All CLEAR? Preparing for IT Downtime.

Health care information technology (IT) outages pose a threat to patient safety and patient care continuity. Organizations' downtime plans must be updated regularly and staff at the work area level should have experience with implementing IT outage operations through downtime drills. This article describes the study institution's IT Outage Toolkit, based on the acronym CLEAR, which guides the development of a downtime plan as well as design, execution, and assessment of work area downtime drills. Self-report and external audits of downtime drills help identify performance gaps and gaps in downtime plans.

Liposome-Mediated Herpes Simplex Virus Uptake Is Glycoprotein-D Receptor-Independent but Requires Heparan Sulfate.

Cationic liposomes are widely used to facilitate introduction of genetic material into target cells during transfection. This study describes a non-receptor mediated herpes simplex virus type-1 (HSV-1) entry into the Chinese hamster ovary (CHO-K1) cells that naturally lack glycoprotein D (gD)-receptors using a commercially available cationic liposome: lipofectamine. Presence of cell surface heparan sulfate (HS) increased the levels of viral entry indicating a potential role of HS in this mode of entry. Loss of viral entry in the presence of actin de-polymerizing or lysosomotropic agents suggests that this mode of entry results in the endocytosis of the lipofectamine-virus mixture. Enhancement of HSV-1 entry by liposomes was also demonstrated in vivo using a zebrafish embryo model that showed stronger infection in the eyes and other tissues. Our study provides novel insights into gD receptor independent viral entry pathways and can guide new strategies to enhance the delivery of viral gene therapy vectors or oncolytic viruses.

Quantification of Myofascial Taut Bands.

OBJECTIVE: To assess the correlation of clinician-identified myofascial taut bands with their presence and characteristics on magnetic resonance elastography (MRE) imaging. DESIGN: Cross-sectional study. SETTING: A magnetic resonance imaging (MRI) research laboratory. PARTICIPANTS: A convenience sample of adults (N=65; 45 women, 20 men) identified by skilled musculoskeletal physicians as having upper trapezius myofascial pain-associated taut bands. INTERVENTIONS: Subjects had their taut bands outlined and were positioned within a 1.5T MRI machine. Shear waves were induced with a pneumatic transducer located over the belly of the involved muscle. Wave propagation was visualized with MRE images across a vibration cycle. Imaging data were assessed independently by 2 skilled MRE interpreters. MAIN OUTCOME MEASURES: The primary outcome measure was the determination of the intra- and interrater reliabilities of MRE taut band identification and their correlation with clinician identification of band presence. Secondary outcomes consisted of the elucidation of the physical characteristics of taut bands and their surrounding muscle tissue. RESULTS: MRE intra- and interrater reliability was excellent, with kappa coefficients and 95% confidence intervals (CIs) of .86 (.68-1.00) and .93 (.79-1.00), respectively. Stiffness in MRE-identified taut bands was elevated at a mean ± SD of 11.5±2.4 kPa and fell to 5.8±0.9 kPa in surrounding muscle tissue (P<.001); muscular tone in trapezius muscles without a taut band was relatively uniform at 6.6±2.1 kPa. Agreement between the physicians and the MRE raters, however, was relatively poor (63.1%; 95% CI, 50.2%-74.7%). CONCLUSIONS: Our findings suggest that while clinicians may overestimate, and current MRE techniques may underestimate, the presence of taut bands, these bands do exist, can be assessed quantitatively, and do represent localized areas of increased muscle stiffness.

Role of Filopodia in HSV-1 Entry into Zebrafish 3-O-Sulfotransferase-3-Expressing Cells.

