382), but post hoc analyses were not significant. Means of the Global Severity Index (BSI) indicated that MediMind may contribute to a decrease in psychological morbidity. CONCLUSION: Due to the high and selective dropout rates, the results cannot be generalized and further research is necessary. Since the participation rate of the trainings was high, a need for further prevention programs is indicated. The study gives important suggestions on further implementation and evaluation of stress prevention in medical schools. TRIAL REGISTRATION: This trial is recorded at German Clinical Trials Register under the number DRKS00005354 (08.11.2013)

Advancing cell therapies for intervertebral disc regeneration from the lab to the clinic: recommendations of the ORS spine section

Intervertebral disc degeneration is strongly associated with chronic low back pain, a leading cause of disability worldwide. Current back pain treatment approaches (both surgical and conservative) are limited to addressing symptoms, not necessarily the root cause. Not surprisingly therefore, long‐term efficacy of most approaches is poor. Cell‐based disc regeneration strategies have shown promise in preclinical studies, and represent a relatively low‐risk, low‐cost, and durable therapeutic approach suitable for a potentially large patient population, thus making them attractive from both clinical and commercial standpoints. Despite such promise, no such therapies have been broadly adopted clinically. In this perspective we highlight primary obstacles and provide recommendations to help accelerate successful clinical translation of cell‐based disc regeneration therapies. The key areas addressed include: (a) Optimizing cell sources and delivery techniques; (b) Minimizing potential risks to patients; (c) Selecting physiologically and clinically relevant efficacy metrics; (d) Maximizing commercial potential; and (e) Recognizing the importance of multidisciplinary collaborations and engaging with clinicians from inception through to clinical trials

บริบทของการบริหารการตลาดสมัยใหม่ภายใต้แนวคิดการทางานแบบอไจล์

อไจล์เป็นแนวคิดและวิธีการบริหารงานขององค์กรยุคดิจิทัล ในการผลักดันธุรกิจให้ขับเคลื่อนไปอย่างรวดเร็วในโลกที่ต้องแข่งขันกันด้วย “ความคล่องตัว” โดยปรับเปลี่ยนโครงสร้างการทำงาน ให้มี ความคล่องตัว มีความยืดหยุ่น ลดขั้นตอนและกระบวนการทำงานลง ให้สามารถทำงานได้เร็วขึ้นและมีประสิทธิภาพมากยิ่งขึ้น โดยอไจล์สามารถนำมาปรับใช้ทำการตลาดให้มีประสิทธิภาพ เพื่อนำเสนอสินค้าและบริการได้เร็วขึ้นกว่าการทำตลาดแบบเดิม ด้วยการสร้างแคมเปญการตลาดขนาดเล็ก หรือประเมิน ความต้องการลูกค้าแบบเรียลไทม์จากข้อมูลที่ทำการเก็บอย่างต่อเนื่อง ซึ่งผลของการนำแนวคิดการทำงานดังกล่าวมาประยุกต์ใช้สามารถสร้างยอดขายที่เพิ่มขึ้นด้วยการนำเสนอสินค้าที่ตอบสนองต่อความต้องการของกลุ่มลูกค้าเป้าหมาย ดังนั้นนักการตลาดยุคใหม่จึงมีความจำเป็นอย่างยิ่งที่จะต้องปรับกลยุทธ์การตลาดให้ทันความเปลี่ยนแปลงผู้บริโภคที่เปลี่ยนไป โดยเฉพาะอย่างยิ่งอุปนิสัยและพฤติกรรมใช้จ่ายของผู้บริโภคชาวไทย โดยนำหลัก อไจล์ มาปรับใช้ เสริมประสิทธิภาพในการทำการตลาดในวันที่ไม่มีอะไรเหมือนเดิมอีกต่อไ