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Eaton CK, McWilliams E, Yablon D, Kesim I, Ge R, Mirus K, Sconiers T, Donkoh A, Lawrence M, George C, Morrison ML, Muther E, Oates GR, Sathe M, Sawicki GS, Snell C, Riekert K. Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e49024. [PMID: 38717433 PMCID: PMC11085043 DOI: 10.2196/49024] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 05/12/2024] Open
Abstract
Background Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes. Conclusions To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.
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Affiliation(s)
- Cyd K Eaton
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Emma McWilliams
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Dana Yablon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Irem Kesim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Renee Ge
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Karissa Mirus
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Takeera Sconiers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Alfred Donkoh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Melanie Lawrence
- Success with Therapies Research Consortium CF Community Member Advisory Board, Bethesda, MD, United States
| | | | - Mary Leigh Morrison
- Success with Therapies Research Consortium CF Community Member Advisory Board, Bethesda, MD, United States
| | - Emily Muther
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Gabriela R Oates
- Division of Pediatric Pulmonary & Sleep Medicine, Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Meghana Sathe
- Children’s Health Dallas, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gregory S Sawicki
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Carolyn Snell
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kristin Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Courtney DB, Watson P, Krause KR, Chan BWC, Bennett K, Gunlicks-Stoessel M, Rodak T, Neprily K, Zentner T, Szatmari P. Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression: A Scoping Review. JAMA Netw Open 2022; 5:e2146331. [PMID: 35103789 PMCID: PMC8808324 DOI: 10.1001/jamanetworkopen.2021.46331] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
Importance The application of precision medicine principles for the treatment of depressive disorders in adolescents requires an examination of the variables associated with depression outcomes in randomized clinical trials (RCTs). Objective To describe predictors, moderators, and mediators associated with outcomes in RCTs for the treatment of depressive disorders in adolescents. Evidence Review A scoping review of RCTs for the treatment of depression in adolescents was conducted. Databases searched included MEDLINE, Embase, APA PsycInfo, and CINAHL. Included publications tested predictors, moderators, and/or mediators associated with depression symptom outcomes (eg, symptom reduction, response, remission) in RCTs pertaining to the treatment of adolescents, ages 13 to 17 years. Predictors were defined as variables that were associated with depression outcomes, independent of treatment group. Moderators were defined as baseline variables that were associated with differential outcomes between treatment groups. Mediators were defined by a formal mediation analysis. In duplicate, variables were extracted and coded with respect to analysis type (univariable or multivariable), statistical significance, direction of effect size, reporting of a priori hypotheses, and adjustment for multiple comparisons. Aggregated results were summarized by variable domain and RCT sample. Findings Eighty-one articles reporting on variables associated with outcomes across 33 RCTs were identified, including studies of biological (10 RCTs), psychosocial (18 RCTs), and combined (4 RCTs) treatments as well as a service delivery model (1 RCT). Fifty-three variable domains were tested as baseline predictors of depression outcome, 41 as moderators, 19 as postbaseline predictors, and 5 as mediators. Variable domains that were reported as significant in at least 3 RCTs included age, sex/gender, baseline depression severity, early response to treatment, sleep changes, parent-child conflict, overall psychopathology, suicidal ideation, hopelessness, functional impairment, attendance at therapy sessions, and history of trauma. Two publications reported a priori hypotheses and adjustment for multiple comparisons, both finding that baseline depression severity and family conflict were associated with poorer outcomes. Conclusions and Relevance This review identified commonly researched variables requiring more scrutiny as well as underresearched variables to inform future study designs. Further efforts to discover predictors, moderators, and mediators associated with treatment response have great potential to optimize care for adolescents with depression.
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Affiliation(s)
- Darren B. Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya Watson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Terri Rodak
- Centre for Addiction and Mental Health Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kirsten Neprily
- School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Tabitha Zentner
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Thomas N, McDonald C, de Boer K, Brand RM, Nedeljkovic M, Seabrook L. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychol Psychother 2021; 94:854-883. [PMID: 33620133 PMCID: PMC8451850 DOI: 10.1111/papt.12332] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.