BACKGROUND: Heparan sulfate proteoglycans (HSPGs) modified by zebrafish (ZF) encoded glucosaminyl 3-O sulfotransferase-3 (3-OST-3) generate a receptor for herpes simplex virus type-1 (HSV-1) entry and spread. In order to elucidate the mechanism by which HSV-1 enters into ZF-3-OST-3 cells, we investigated the mode of viral entry. RESULTS: Under high resolution scanning electron microscopy (SEM), actin cytoskeleton changes were observed by a dramatic increase in the number of filopodia formed during early interactions of HSV-1 with the target cells. While the increase in number was common among all the infected cells, the highest numbers of filopodia was observed in cells expressing the 3-OST-3 modified form of heparan sulfate (HS) encoded either by human or ZF. The levels of viral infection and filopodia induction were reduced with the actin polymerization inhibitors, Cytochalasin-D and Lantriculin B, suggesting an important role for actin reorganization during ZF-3-OST-3 mediated HSV-1 entry. Supporting an interesting possibility of filopodia usage during HSV-1 spread, pre-treatment of cytochalasin D in ZF-3-OST-3 cells drastically reduced virus glycoprotein induced cell fusion. CONCLUSIONS: Taken together, our results provide new evidence on the involvement of filopodia during HSV-1 infection of ZF-3-OST-3 cells and confirm a role for modified heparan sulfate in cytoskeleton rearrangement during HSV-1 entry.

Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia.

INTRODUCTION: Although alcohol consumption is a common lifestyle behavior with previous studies reporting positive effects of alcohol on chronic pain and rheumatoid arthritis, no studies to this date have examined alcohol consumption in patients with fibromyalgia. We examined the association between alcohol consumption and symptom severity and quality of life (QOL) in patients with fibromyalgia. METHODS: Data on self-reported alcohol consumption from 946 patients were analyzed. Subjects were grouped by level of alcohol consumption (number of drinks/week): none, low (≤ 3), moderate (>3 to 7), and heavy (>7). RESULTS: Five hundred and forty-six subjects (58%) did not consume alcohol. Low, moderate, and heavy levels of alcohol consumption were reported for 338 (36%), 31 (3%), and 31 patients (3%), respectively. Employment status (P <0.001), education level (P = 0.009), body mass index (P = 0.002) and opioid use (P = 0.002) differed significantly among groups with drinkers having higher education, a lower BMI, and a lower frequency of unemployment and opioid use than nondrinkers. After adjusting for these differences, the measures including the number of tender points (P = 0.01), FIQ total score (P = 0.01), physical function (P <0.001), work missed (P = 0.005), job ability (P = 0.03), and pain (P = 0.001) differed across groups, as did the SF-36 subscales of physical functioning (P <0.001), pain index (P = 0.002), general health perception (P = 0.02), social functioning (P = 0.02), and the physical component summary (P <0.001). Pairwise comparison among the 4 groups showed that the moderate and low alcohol drinkers had lower severity of fibromyalgia symptoms and better physical QOL than nondrinkers. CONCLUSIONS: Our study demonstrates that low and moderate alcohol consumption was associated with lower fibromyalgia symptoms and better QOL compared to no alcohol consumption. The reasons for these results are unclear. Since recent studies have demonstrated that γ-Aminobutyric Acid (GABA) levels are low in fibromyalgia, and alcohol is known to be a GABA-agonist, future studies should examine whether alcohol could have a salutary effect on pain and other symptoms in fibromyalgia.

Exercise in muscle pain disorders.

Muscle pain disorders range from local or regional (myofascial pain) to widespread (fibromyalgia). Many people with muscle pain have decreased fitness. Exercise intolerance is a common feature as well, and yet exercise plays an important role in the treatment of muscle pain disorders. Results of studies have shown repeatedly, via multiple modes and methods of delivery, that exercise is at least as effective as the best pharmacologic treatments. An understanding by clinicians and their patients of the unique benefits of a carefully crafted exercise program is one step in the successful management of these often frustrating muscle pain disorders.

Association between body mass index and response to a brief interdisciplinary treatment program in fibromyalgia.

