Effectiveness of Cannabidiol to Manage Chronic Pain: A Systematic Review.

OBJECTIVES: Cannabidiol (CBD), a component in Cannabis, is used to treat seizures, anxiety, and pain. Little is known about how effectively CBD works in managing chronic pain, a condition characterized by discomfort that persists beyond 3-6 months or beyond expected normal healing. Therefore, this systematic review aimed to synthesize evidence on the effectiveness of CBD in chronic pain management. DESIGN: A systematic review of literature utilizing PRISMA 2020 guidelines. DATA SOURCES: PubMed/MEDLINE, Web of Science, CINAHL, Academic Search Complete, PsycArticles, PsycINFO, SocINDEX, and CENTRAL. The gray literature search was performed through the World Health Organization, the Centers for Disease Control and Prevention, and the European Centre for Disease Prevention and Control. REVIEW/ANALYSIS METHODS: We searched eight databases and gray literature for relevant studies until August 30, 2022. We gathered original research articles with various study designs published in English that looked at patients who used CBD to manage their chronic pain. Two authors assessed the risk of bias and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used narrative synthesis to analyze the results. RESULTS: We included 15 studies among 1,516 identified articles. The majority of the studies indicated pain reduction ranging from 42% - 66% with CBD alone and CBD with Tetrahydrocannabinol. Three studies showed no significant improvement in reducing pain, and one had mixed findings in pain control. The included studies had various methods of measuring pain reduction, mostly through self-reporting and scales such as visual analog scales and verbal numerical scales, among others. CONCLUSION: CBD may be useful in treating chronic pain. Findings should be interpreted with caution due to the small number of included studies and heterogeneity brought about by different study designs and outcome measures. More studies with robust study designs are warranted to evaluate CBD's effectiveness in treating chronic pain.

Training intraverbal naming to establish equivalence class performances.

The purpose of this three-experiment study was to evaluate whether performance consistent with the formation of equivalence classes could be established after training adults to tact and intraverbally relate the names of visual stimuli. Fourteen participants were exposed to tact training, listener testing, and intraverbal training (A'B' and B'C') prior to matching-to-sample (MTS) and intraverbal posttests presented in different sequences across experiments. All participants demonstrated emergent MTS and intraverbal relations consistent with equivalence class formation. More importantly, all participants emitted experimentally defined or self-generated tacts or intraverbally named the correct sample-comparison pairs at some point during posttests. These results are consistent with the intraverbal naming account (Horne & Lowe, 1996) in that participants who passed novel relations MTS tests also demonstrated emergence of corresponding intraverbal relations. However, verbal reports and latency data suggest that participants did not necessarily have to use intraverbal naming as a problem solving strategy continuously throughout MTS posttests. These results extended previous research by showing that verbal behavior training of baseline relations (A'B' and B'C') is sufficient to establish novel conditional relations consistent with equivalence class formation.

Early Language Intervention Using Distance Video-Teleconferencing: A Pilot Study of Young Boys With Fragile X Syndrome and Their Mothers.

PURPOSE: This study examined the effects of a naturalistic parent-implemented language intervention on the use of verbally responsive language by mothers of 6 young boys with fragile X syndrome. The intervention included parent education sessions and clinician coaching delivered onsite and by distance video-teleconferencing. METHOD: A single-case multiple baseline across participants was used to examine intervention effects on maternal use of language support strategies. A nonparametric analysis was used to evaluate the relative effectiveness of onsite compared with distance coaching sessions. RESULTS: Mothers increased their use of utterances that followed into their child's focus of attention and prompted child communication acts. Intervention effects were not observed for maternal contingent responses to child communication, possibly due to the limited number of spontaneous communication acts children produced. Children showed moderate increases in the use of prompted communication acts, whereas intervention effects on spontaneous communication acts were more modest and variable. Comparable increases in maternal strategy use were observed during onsite and distance sessions. CONCLUSIONS: No previous study has examined a distance-delivered parent-implemented language intervention for young boys with fragile X syndrome. Mothers were able to increase their use of verbally responsive language. Intervention efficacy might be enhanced by incorporating an augmentative and alternative communication device for some children and a more concerted focus on increasing the frequency of child communication acts. Findings provide preliminary support for the efficacy of the distance delivery format.