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Affiliation(s)
- Neil Thomas
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Caity McDonald
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Kathleen de Boer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Rachel M. Brand
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQldAustralia
| | - Maja Nedeljkovic
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Seabrook
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
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Leaf JB, Leaf R, McEachin J, Bondy A, Cihon JH, Detrich R, Eshleman J, Ferguson JL, Foxx RM, Freeman BJ, Gerhardt P, Glenn SS, Miller M, Milne CM, Mountjoy T, Parker T, Pritchard J, Ross RK, Saunders MS, Streff T. The Importance of Professional Discourse for the Continual Advancement of Practice Standards: The RBT® as a Case in Point. J Autism Dev Disord 2021; 51:1789-1801. [PMID: 32761432 PMCID: PMC8084792 DOI: 10.1007/s10803-020-04631-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Behavior Analyst Certification Board (BACB®) created a third level of certification, the Registered Behavior Technician™ (RBT®) in 2014. The RBT® was created based upon the requests of stakeholders who wanted to credential those individuals who make direct contact with clients under the supervision of a Board Certified Behavior Analyst®. There has been tremendous growth in the number of RBTs® with over 60,000 individuals certified to date. The BACB® recently sent out a newsletter outlining changes to the RBT® certification, including the processes of training, supervising, and becoming an RBT®. These changes represent a number of potential concerns. The purpose of this paper is to highlight these concerns and to propose solutions to improve the RBT® certification.
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Affiliation(s)
- Justin B. Leaf
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Ronald Leaf
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | - John McEachin
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Andy Bondy
- Pyramid Educational Consultants, Inc, New Castle, DE USA
| | - Joseph H. Cihon
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | - John Eshleman
- The Chicago School of Professional Psychology, Chicago, IL USA
| | - Julia L. Ferguson
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | | | | | | | | | - Christine M. Milne
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | - Tracee Parker
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | | | | | - Todd Streff
- Streff Behavior Consulting, Foristell, MO USA
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5
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Campos-Outcalt D. A review of the latest USPSTF recommendations. J Fam Pract 2021; 70:189-204. [PMID: 34339362 DOI: 10.12788/jfp.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Task Force has expanded the age range for screening for hepatitis C virus infection in adolescents and adults, and now endorses behavioral counseling for all adults with any CVD risk factors.
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6
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Tauben DJ, Langford DJ, Sturgeon JA, Rundell SD, Towle C, Bockman C, Nicholas M. Optimizing telehealth pain care after COVID-19. Pain 2020; 161:2437-2445. [PMID: 32826752 PMCID: PMC7566302 DOI: 10.1097/j.pain.0000000000002048] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Affiliation(s)
- David J. Tauben
- Departments of Anesthesiology & Pain Medicine
- Medicine, University of Washington, Seattle, WA, United States
| | | | | | - Sean D. Rundell
- Departments of Rehabilitation Medicine
- Health Services, University of Washington, Seattle, WA, United States
| | - Cara Towle
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Christina Bockman
- Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, WA, United States
| | - Michael Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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7
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Bench VR, Beach M, Ren D. Evaluation of an Adapted Collaborative Care Model for Older Adult Depression Severity Reduction and Quality of Life Improvement. J Evid Based Soc Work (2019) 2020; 17:527-537. [PMID: 32573365 DOI: 10.1080/26408066.2020.1768193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The purpose of this clinical study was to evaluate the efficacy of a collaborative care model in the reduction of depression severity and the improvement of quality of life (QOL) of older adults. METHODS Individual participant encounters were conducted approximately every 2 weeks over 4 months with nineteen participants. Average participant age was 73 years. A pre-experimental single pretest-posttest group was conducted in which the Patient Health Questionnaire 9 (PHQ-9) and Quality of Life Assessment (QOLA) scores respectively measured depression severity and QOL of participants. RESULTS The average PHQ-9 score (0-27; higher indicates worse depression) decreased from 14 pre-intervention to 8.3 post-intervention (p < .001), while the average QOLA score (0-10; higher indicates better QOL) increased from 5.7 pre-intervention to 6.5 post-intervention (p = .342). CONCLUSION The adapted collaborative care model provided an affordable, effective method of older adult depression management within the contexts of this clinical study.
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Affiliation(s)
- Victor Ross Bench
- Department of Acute & Tertiary Care, University of Pittsburgh, School of Nursing , Pittsburgh, PA, USA
| | - Michael Beach
- Department of Acute & Tertiary Care, University of Pittsburgh, School of Nursing , Pittsburgh, PA, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh, School of Nursing , Pittsburgh, PA, USA
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8
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Ebberwein CA, Hopper MT, Vedala R, Macaluso MM. When worry is excessive: Easing the burden of GAD. J Fam Pract 2020; 69:357-361. [PMID: 32936846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A stepped approach to management using these communication tips and coping strategies can help decrease the stigma of generalized anxiety disorder and increase patients' sense of ownership in their care.
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Affiliation(s)
- Christopher A Ebberwein
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, USA.
| | - Melissa T Hopper
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, USA
| | - Raghuveer Vedala
- Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Matthew M Macaluso
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, USA
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9
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Beck AK, Baker AL, Carter G, Wratten C, Bauer J, Wolfenden L, McCarter K, Britton B. Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention. Nutrients 2020; 12:E2332. [PMID: 32759848 PMCID: PMC7469004 DOI: 10.3390/nu12082332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). PURPOSE To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of "EAT: Eating As Treatment", a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. RESULTS Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. CONCLUSIONS Although what level of fidelity is "good enough" remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects.