OBJECTIVE: The aim of this study was to evaluate the association between baseline body mass index (BMI) and treatment outcome after a brief interdisciplinary fibromyalgia treatment program. DESIGN: Subjects (n = 477) with fibromyalgia participated in the fibromyalgia treatment program. They completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 Health Status Questionnaire (SF-36) at baseline and 6 to 12 mos after the fibromyalgia treatment program. Posttreatment changes in FIQ and SF-36 scores were compared after stratifying participants into four BMI groups: nonobese, overweight, moderately obese, and severely obese. RESULTS: All BMI groups achieved significant improvement in the FIQ total score; the FIQ subscales feel good, pain, fatigue, and morning tiredness; and the SF-36 subscales pain index, vitality, social functioning, and mental health index. Posttreatment changes in mean scores for each subscale generally did not differ significantly across BMI groups after adjusting for age and baseline scores. However, the SF-36 subscale scores of physical functioning and role-emotional were significantly less improved in the severely obese compared with the nonobese. CONCLUSIONS: Baseline BMI did not affect response to the fibromyalgia treatment program, as measured by the FIQ total score or SF-36 physical and mental component summary scores. However, the severely obese group showed less improvement compared with the nonobese group in the SF-36 physical functioning and role-emotional subscales.

Predictors of clinical outcome in fibromyalgia after a brief interdisciplinary fibromyalgia treatment program: single center experience.

OBJECTIVE: To determine which patient characteristics are closely associated with a positive response to a brief interdisciplinary fibromyalgia treatment program (FTP). DESIGN: A prospective cohort study. SETTING: FTP at a tertiary medical center. PARTICIPANTS: A total of 536 patients with a confirmed diagnosis of fibromyalgia who underwent the FTP and completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6-12 months after treatment. INTERVENTIONS: A brief 1.5-day interdisciplinary FTP, which included evaluation with a registered nurse and a physician for a diagnosis or confirmation of fibromyalgia, fibromyalgia education, interactive self management session, and physical and occupational therapy. MAIN OUTCOME MEASUREMENTS: The responder definition was an improvement of 14% or more in the FIQ total score from their baseline to 6-12 months after treatment. RESULTS: Mean (standard deviation) age of our patients was 50.3 ± 13.0 years; 515 women (96%) and 23 men (4%). Two hundred forty-eight patients (46%) met the responder definition at 6-12 months follow-up. In an univariate analysis, younger age (P = .008), college or higher education (P = .02), fewer tender points (P = .048), and higher FIQ depression subscore (P = .02) significantly predicted positive response. In a multivariate analysis, these factors all remained statistically significant. In addition, a positive abuse history became significant (P = .03). There was no significant association for gender, duration of symptoms, marital status, employment, smoking status, or 3 numeric rating scale pain scores. CONCLUSIONS: Patients with younger age, more years of education (with college or graduate degree), higher baseline FIQ depression score, lower tender point count, and absent abuse history experience greater benefit from a brief FTP.

Association of body mass index with symptom severity and quality of life in patients with fibromyalgia.

OBJECTIVE: To examine the association between body mass index (BMI) and symptom severity and quality of life (QOL) in patients with fibromyalgia. METHODS: We assessed BMI status and its association with symptom severity and QOL in 888 patients with fibromyalgia who were seen in a fibromyalgia treatment program and who completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form 36 (SF-36) health survey. RESULTS: The BMI distribution of nonobese (BMI <25.0 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), moderately obese (BMI 30.0-34.9 kg/m(2)), and severely obese (BMI ≥35.0 kg/m(2)) patients was 28.4% (n = 252), 26.8% (n = 238), 22.2% (n = 197), and 22.6% (n = 201), respectively. Age was significantly different among the 4 groups, with those having a greater BMI being older (P = 0.004). After adjustment for age, group differences were significant in the number of tender points (P = 0.003) and the FIQ and SF-36 scores. The groups with the greater BMI had greater fibromyalgia-related symptoms with worse FIQ total scores (P < 0.001), as well as worse scores in the FIQ subscales of physical function (P < 0.001), work missed (P = 0.04), job ability (P = 0.003), pain (P < 0.001), stiffness (P < 0.001), and depression (P = 0.03). These groups also had poorer SF-36 scores in physical functioning (P < 0.001), pain index (P = 0.005), general health perceptions (P = 0.003), role emotional (P = 0.04), and physical component summary (P < 0.001). Post hoc analysis among the 4 groups showed that differences resided primarily in the severely obese group compared with the other groups. CONCLUSION: In patients with fibromyalgia, severe obesity (BMI ≥35.0 kg/m(2)) is associated with higher levels of fibromyalgia symptoms and lower levels of QOL.

Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol.

