Browsing by Author "Ko, Bryan"

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    The Combinatorial Effects of Cognitive Behavioral Therapy with Aerobic Exercise in the Treatment of Fibromyalgia
    (Proceedings of IMPRS, 2020-07-31) Ko, Bryan; Bair, Matthew
    In the US alone, the chronic pain condition of fibromyalgia affects approximately 10 million people. Current treatment protocols focus heavily on pharmacological interventions; however, such treatments are unfavorable due to debilitating side effects and a lack of effectiveness in 2/3 of patients. Two non-pharmacological interventions which have been shown to produce meaningful pain relief are Cognitive Behavioral Therapy (CBT) and Aerobic Exercise. However, the combinatorial effects of these treatments have never been fully explored and it is unknown if these treatments interact in an additive manner or if the benefits of one negate the benefits of the other. In this work we conducted a literature review using the databases of Pubmed, OVID MEDLINE, PsychInfo, and Embase from 1995 to May 2020 to determine if the combinatorial effects of these two treatments on pain relief and pain interference are significantly greater than that of aerobic exercise alone. We reviewed over 200 potential articles for relevance. Seven papers were found to directly address our target question, two from the US and five from Europe with sample sizes ranging from 34 to 442. One paper showed improvement in pain intensity and two papers showed improvement in pain interference due to combinatorial treatment over aerobic exercise alone. When evaluating our results, we weighted these papers based on sample size, length of treatment and observation, method of CBT administration, and surveys chosen for data collection. We were unable to definitively show that CBT in combination with aerobic exercise is more effective than aerobic exercise alone at decreasing pain intensity and/or interference in patients with fibromyalgia. However, most of these papers identified several psychological and design based confounding factors that could influence their results. We recommend that more research be conducted in this area to further ascertain the effectiveness of this specific combinatorial treatment for fibromyalgia.
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    Stunned Myocardium as a Sequela of Acute Severe Anemia: An Adult Simulation Case for Anesthesiology Residents
    (Association of American Medical Colleges, 2024-09-06) Okano, David Ryusuke; Ko, Bryan; Giuliano, Marelle; Mitchell, Sally; Cartwright, Johnny; Moore, Christopher; Boyer, Tanna; Anesthesia, School of Medicine
    Introduction: Anesthesiologists develop anesthetic plans according to the surgical procedure, patient's medical history, and physical exams. Patients with ischemic heart disease are predisposed to intraoperative cardiac complications from surgical blood loss. Unanticipated events can lead to intraoperative complications despite careful anesthesia planning. Methods: This anesthetic management simulation was developed for the anesthesiology residency curriculum during the first clinical anesthesia year (CA 1/PGY 2 residents). A total of 23 CA 1 residents participated. A 50-minute encounter focused on a 73-year-old male who presents for an elective total hip replacement and develops acute myocardial stunning in the setting of critical acute blood loss and a delay in the transportation of blood products. Results: One hundred percent of the residents felt the simulation was educationally valuable in the immediate postsimulation survey (Kirkpatrick level 1). The follow-up survey showed that 100% of residents felt the simulation increased their knowledge of managing acute cardiac ischemia (Kirkpatrick level 2), and 93% felt it increased awareness and confidence in similar real-life situations that positively affected patient outcomes (Kirkpatrick level 3). Discussion: Our simulation provides a psychologically safe environment for anesthesiology residents to develop management skills for acute critical anemia and cardiogenic shock and foster communication skills with a surgery team.