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Holtrop K, Piehler TF, Miller D, Young D, Tseng CF, Gray LJ. The Effectiveness of GenerationPMTO During Sustained Implementation in the Public Mental Health System: A Single-Arm Open Trial Evaluation. Behav Ther 2024; 55:248-262. [PMID: 38418038 DOI: 10.1016/j.beth.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/05/2023] [Accepted: 06/27/2023] [Indexed: 03/01/2024]
Abstract
To support families and reduce the burden of child mental, emotional, and behavioral problems, evidence-based parenting interventions must remain effective in real-world service delivery contexts. The purpose of the current study was to evaluate the effectiveness of the GenerationPMTO (GenPMTO) intervention during sustained implementation in the Michigan public mental health system using a single-arm open trial (pre-post) design. We also examined potential predictors of treatment response. A multilevel analysis framework was utilized to evaluate data from 365 caregivers who completed GenPMTO treatment. Results revealed significant positive improvements from pretest to posttest in all four outcome domains (i.e., parenting confidence, parenting practices, caregiver depressive symptoms, child behavior problems). When compared to group-based GenPMTO delivery, the individual delivery format was associated with significantly greater improvements in overall effective parenting practices, as well as in the subdomain of skill encouragement. Caregiver gender, caregiver educational level, and child age were all implicated as predictors of GenPMTO outcomes. These findings add to the literature by supporting the effectiveness of the GenPMTO intervention when fully integrated into mental health care practice and can inform continued efforts to provide families with evidence-based services in community settings.
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Yalçın M, Arıtürk S, Görgü Akçay NS, Tekinsav Sütcü S. Cognitive Behavioral Group Therapy for Anger Management in Juvenile Delinquents: Effectiveness Study in a Turkey Child Prison. Int J Offender Ther Comp Criminol 2023:306624X231165418. [PMID: 37085985 DOI: 10.1177/0306624x231165418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to evaluate the effectiveness of cognitive-behavioral group therapy (CBGT) for anger management in Juvenile Delinquents. The therapy program consisted of eight sessions including relaxation, self-instruction, cognitive restructuring, and assertiveness training techniques. The therapy program has been conducted for juvenile delinquents in one of the juvenile prisons in Turkey. Sixty juvenile delinquents, aged between 14 and 18, who met the inclusion criteria (treatment = 30, control = 30), were included at the beginning of the study. To evaluate the effectiveness of the program, State Trait Anger and Expression Inventory (STAXI), and Brief Symptom Inventory (BSI) were administered as pre-test. At the end of the therapy program, final analysis was conducted on 35 participants (20 therapy group, 15 control group) due to participants dropout. Mixed ANOVA was conducted to examine the time (pre-test and post-test) and group effects (therapy and control group). Results showed that the participants in the therapy group showed a significant decrease in trait anger and anger expression scores, both subscales of STAXI and in the hostility subscale of BSI; a statistically significant increase in the anger control scores of the subscale of STAXI when compared to the control group. In conclusion, this culturally attuned CBGT for anger management may be applicable for Juvenile Delinquents in Turkey.
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Affiliation(s)
- Melikenaz Yalçın
- Psychology Department, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Seda Arıtürk
- Psychology Department, Katip Çelebi University, İzmir, Turkey
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Volovik-Shushan S, Krupa T, Bloch Y, Lipskaya-Velikovsky L. Occupational intervention in mental health hospitals: Study of contextual impact. Scand J Occup Ther 2023; 30:137-147. [PMID: 35603883 DOI: 10.1080/11038128.2022.2076734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recovery-promoting and occupation-oriented interventions for people with schizophrenia who receive in-patient services are scarcely investigated, limiting our understanding of the factors affecting intervention effectiveness and hindering occupational inclusion. AIMS To investigate the impact of contextual factors on the effectiveness of 'Occupational Connections' (OC) - occupational intervention for in-patient psychiatric settings. MATERIALS AND METHODS Quasi-experimental, single-blind study compared between inpatients with schizophrenia participating in OC (N = 14) and those receiving treatment as usual only (N = 16) on primary outcomes of participation dimensions and recovery-orientation of the service, and on secondary outcomes of cognition, symptom severity, and functional capacity. RESULTS Participation in OC in a new context appears to contribute to improvement in cognitive fluency and flexibility, schizophrenia symptoms, and functional capacity (-2.8<t < 4.32, p < 0.05) with no improvement in the participation dimensions (-1.36<t < 1.36, p > 0.05) or reduction (-2.25<t < 3.74, p < 0.05). The pattern of change in primary and secondary outcomes in a new context was distinct from previous reports on OC effectiveness. CONCLUSIONS AND SIGNIFICANCE These findings suggest the impact of contextual factors on OC effectiveness. Personal participants' factors, institutional features, clinician characteristics, and intervention qualities should be considered in the process of the OC further development, evidence building, and clinical implementation to ensure optimal intervention results.
