Objective: The purpose of this case report is to describe a patient with bilateral idiopathic osteonecrosis of the femoral head (ONFH), provide a discussion of differential diagnosis for anterior hip pain, imaging, and treatment recommendations for ONFH. Clinical features: A 34-year-old man was initially treated by a chiropractic physician for low back pain. At the end of a three week trial of care, the patient's low back pain resolved. However, he reported a new complaint of mild left anterior hip stiffness. After re-examination, a homecare exercise program was prescribed. The patient returned 1 month later with substantial left anterior hip pain and walked with a noticeable limp. Radiography of the left hip demonstrated advanced ONFH. Magnetic resonance imaging of both hips demonstrated the extent of involvement of the left hip while incidentally revealing ONFH on the right. Intervention and Outcome: A total hip arthroplasty was performed on the left hip and the right hip is being monitored without intervention. Conclusion: Osteonecrosis of the femoral head is a challenging clinical problem with non-specific and wide-ranging signs and symptoms requiring clinicians to engage a cautious and comprehensive differential diagnosis. Prompt recognition ensures that appropriate treatment can be initiated in a timely manner and optimal patient outcomes achieved.
Behavioural activation (BA) is an efficacious treatment approach. Activity monitoring is a key component of brief BA treatments; however, no studies have examined the most efficacious format for monitoring. The present pilot study tested brief versus intensive activity monitoring approaches during a BA intervention administered in a college orientation course. Outcomes characterised (1) engagement with the treatment protocol via activity monitoring and (2) participant qualitative experiences with monitoring and the intervention as reported during focus group interviews. Four course sections were randomly assigned to receive monitoring forms that were brief (assessed activities three times daily) or intensive (assessed activities hourly). Forms were provided electronically to students via a web-based platform which tracked completion. There were no significant differences in monitoring frequency (38.0 vs. 23.0 days; p = .154) or the duration of monitoring engagement (62.0 vs. 36.0 days; p = .054) between the brief and intensive conditions. Qualitative findings suggested that participants in both conditions found utility in activity monitoring, particularly during the first month as they transitioned to college. Overall, findings indicated that participants may find utility in monitoring during the first month of a BA intervention using either brief or intensive monitoring forms.
Clinical Trials Registration Number: NCT04038190
College-aged individuals report having difficulty deciding what and how much information to provide to friends, yet they often turn to one another for information when experiencing relational uncertainty in a romantic relationship. Given the central role friendships have in college-aged individuals’ lives, identifying ways to decrease the difficulty of providing information is necessary. By framing friends’ relational uncertainty conversations as an information management process, the information-provider’s cognitions and emotions are highlighted as factors likely influencing the information provided to friends requesting it to manage their relational uncertainty. In an online survey (N = 367), participants recalled their most recent conversation in which a friend requested information to help manage a romantic relational uncertainty. Results showed participants provided a greater amount, more accurate, and more positively valenced information to friends when participants had positive expected outcomes and greater efficacy assessments. However, anxiety had a small negative effect on expected outcomes, efficacy assessments, and the information provided. In addition to the theoretical contributions, results suggest that helping college-aged individuals focus on the positive outcomes of relational uncertainty conversations and improving their efficacy could help them be better information-providers to friends.
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