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Affiliation(s)
- Alison Kate Beck
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Chris Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Judith Bauer
- Centre for Dietetics Research, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kristen McCarter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ben Britton
- Hunter New England Health, New Lambton 2305, Australia
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Hawkes RE, Cameron E, Bower P, French DP. Does the design of the NHS Diabetes Prevention Programme intervention have fidelity to the programme specification? A document analysis. Diabet Med 2020; 37:1357-1366. [PMID: 31808578 PMCID: PMC7496858 DOI: 10.1111/dme.14201] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/16/2022]
Abstract
AIMS To assess fidelity of the Healthier You: NHS Diabetes Prevention Programme (NHS-DPP), a behavioural intervention for people in England at high risk of developing type 2 diabetes, to the specified programme features. METHODS Document analysis of the NHS-DPP programme specification, including National Institute for Health and Care Excellence (NICE) PH38 diabetes prevention guidance. This was compared with the intervention design (framework response documents and programme manuals) from all four independent providers delivering the NHS-DPP. Documents were coded using the Template for Intervention Description and Replication framework (describing service parameters) and the Behaviour Change Technique Taxonomy v1. RESULTS Providers demonstrated good fidelity to service parameters of the NHS-DPP. The NHS-DPP specification indicated 19 unique behaviour change techniques. Framework responses for the four providers contained between 24 and 32 distinct behaviour change techniques, and programme manuals contained between 23 and 45 distinct behaviour change techniques, indicating variation in behaviour change content between providers' intervention documents. Thus, each provider planned to deliver 74% of the unique behaviour change techniques specified, and a large amount of behaviour change content not mandated. CONCLUSIONS There is good fidelity to the specified service parameters of the NHS-DPP; however, the four providers planned to deliver approximately three-quarters of behaviour change techniques specified by the NHS-DPP. Given that behaviour change techniques are the 'active ingredients' of interventions, and some of these techniques in the programme manuals may be missed in practice, this highlights possible limitations with fidelity to the NHS-DPP programme specification at the intervention design stage.
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Affiliation(s)
- R. E. Hawkes
- Division of Psychology and Mental HealthManchester Centre of Health PsychologyManchesterUK
| | - E. Cameron
- Division of Psychology and Mental HealthManchester Centre of Health PsychologyManchesterUK
- Division of PsychologyUniversity of StirlingStirlingUK
| | - P. Bower
- Division of Population HealthHealth Services Research & Primary CareUniversity of ManchesterManchesterUK
| | - D. P. French
- Division of Psychology and Mental HealthManchester Centre of Health PsychologyManchesterUK
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11
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Kurtkoti R. Chronic Oedema: Paradigm shift in lipoedema. Br J Community Nurs 2020; 25:S5. [PMID: 32271102 DOI: 10.12968/bjcn.2020.25.sup4.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Brieler JA, Matsunaga A, Gafford J. Working adeptly to diagnose and treat adult ADHD. J Fam Pract 2020; 69:145-149. [PMID: 32289128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rely on DSM-5 criteria and an appropriate rating scale to assess how an individual's inattention, hyperactivity, and impulsivity interfere with functioning in different settings.
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Affiliation(s)
- Jay A Brieler
- Department of Family and Community Medicine, Saint Louis University School of Medicine, MO, USA.
| | - Alison Matsunaga
- Department of Family and Community Medicine, Saint Louis University School of Medicine, MO, USA
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13
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Man J, Kangas M. Best Practice Principles When Working With Individuals With Intellectual Disability and Comorbid Mental Health Concerns. Qual Health Res 2020; 30:560-571. [PMID: 31328633 DOI: 10.1177/1049732319858326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Working with individuals with dual disabilities can be a complex process in the presence of limited evidence base to guide clinical practice. The aims of this qualitative study were to investigate perceptions of best practices of Australian psychologists who work with this specialist population. Thirty-eight Australian psychologists working in the intellectual disability field participated in eight semistructured focus groups. Perceptions of evidence-based practice for individuals with intellectual disabilities and in relation to mental health assessment were explored. Psychologists demonstrated resourcefulness in adapting to limits in available evidence-based practice and in modifying mainstream practice to suit the needs of individuals with dual disabilities. Findings suggest the necessity of practice-based evidence in contributing to the evidence base, and person-centered approaches in relation to best practice for people with intellectual disabilities. Implications for strengthening psychologists' clinical competency and bridging the research and practice gap are discussed.