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Affiliation(s)
- Shani Volovik-Shushan
- Shalvata Mental Health Care Center, Hod-Hasharon, Israel.,School of Health Profession, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Terry Krupa
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Yuval Bloch
- Shalvata Mental Health Care Center, Hod-Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Roslan AF, Pheh KS, Mahadevan R, Bujang SM, Subramaniam P, Yahya HF, Chan LF. Effectiveness of online advanced C.A.R.E suicide prevention gatekeeper training program among healthcare lecturers and workers in national university of Malaysia: A pilot study. Front Psychiatry 2023; 14:1009754. [PMID: 36741120 PMCID: PMC9892857 DOI: 10.3389/fpsyt.2023.1009754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Suicide is a major cause of death among adolescents and young adults, especially students. This is particularly true for healthcare students with a higher risk and more access to lethal means. Thus, it is vital for healthcare educators who have regular contact with these healthcare students to be trained as gatekeepers in preventing suicide. Evidence of the effectiveness of such gatekeeper training, mainly using an online module, is lacking predominantly in Malaysia. This study aims to investigate the effectiveness of an online gatekeeper suicide prevention training program that is conducted for healthcare lecturers. METHODS A single-arm interventional pre-and post-pilot study was conducted on a sample of healthcare lecturers and workers who are involved in supervising healthcare students. A purposive sampling technique was used to recruit 50 healthcare educators in Malaysia. The program was conducted by trained facilitators and 31 participants completed a locally validated self-rated questionnaire to measure their self-efficacy and declarative knowledge in preventing suicide; immediately before and after the intervention. RESULTS Significant improvement was seen in the overall outcome following the intervention, mostly in the self-efficacy domain. No significant improvement was seen in the domain of declarative knowledge possibly due to ceiling effects; an already high baseline knowledge about suicide among healthcare workers. This is an exception in a single item that assesses a common misperception in assessing suicide risk where significant improvement was seen following the program. CONCLUSION The online Advanced C.A.R.E. Suicide Prevention Gatekeeper Training Program is promising in the short-term overall improvement in suicide prevention, primarily in self-efficacy.
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Affiliation(s)
- Amran Fadzrul Roslan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Kai Shuen Pheh
- Department of Psychology and Counselling, Faculty of Arts and Social Sciences, Tunku Abdul Rahman University, Kampar, Malaysia
| | - Raynuha Mahadevan
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Siti Mariam Bujang
- Department of Medical Education, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Unit of Health Psychology, Faculty of Health Sciences, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Hanieza Fadzlina Yahya
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
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Pankakoski M, Sarkeala T, Anttila A, Heinävaara S. Effectiveness of Cervical Testing in and outside a Screening Program-A Case-Control Study. Cancers (Basel) 2022; 14:5193. [PMID: 36358612 PMCID: PMC9653595 DOI: 10.3390/cancers14215193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 04/29/2024] Open
Abstract
In many countries with organized cervical cancer screening, opportunistic Pap and human papillomavirus (HPV) tests are common. However, little is known about their effectiveness. We examined the effect of testing in and outside the Finnish screening program on the risk of cervical cancer. We conducted a case-control study that involved 1677 cases with invasive cervical cancer that were diagnosed between 2010 and 2019. Five- and three-year test intervals were analyzed across all ages, by age group and by cancer morphology subtype. Conditional logistic regression was used, adjusting for socioeconomic variables. Women undergoing any kind of cervical test had a significantly lowered risk of cervical cancer (adjusted OR = 0.43, 95% CI = 0.38-0.48, tests in five-year intervals). The results were similar, regardless of whether the test had been taken in the screening program or outside of it, or whether the interval was five years or three years. Testing of women at ages 35-64 showed the strongest effects, but moderate preventive effects were seen until age 79. No significant effect was seen below age 30. Tests in and outside the program were effective at the screening target age. However, participation in the program should be encouraged for optimal cost-effectiveness. Preventive effects were also seen above the program target ages.