BACKGROUND: Functional ("psychogenic") gait and other movement disorders have proven very difficult to treat. OBJECTIVES: Describe the Mayo Clinic functional movement disorder motor-reprogramming protocol conducted in the Department of Physical Medicine and Rehabilitation (PMR), and assess short-term and long-term outcomes. DESIGN: Historical-cohort-study assessing non-randomized PMR intervention. SETTING: Tertiary care center. PATIENTS: Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008. CONTROL GROUP: age- and sex-matched patients with treatment-as-usual (n = 60). INTERVENTIONS: An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment. MAIN OUTCOME MEASURES: Improvement of the movement disorder by the end of the week-long program (patient- and physician-rated), plus the long-term outcome (patient-rated). RESULTS: Patient demographics: median symptom duration, 17 months (range, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). Physician-rated outcomes after the one-week treatment program documented 73.5% were markedly improved, nearly normal or in remission, similar to the patient-ratings (68.8%). Long-term treatment outcomes (patient-rated; median follow-up, 25 months) revealed 60.4% were markedly improved or almost completely normal/in remission, compared to 21.9% of controls (p < 0.001). CONCLUSIONS: Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial.

Direct medical costs in patients with fibromyalgia: Cost of illness and impact of a brief multidisciplinary treatment program.

OBJECTIVE: To compare the direct medical costs of clinically diagnosed patients with fibromyalgia with the medical costs of matched controls during a 4-yr period and to assess the impact of a fibromyalgia treatment program on healthcare utilization and associated medical costs. DESIGN: A retrospective comparison of economic outcomes in 87 patients who participated in a fibromyalgia treatment program between 2001 and 2004 and who were local residents for the entire 4-yr period spanning their participation in the program, with age and sex-matched controls. Costs for the 2 yrs before and 2 yrs after program participation were also compared. RESULTS: Four-year medical costs for controls were $7774 compared with $15,759 for those with fibromyalgia. There was no significant change in direct costs after participation in a brief fibromyalgia treatment program. Those with increased symptom severity averaged $2034 higher direct medical costs during the 4-yr period. CONCLUSIONS: Patients with clinically diagnosed fibromyalgia incur direct medical costs about twice that of their matched controls. This increased cost is related to the severity of their symptoms as measured by the Fibromyalgia Impact Questionnaire and was not impacted by participation in a brief cognitive behaviorally based fibromyalgia treatment program.

Dietary soy supplement on fibromyalgia symptoms: a randomized, double-blind, placebo-controlled, early phase trial.

Most patients with fibromyalgia use complementary and alternative medicine (CAM). Properly designed controlled trials are necessary to assess the effectiveness of these practices. This study was a randomized, double-blind, placebo-controlled, early phase trial. Fifty patients seen at a fibromyalgia outpatient treatment program were randomly assigned to a daily soy or placebo (casein) shake. Outcome measures were scores of the Fibromyalgia Impact Questionnaire (FIQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and after 6 weeks of intervention. Analysis was with standard statistics based on the null hypothesis, and separation test for early phase CAM comparative trials. Twenty-eight patients completed the study. Use of standard statistics with intent-to-treat analysis showed that total FIQ scores decreased by 14% in the soy group (P = .02) and by 18% in the placebo group (P < .001). The difference in change in scores between the groups was not significant (P = .16). With the same analysis, CES-D scores decreased in the soy group by 16% (P = .004) and in the placebo group by 15% (P = .05). The change in scores was similar in the groups (P = .83). Results of statistical analysis using the separation test and intent-to-treat analysis revealed no benefit of soy compared with placebo. Shakes that contain soy and shakes that contain casein, when combined with a multidisciplinary fibromyalgia treatment program, provide a decrease in fibromyalgia symptoms. Separation between the effects of soy and casein (control) shakes did not favor the intervention. Therefore, large-sample studies using soy for patients with fibromyalgia are probably not indicated.

Development of a unique triage system for acute care physical therapy and occupational therapy services: an administrative case report.