Training Intraverbal Naming to Establish Matching-to-Sample Performances.

The current study evaluated whether training intraverbal naming would be sufficient to establish visual-visual matching-to-sample (MTS) performances in college students. In the first experiment, we used a multiple-probe design across stimulus sets to assess whether six participants could match arbitrary visual stimuli (AB) after learning to tact their two experimentally defined classes (A' and B') and then intraverbally relate their names (i.e., "A' goes with B'"). All participants matched the stimuli accurately after training, as well as emitted the trained intraverbals. In the second experiment, we used a multiple baseline design across four participants to assess whether the same training would produce bi-directional intraverbals in the form of "B' goes with A'," and MTS performance consistent with symmetry (BA). All participants responded accurately during matching and intraverbal tests. Across both experiments, participants stated the trained intraverbals while performing the matching task. Results showed that MTS performance can be established solely by verbal behavior training.

Providing a parent-implemented language intervention to a young male with fragile X syndrome: brief report.

PURPOSE: Although fragile X syndrome (FXS) is the leading inherited cause of intellectual disability, there are no published intervention studies focused on improving communication and language outcomes for affected children. The current study utilized a collaborative coaching approach incorporating strategies from speech-language pathology and applied behavior analysis to examine the efficacy of a naturalistic parent-implemented language intervention for a young boy with FXS. METHODS: The mother was taught the language and behavioral support strategies and submitted weekly video recordings of a caregiving routine. Written feedback was provided. RESULTS: Results indicated moderate increases in maternal use of targeted language support strategies and variable performance in maternal use of behavior support strategies. Child use of appropriate requests increased while challenging behaviors decreased. CONCLUSIONS: This collaborative approach model should be used to guide future larger scale replications and develop new intervention models.

Examining the operant function of challenging behavior in young males with fragile X syndrome: a summary of 12 cases.

This study used experimental functional analyses to examine the operant function of challenging behaviors exhibited by 12 males (ages 27-51 months) with fragile X syndrome (FXS). Eight children met criteria for negatively reinforced challenging behavior in the form of escape from demands and/or escape from social interactions. Nine children met criteria for positively reinforced challenging behavior in the form of obtaining access to highly preferred items. Attention was identified as a maintaining consequence for three children. The functional analysis was inconclusive for one child. Results suggest that, for young males with FXS, challenging behaviors may more likely be tangibly and escape maintained than attention maintained. Our findings affirm past research suggesting a unique behavioral phenotype for this population.

A prevalence study of pathologic gambling among substance-related disorder patients admitted at the medical city using the south oaks gambling screen

Objectives: To determine the prevalence of pathologic gambling among substance-related disorder patients admitted at The Medical City Psychiatric Unit and describe the demographic characteristics of identified pathologic gamblers. Methods: Patients admitted under the pyschiatry service of The Medical City from June 2003 to March 2004 who fulfilled the DSM-IV TR diagnostic criteria for Substance-Related disorders were included in this study. The South Oaks Gambling Screen (SOGS), a validated and reliable instrument for screening populations with gambling problems was administered to determine the presence of pathologic gambling. Demographic data was also collected from patients. Results: Fifty one patients were eligible for the study but only 49 participated in the study since 2 did not give their consent. Eleven patients (22.45%) were identified as probable pathologic gamblers (PPG) and 21 patients (42.86%) were considered problem gamblers (PG). Majority of the PPG were male, ?40 years of age, received some college education, abused methamphetamine, and had a family history of gambling problems. Conclusion: There was a high prevalence of pathologic gambling among patients with substance-related disorders. Thus, it is recommended that assessment of gambling problems should be part of the initial psychiatric evaluation of substance-related disorder patients. Further local research on this topic should also be conducted to validate results of this study.