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Affiliation(s)
- Maiju Pankakoski
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
| | - Tytti Sarkeala
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Ahti Anttila
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
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Girardet RG, Shellman AB, Llorens A, Nguyen L, Ellsworth M, Rennie K, Ha C. Evaluation of an Intensive Program for Children With Co-occurring Medical and Emotional Disorders. Clin Pediatr (Phila) 2022; 61:605-614. [PMID: 35677990 DOI: 10.1177/00099228221091429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study objective was to assess clinical outcomes and cost avoidance of an intensive day treatment program for children with co-occurring chronic medical disease and emotional problems. Intensive day treatment programs for this population are uncommon, and their effectiveness has not been previously reported. A total of 175 children were enrolled during the 3-year study period. Children had more than 30 medical diagnoses including chronic pain, dysautonomia, neurologic disorders, and diabetes. Complete utilization data were available for 118 patients, and demonstrated decreased hospitalizations and increased behavioral health visits during the 12 months post program compared with 12 months prior. Private insurance and female sex were associated with reduced utilization costs after program participation. Estimated avoided cost for the 118 children was $1 111 485. Patients reported significant improvements in somatic symptoms, sleep problems, inattention, depression, anger, and anxiety. Limited data indicated improvements in school attendance. Additional research addressing other outcomes, such as school-related symptoms, would be helpful.
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Affiliation(s)
- Rebecca G Girardet
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Alison B Shellman
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ashlie Llorens
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Anew Psychological Services, Houston, TX, USA
| | - Linh Nguyen
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Misti Ellsworth
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kimberly Rennie
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,NeuroBehavioral Health, Milwaukee, WI, USA
| | - Carolyn Ha
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Katy Psychological Services, Katy, TX, USA
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Supported Housing for non-homeless individuals with severe mental illness: Comparison of two effectiveness studies using a randomised controlled and an observational study design. Front Psychiatry 2022; 13:1033328. [PMID: 36440393 PMCID: PMC9685807 DOI: 10.3389/fpsyt.2022.1033328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article reports on a prospective, direct comparison of the designs of two parallel studies in this field. METHODS A two-centre, parallel-group non-inferiority effectiveness study was conducted at two locations in Switzerland using identical instruments and clinical hypotheses. One centre applied an RCT design and the other an observational study (OS) design with propensity score methods (ClinicalTrials.gov: NCT03815604). The comparability of the two study centres was investigated in terms of participants, procedures, and outcomes. The primary outcome was social inclusion and the secondary outcomes were quality of life and psychiatric symptoms. RESULTS The study included 141 participants (RCT: n = 58; OS: n = 83). Within one year, 27% study dropouts occurred (RCT: 34%; OS: 22%). A similar balance of sample characteristics was achieved in the RCT and the OS using propensity score methods (inverse probability of treatment weighting). After one year, ISH was non-inferior to the control condition regarding social inclusion (mean differences [95% CI]) in the RCT (6.28 [-0.08 to 13.35]) and the OS (2.24 [-2.30 to 6.77]) and showed no significant differences in quality of life (RCT: 0.12 [-0.52 to 0.75]; OS: 0.16 [-0.26 to 0.58]) and symptoms (RCT: -0.18 [-0.75 to 0.40]; OS: 0.21 [-0.17 to 0.60]) in both study centres. However, strong and persistent preferences for ISH in the RCT control group reduced participants' willingness to participate. Because of several limitations in the RCT, the results of the RCT and the OS are not comparable. CONCLUSION Participants were comparable in both study sites. However, there were significant problems in conducting the RCT because of strong preferences for ISH. The OS with propensity score methods provided results of more stable groups of participants and revealed balanced samples and valid outcome analysis. Our results do not support further investment in RCTs in this field.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Ferreira DH, Louw S, McCloud P, Fazekas B, McDonald CF, Agar MR, Clark K, McCaffrey N, Ekström M, Currow DC. Controlled-Release Oxycodone vs. Placebo in the Treatment of Chronic Breathlessness-A Multisite Randomized Placebo Controlled Trial. J Pain Symptom Manage 2020; 59:581-589. [PMID: 31655189 DOI: 10.1016/j.jpainsymman.2019.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/12/2022]
Abstract
CONTEXT Chronic breathlessness is a clinical syndrome that results in significant distress and disability. Morphine can reduce chronic breathlessness when the contributing etiologies are optimally treated. OBJECTIVES Does oxycodone reduce chronic breathlessness compared with placebo? METHODS A multisite, randomized, placebo-controlled, double-blind, parallel-arm, fixed-dose trial of oral controlled-release oxycodone 15 mg (5 mg, eight hourly) or placebo (ACTRN12609000806268 at www.anzctr.org.au). As-needed immediate-release morphine (2.5 mg per dose; six and less doses/day) was available for both arms as required by one ethics committee overseeing the trial. Recruitment occurred from 2010 to 2014 in 14 inpatient and outpatient respiratory, cardiology, and palliative care services across Australia. Participants were adults, with chronic breathlessness (modified Medical Research Council Scale 3 or 4), who were opioid naive. The primary end point was the proportion of people with greater than 15% reduction from baseline in the intensity of breathlessness now (0-100 mm visual analogue scale) comparing arms Days 5-7. Secondary end points were average and worst breathlessness, quality of life, function, and harms. RESULTS Of 157 participants randomized, 155 were included (74 oxycodone and 81 placebo), but the study did not reach target recruitment. There was difference in neither between groups for the primary outcome (P = 0.489) nor any of the prespecified secondary outcomes. Placebo participants used more as-needed morphine (mean 7.0 vs. 4.2 doses; P ≤ 0.001). Oxycodone participants reported more nausea (P < 0.001). CONCLUSION There was no signal of benefit from oxycodone over placebo. Future research should focus on investigating the existence of an opioid class effect on the reduction of chronic breathlessness.