BACKGROUND AND PURPOSE: This administrative case report documents the development of a mechanism by which systematic triage was used to assign patients to therapists in acute care settings. The primary objective was to develop a triage tool to improve patient access to medically necessary therapy services. CASE DESCRIPTION: A unique triage tool and a decision tree were developed to determine which patients referred to therapists for acute care therapy required skilled services. The triage tool was used to examine therapy referrals for patients from 2 large academic hospitals; 6 criteria were used to determine which evaluations should be cancelled. During the trial period, the predictive ability of individual triage criterion items was analyzed, the tool was modified and validated, and a decision tree was established. Descriptive and chi-square analyses were performed on all variables of interest. OUTCOMES: The systematic triage system reduced the number of therapy evaluations that were not appropriate by 29%, resulting in an improvement in the availability of therapy services for patients who required skilled care. The average number of patients per therapist per workday decreased from 18.9 to 12.1 and from 15.1 to 12.8 in the 2 hospitals. An improvement in a newly developed "workload index" related to missed patient visits also indicated the success of this project. DISCUSSION: A novel systematic triage system reduced the number of therapy evaluations that were not appropriate, resulting in an improvement in the availability of therapy services for patients who require skilled intervention.

Zebrafish-encoded 3-O-sulfotransferase-3 isoform mediates herpes simplex virus type 1 entry and spread.

Heparan sulfate proteoglycans modified by human glucosaminyl 3-O-sulfotransferase-3 (3-OST-3) isoform generates the cellular receptor for herpes simplex virus type 1 (HSV-1). Interestingly, the ability of zebrafish (ZF)-encoded 3-OST-3 isoform to modify heparan sulfate to mediate HSV-1 entry and cell-cell fusion has not been determined although it is predominantly expressed in ZF, a popular model organism to study viral infections. Here, we demonstrate that expression of ZF-encoded 3-OST-3 isoform renders the resistant Chinese hamster ovary (CHO-K1) cells to become susceptible for HSV-1 entry. The following lines of evidence support the important role of ZF-encoded 3-OST-3 isoform as the mediator of HSV-1 entry into CHO-K1 cells: (1) ZF 3-OST-3-expressing CHO-K1 cells were able to preferentially bind HSV-1 glycoprotein D, and (2) CHO-K1 cells expressing ZF-encoded 3-OST-3 acquire the ability to fuse with cells expressing HSV-1 glycoproteins. Finally, knocking down 3-OST-3 receptor by siRNA in ZF fibroblasts cells significantly reduced HSV-1 entry and glycoprotein D binding to cells. Taken together, our results provide novel insight into the significance of ZF 3-OST-3 isoform as an HSV-1 entry and fusion receptor and its potential involvement in the HSV-1 disease model of ZF.

Brief interdisciplinary treatment program for fibromyalgia: six to twelve months outcome.

OBJECTIVE: To evaluate the impact and long-term benefit of a brief 1(1/2)-day fibromyalgia treatment program. DESIGN: We assessed 6-12-mo outcome of 521 participants who underwent a 1(1/2)-day interdisciplinary fibromyalgia treatment program in a tertiary medical center. We administered three self-reported instruments: the Fibromyalgia Impact Questionnaire, the Short Form-36 Health Status Questionnaire, and a satisfaction survey, at baseline, and 6-12 mos after completing the fibromyalgia treatment program. The difference in the Fibromyalgia Impact Questionnaire and Short Form-36 scores before and after the fibromyalgia treatment program was the main outcome measure. RESULTS: Compared with baseline, the Fibromyalgia Impact Questionnaire total score was decreased by a mean (SD) of 7.2 (17.7) points at follow-up (P < 0.001). All Fibromyalgia Impact Questionnaire subscales improved significantly at follow-up (all P < 0.001), except depression score (P = 0.67). The Short Form-36 scores improved significantly in all areas at follow-up (all P < 0.001), except general health perception (P = 0.58) and role emotional (P = 0.13). CONCLUSIONS: A brief 1(1/2)-day fibromyalgia treatment program improves symptoms and quality of life in patients with fibromyalgia for 6-12 mos. Further clinical investigations are needed to compare this fibromyalgia treatment program with other programs and interventions.

Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia.