Las úlceras porppresión en pacientes sometidos ventilación mecánica en la uniidad de cuidados intensivos e intermedios del iner

Introducción: Las úlceras por presión son el resultado de la destrucción cutánea y por consiguiente necrosis del tejido subyacente, grasa y músculo. Son producidas por diversos factores como la humedad, desnutrición, obesidad, presencia de enfermedades subyacentes, temperatura corporal elevada, infección y circulación periférica deficiente. Son un indicador importante de la calidad de atención que se les brinda a los pacientes hospitalizados. Por esta razón, los profesionales de enfermería tienen una importancia vital, ya que son los encargados de establecer un plan de cuidados para prevenir su aparición. Las zonas con mayor afectación son el sacro (30%), cóccix (28%), trocánteres (17%), talones (12%), otros (13%). Objetivo: Identificar los factores que influyen en el paciente con ventilación mecánica al desarrollo de úlceras por presión. Material y métodos: El estudio fue realizado en dos fases. En la primera se aplicaron 42 encuestas al personal de enfermería para valorar los conocimientos acerca de las úlceras, y el cuidado que se le proporciona al paciente que las presenta. La segunda parte consistió en la evaluación de 15 pacientes para identificar los riesgos por la presencia de úlceras. Resultados: La presencia de úlceras por presión es elevada (80%); la incidencia fue de 13% en la primera semana, es decir, 1 de cada 10 pacientes. Las zonas más frecuentemente afectadas fueron los talones, aunque el sacro y maléolos requieren de mayores intervenciones. A pesar de las medidas de manejo en la Unidad de Cuidados Intensivos Respiratorios y Unidad de Cuidados Intermedios Respiratorios, un 36% de las úlceras empeoraron. Conclusiones: La maniobra de prevención más utilizada es la movilización. La frecuencia con la que se realiza es dos veces por turno. El estado nutricional es un factor de riesgo para la aparición de úlceras, la de mayor relación es la obesidad y la gran mayoría del personal encuestado no conoce algún índice para valorar el riesgo de úlceras por presión, la atención que se le proporciona al paciente es la rutina hospitalaria.

Introduction: Decubitus pressure ulcers are a consequence of skin destruction and cause necrosis of the underlying tissue, fat and muscle. They are produced by several factors including humidity, malnutrition, obesity, underlying morbidity, high body temperature, infection and deficient peripheral blood circulation. The most frequently affected zones are the sacrum (30%), coccyx (28%), tronchanters (17%), heel (12%) and others (13%). Decubitus pressure ulcers are an important indicator of quality health care provided to patients. Since it is the nursing professionals who establish a care plan in order to prevent ulcers, they are a key element in ulcer appearance. Objective: To identify influential factors of decubitus pressure ulcer development in mechanically ventilated patients. Material and methods: This study consisted of two phases. In the first phase, 42 surveys were applied to the nursing staff to evaluate their knowledge on decubitus pressure ulcers and on the health care provided to pressure ulcer patients. The second phase included an evaluation of 15 patients to identify risks of developing these ulcers. Results: The presence of decubitus pressure ulcers is high (80%), with incidence of 13% during the first week, i.e., 1 out of each 10 patients. The more frequently affected zones were heels, even though the sacrum and malleolus required more interventions. Despite management measures in the intensive and intermediate care units, 36% of the ulcers got worse. Conclusions: The most frequently used prevention maneuver is mobilization. The established frequency is twice per shift. Nutritional status is a risk factor for ulcer development, and obesity is the most closely associated. Most of the staff who answered the survey had little knowledge of any index to assess the risk of developing decubitus pressure ulcers. The health care provided to the patient is the hospital routine care.