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Affiliation(s)
- Diana H Ferreira
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Sandra Louw
- McCloud Consulting Group, Narabang Way, Belrose, New South Wales, Australia
| | - Philip McCloud
- McCloud Consulting Group, Narabang Way, Belrose, New South Wales, Australia
| | - Belinda Fazekas
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine F McDonald
- Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Meera R Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Katherine Clark
- Northern Sydney Local Health District, St Leonards, New South Wales, Australia; University of Sydney, Glebe, New South Wales, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Magnus Ekström
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; Department of Clinical Sciences Lund, Lund University, Faculty of Medicine, Respiratory Medicine and Allergology, Lund, Sweden
| | - David C Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
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Ferreira DH, Ekström M, Sajkov D, Vandersman Z, Eckert DJ, Currow DC. Extended-Release Morphine for Chronic Breathlessness in Pulmonary Arterial Hypertension-A Randomized, Double-Blind, Placebo-Controlled, Crossover Study. J Pain Symptom Manage 2018; 56:483-492. [PMID: 30031217 DOI: 10.1016/j.jpainsymman.2018.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT Pulmonary arterial hypertension (PAH) affects people of all ages and is associated with poor prognosis. Chronic breathlessness affects almost all people with PAH. OBJECTIVES This randomized, placebo-controlled, double-blind, crossover study aimed to evaluate the effects of regular, low-dose, extended-release (ER) morphine for PAH-associated chronic breathlessness. METHODS Participants with PAH-associated chronic breathlessness were randomized to 1) seven days of ER morphine 20 mg, 2) seven-day washout, and 3) seven days of identically looking placebo, or vice versa. Primary end points were breathlessness "right now"-morning and evening-measured with a Visual Analogue Scale. Secondary end points included additional breathlessness measures, quality of life, function, harms, and blinded treatment preference (ACTRN12609000209291). RESULTS Within a period of seven years, 50 patients were assessed in detail and 23 (46%) were randomized (despite broad eligibility criteria). Four participants withdrew while taking morphine. Nineteen participants completed the study. Breathlessness "right now" was higher on morphine compared with placebo both for morning [mean (M) ± SD 31.7 ± 25 mm vs. 26.9 ± 22 mm; effect size (80% CI) = -0.22 (-0.6 to 0.2)] and evening [(M ± SD 33.5 ± 28 mm vs. 25.6 ± 21 mm; effect size (80% CI) = -0.33 (-0.8 to 0.1)]. All secondary measures of breathlessness were higher with morphine as were nausea and constipation. CONCLUSION This study does not support a Phase III study of ER morphine for people with PAH-associated chronic breathlessness. Recruiting to the target sample size was difficult, the direction of effect in every measure of breathlessness favored placebo and morphine generated more harms.