OBJECTIVE: The aim of this study was to determine the reliability of the Box and Block (B&B) Test of Manual Dexterity for upper-extremity function in patients with fibromyalgia and to compare their results with those of healthy control participants. METHOD: We assessed reliability of the B&B Test within and between testers using the intraclass correlation coefficient (ICC). We compared fibromyalgia patient (n = 30) and control group (n = 30) scores using analysis of variance and population-based normative data. RESULTS: The B&B Test was reliable with ICCs of .90 to .85. Fibromyalgia patients' B&B Test scores were significantly lower (more impaired) than those of the control group and standardized norms. CONCLUSIONS: The B&B Test is a reliable measure of upper-extremity function in fibromyalgia patients and is able to reveal a reduction in upper-extremity function in these patients compared with both healthy control participants and normative scores.

Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia.

OBJECTIVES: This study examined the relationship between the severity of fibromyalgia symptoms and current tobacco use in patients evaluated at a specialized fibromyalgia treatment program. METHODS: Demographic and clinical data from 984 consecutive patients evaluated at the Mayo Clinic Fibromyalgia Treatment Program including the Fibromyalgia Impact Questionnaire (FIQ) were prospectively collected and stored in an electronic medical record and an electronic database. Univariate analyses were performed comparing tobacco users and nonusers. A post-hoc analysis of covariance was conducted for tobacco use, using group differences of confounding clinical and demographic variables. A P value < or = 0.05 was accepted as the level of significance. RESULTS: One hundred and forty-five patients were identified as tobacco users (14.7%). Tobacco use was associated with greater pain intensity as measured by pain scales and the pain component of the FIQ. Tobacco users had a greater FIQ composite score 70.0(15.1) versus 61.8(16.8), P<0.001. By univariate analysis, tobacco users had higher scores on all the FIQ components and fewer good days and more days of work missed per week. Tobacco use was associated with several confounding clinical and demographic variables including lower education, higher unemployment, not being married or widowed, and history of abuse. After adjusting for these confounding variables, tobacco users continued to have greater pain intensity, a higher total and component FIQ scores except for fatigue. Smoking was not associated with a higher number of tender points. DISCUSSION: Current tobacco use was associated with more severe fibromyalgia symptoms in patients presenting to a specialized fibromyalgia treatment program.

Identification and quantification of myofascial taut bands with magnetic resonance elastography.

OBJECTIVE: To explore the feasibility of using a new magnetic resonance imaging (MRI) technique--magnetic resonance elastography (MRE)--to identify and quantitate the nature of myofascial taut bands. DESIGN: This investigation consisted of 3 steps. The first involved proof of concept on gel phantoms, the second involved numeric modeling, and the third involved a pilot trial on 2 subjects. Imaging was performed with a 1.5 T MRI machine. Shear waves were produced with a custom-developed acoustically driven pneumatic transducer with gradient-echo image collection gated to the transducer's motion. Shear wave propagation were imaged by MRE. SETTING: An MRI research laboratory. PARTICIPANTS: Two women, one with a 3-year history of myofascial pain and the other serving as the control. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: MRE images, finite element analysis calculations, and tissue and phantom stiffness determinations. RESULTS: Results of the phantom measurements, finite element calculations, and study patients were all consistent with the concept that taut bands are detectable and quantifiable with MRE imaging. The findings in the subjects suggest that the stiffness of the taut bands (9.0+/-0.9 KPa) in patients with myofascial pain may be 50% greater than that of the surrounding muscle tissue. CONCLUSIONS: Our findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination.

A description of a brief multidisciplinary treatment program for fibromyalgia.

The majority of fibromyalgia treatment programs are weeks or months in duration. This tertiary care center draws people worldwide for diagnostic purposes; however, most patients are unable to stay for extended treatment. It was deemed important to offer a brief multidisciplinary fibromyalgia treatment program that provided fundamental education and established a foundation for self-management strategies. This article describes the components of a brief multidisciplinary program for fibromyalgia. Initial results indicate improvement in patient outcomes and in patient and physician satisfaction. Patients who complete any fibromyalgia program need to maintain a relationship with their primary care providers for ongoing care. Some patients may need a more comprehensive program because of their level of functional impairment.