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Affiliation(s)
- Diana H Ferreira
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
| | - Magnus Ekström
- Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute and Department of Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Zac Vandersman
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA) and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - David C Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; Wolfson Centre for Palliative Care Research, University of Hull, Hull, England
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Abstract
OBJECTIVES The objectives of this study are (1) to compare the satisfaction between patients who have received treatment as usual face-to-face (TAU group) and patients who have received optional videoconferencing-based treatment for alcohol use disorders (TAU+I group); and (2) to elaborate on the TAU+I group's satisfaction with the treatment in general and the technical equipment. METHODS The design consisted of mixed methods: a survey and a qualitative study. Data consisted of self-reported data from questionnaires filled out by both groups and semistructured interviews with the TAU+I group. Data from the questionnaires were analyzed statistically using Stata. The semistructured interviews were analyzed using a general inductive approach. RESULTS The survey indicated that the TAU+I group and TAU group were equally satisfied with the elements in the treatment. The interview indicated that the TAU+I group seemed to have a high satisfaction with most elements in the treatment. Patients who used videoconferencing were satisfied with establishing the videoconferencing connection and with the picture quality but less satisfied with the sound quality. CONCLUSIONS Overall, the patients were satisfied with the treatment. We saw a nonsignificant tendency that the TAU+I group were more satisfied with the treatment in general, compared with the TAU group. It is a possibility that patients in this group felt more satisfied with the treatment as they had the opportunity to choose videoconferencing. Offering videoconferencing-based treatment may be a positive feature in the treatment and lead to improved outcomes of the treatment courses. The technical equipment and routine using it should be improved in future studies or during implementation.
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Reinholt N, Aharoni R, Winding C, Rosenberg N, Rosenbaum B, Arnfred S. Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. Cogn Behav Ther 2016; 46:29-43. [PMID: 27705086 DOI: 10.1080/16506073.2016.1227360] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.
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Affiliation(s)
- Nina Reinholt
- a Faculty of Health Sciences, Mental Health Centre Copenhagen , University of Copenhagen , Copenhagen , Denmark
| | - Ruth Aharoni
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Clas Winding
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Nicole Rosenberg
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Bent Rosenbaum
- c Department of Psychology , University of Copenhagen , Copenhagen , Denmark
| | - Sidse Arnfred
- d Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark
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Shah BR, Hwee J, Cauch-Dudek K, Ng R, Victor JC. Diabetes self-management education is not associated with a reduction in long-term diabetes complications: an effectiveness study in an elderly population. J Eval Clin Pract 2015; 21:656-61. [PMID: 25847059 DOI: 10.1111/jep.12360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The efficacy of diabetes self-management education on glycaemic control, self-care behaviour and knowledge has been established by short-term studies in experimental settings. The objective of this study was to assess its effectiveness to improve quality of care and reduce the risk of long-term diabetes complications in unselected older patients with recently diagnosed diabetes in routine clinical care. METHODS Using population-level health care administrative databases and registries, all patients aged ≥66 years in Ontario, Canada with diabetes for <5 years were identified. Self-management education programme attendees (n = 8485) in 2006 were matched with non-attendees using high-dimensional propensity scores, creating extremely well-balanced study arms. Quality of care measures and the long-term risk of diabetes complications were compared. RESULTS Self-management programme attendees were more likely than non-attendees to achieve process measures of quality of care such as retinal screening examinations (75.3% versus 70.3%, adjusted relative risk 1.05, 99% confidence interval 1.03-1.08), and ≥2 glycated haemoglobin tests (57.5% versus 53.3%, adjusted relative risk 1.08, 99% confidence interval 1.05-1.11). However, with a median follow-up of 5.3 years, diabetes complications and mortality were not different between arms. CONCLUSIONS In real-world clinical care, self-management education for older patients with recently diagnosed diabetes was associated with modest improvements in quality of care, but no reductions in long-term clinical events.
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Affiliation(s)
- Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeremiah Hwee
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen Cauch-Dudek
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Charles Victor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Hutchins SS, Brown C, Mayberry R, Sollecito W. Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies. J Comp Eff Res 2015; 4:227-238. [PMID: 25959743 DOI: 10.2217/cer.15.11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To improve evidence for public health practice, the conduct of effectiveness studies by practitioners is needed and may be stimulated if knowledge that smaller than usual samples may provide the same reliability of intervention effect size as larger samples. MATERIALS & METHODS We examined reliability of intervention effect using computerized simulations of 2000 hypothetical immunization effectiveness studies from an actual study population and by small (30 and 60) and larger (100 and 200) control groups compared with an intervention group of 200 participants. RESULTS & CONCLUSION Across simulated studies, the mean intervention effect (14%) and effect sizes were equivalent regardless of control group size and equal to the actual study effect. These results are relevant for similarly designed and executed studies and indicate that studies with smaller control groups can generate valid and accurate evidence for effective public health practice in communities.
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Affiliation(s)
- Sonja S Hutchins
- Office of Minority Health & Health Equity, Centers for Disease Control & Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Cedric Brown
- National Center for Immunization & Respiratory Diseases, Centers for Disease Control & Prevention, GA, USA
| | - Robert Mayberry
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - William Sollecito
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, NC, USA
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14
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Sigmarsdóttir M, Degarmo DS, Forgatch MS, Guðmundsdóttir EV. Treatment effectiveness of PMTO for children's behavior problems in Iceland: assessing parenting practices in a randomized controlled trial. Scand J Psychol 2015; 54:468-76. [PMID: 24580570 DOI: 10.1111/sjop.12078] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/07/2013] [Indexed: 12/01/2022]
Abstract
Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training - Oregon model (PMTO™), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre-post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.
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Affiliation(s)
- Margrét Sigmarsdóttir
- University of Copenhagen, Denmark; The School Administration Office in Hafnarfjördur, Iceland
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15
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Ishigooka J, Nakagome K, Ohmori T, Iwata N. Japan useful medication program for schizophrenia (JUMPs)-long-term study on discontinuation rate, resolution and remission, and improvement in social functioning rate associated with atypical antipsychotic medications in patients with schizophrenia. BMC Psychiatry 2013; 13:243. [PMID: 24090047 PMCID: PMC3852294 DOI: 10.1186/1471-244x-13-243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is desirable to establish evidence for the selection of antipsychotics from the viewpoint of recovery of social activity in individual patient with schizophrenia receiving medication. From this perspective, awareness of the importance of studies about drug effectiveness on treatment discontinuation rate, remission rate, and improvement in QOL has grown recently. In Western countries, numerous reports are available in effectiveness studies, which are related to olanzapine and risperidone primarily, whereas evidence for other second-generation antipsychotics (SGAs) is poor. In Japan, no effectiveness study has been reported: thus, it is desirable to collect data that will serve as evidence for selection of the 3 SGAs approved after olanzapine. METHODS The present study was a long-term effectiveness study under healthcare setting in Japan. It was designed as an open-label, multicenter, randomized, comparative study involving 104-week oral treatment with 1 of the 3 drugs (aripiprazole, blonanserin, and paliperidone) in patients with schizophrenia aged 20 years or over who required antipsychotic medication or switching of the current medication to others for reasons such as lack of efficacy and intolerability. The primary endpoint is treatment discontinuation rate for any causes. The secondary endpoints include remission rate, improvement of social activity, alleviation, aggravation or recurrence of psychiatric symptoms, and safety. The target number of subjects was set at 300. DISCUSSION Because this study is expected to yield evidence regarding the selection of antipsychotics for facilitating the recovery of social activity in patients with schizophrenia, it is considered highly valuable to perform this effectiveness study under ordinary healthcare setting in Japan. TRIAL REGISTRATION UMIN Clinical Trials Registry 000007942.
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Affiliation(s)
- Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Kazuyuki Nakagome
- Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, The University of Tokushima Graduate School, Tokushima, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Hopson LM, Holleran Steiker LK. The Effectiveness of Adapted Versions of an Evidence-based Prevention Program in Reducing Alcohol Use among Alternative School Students. Child Sch 2010; 32:81-92. [PMID: 20622971 PMCID: PMC2901113 DOI: 10.1093/cs/32.2.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although there is a strong evidence base for effective substance abuse prevention programs for youth, there is a need to facilitate the implementation and evaluation of these programs in real world settings. This study evaluates the effectiveness of adapted versions of an evidence-based prevention program, keepin' it REAL (kiR), with alternative school students. Programs are often adapted when used in schools and other community settings for a variety of reasons. The kiR adaptations, developed during an earlier phase of this study, were created to make the curriculum more appropriate for alternative high school youth. The adaptations were evaluated using a quasi-experimental design in which questionnaires were administered at pretest, posttest, and follow-up, and focus groups were conducted at posttest. MANOVA analyses indicate significantly reduced intentions to accept alcohol and, for younger participants, reduced alcohol use. Focus group data support the need for age appropriate prevention content. The authors discuss implications for practitioners implementing prevention programs in schools.
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Affiliation(s)
- Laura M. Hopson
- University at Albany School of Social Welfare, 135 Western Avenue, Richardson Hall, Albany, NY 12222, (518) 591-8787
| | - Lori K. Holleran Steiker
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd., Austin, TX 78712, (512) 232-9330
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