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Affiliation(s)
- Joyce Man
- Centre for Emotiona Health, Macquarie University, Sydney, New South Wales, Australia
- University of Cambridge, Cambridge, United Kingdom
| | - Maria Kangas
- Centre for Emotiona Health, Macquarie University, Sydney, New South Wales, Australia
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Ali F, Seri S, Cavanna AE. Levels of diagnostic certainty for nonepileptic attack disorder in the neuropsychiatry setting. Epilepsy Behav 2020; 103:106875. [PMID: 31937509 DOI: 10.1016/j.yebeh.2019.106875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/22/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022]
Abstract
Nonepileptic attack disorder (NEAD) is a medical condition commonly seen in neuropsychiatry services, often as a differential diagnosis of other neuropsychiatric conditions. Recommendations by the International League Against Epilepsy (ILAE) Nonepileptic Seizures Task Force propose a four-level hierarchical approach to the diagnosis of NEAD, based on history, witnessed event, and electroencephalographic (EEG) investigation. We set out to provide the first description of the diagnostic levels of patients with NEAD at a specialist neuropsychiatry clinic. Comprehensive clinical data from 148 consecutive patients with NEAD attending the specialist Neuropsychiatry Clinic run by a single Consultant in Behavioral Neurology were retrospectively reviewed. Patients with NEAD were primarily referred to neuropsychiatry by Consultant Neurologists (n = 94; 63.5%). The majority of patients were female (n = 108; 73.0%), with a disease duration of 7.9 years (standard deviation: 10.4). Anxiety was the most common comorbidity (n = 43; 26.7%). Categorization of patients according to the ILAE Nonepileptic Seizures Task Force criteria was mainly based on clinical features and EEG findings, as only 7 (4.7%) patients had attacks witnessed by a specialist. The largest diagnostic categories were 'possible' (n = 54; 36.5%) and 'clinically established' (n = 40; 27.0%), followed by 'documented' (n = 12; 8.1%) and 'probable' (n = 5; 3.4%). In 125 patients (84.4%), EEGs were performed. Selective serotonin reuptake inhibitors were the most frequently prescribed psychotropic medications (n = 48; 32.4%); 89 patients (60.1%) received behavioral therapy. There were no differences in pharmacological or behavioral management strategies across the patients categorized under different diagnostic levels. Patients with NEAD seen within neuropsychiatry settings are mainly assigned 'possible' and 'clinically established' levels of diagnostic certainty. Difficulty in capturing typical clinical events witnessed by an experienced clinician while on video-EEG can limit the clinical application of the 'documented' diagnostic level. If appropriate, active interventions can be implemented irrespective of diagnostic levels to minimize delays in the neuropsychiatric care pathways.
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Affiliation(s)
- Fizzah Ali
- Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK
| | - Stefano Seri
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK; School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK.
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Singla DR, Hollon SD, Velleman R, Weobong B, Nadkarni A, Fairburn CG, Bhat B, Gurav M, Anand A, McCambridge J, Dimidjian S, Patel V. Temporal pathways of change in two randomized controlled trials for depression and harmful drinking in Goa, India. Psychol Med 2020; 50:68-76. [PMID: 30616698 PMCID: PMC6945322 DOI: 10.1017/s0033291718003963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/24/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study explored the temporal pathways of change within two treatments, the Healthy Activity Program (HAP) for depression and the Counselling for Alcohol Problems (CAP) Program for harmful drinking. METHODS The study took place in the context of two parallel randomized controlled trials in Goa, India. N = 50 random participants who met a priori criteria were selected from each treatment trial and examined for potential direct and mediational pathways. In HAP, we examined the predictive roles of therapy quality and patient-reported activation, assessing whether activation mediated the effects of therapy quality on depression (Patient Health Questionnaire-9) outcomes. In CAP, we examined the predictive roles of therapy quality and patient change- and counter-change-talk, assessing whether change- or counter-change-talk mediated the effects of therapy quality on daily alcohol consumption. RESULTS In HAP, therapy quality (both general and treatment-specific skills) was associated with patient activation; patient activation but not therapy quality significantly predicted depression outcomes, and patient activation mediated the effects of higher general skills on subsequent clinical outcomes [a × b = -2.555, 95% confidence interval (CI) -5.811 to -0.142]. In CAP, higher treatment-specific skills, but not general skills, were directly associated with drinking outcomes, and reduced levels of counter-change talk both independently predicted, and mediated the effects of higher general skills on, reduced alcohol consumption (a × b = -24.515, 95% CI -41.190 to -11.060). Change talk did not predict alcohol consumption and was not correlated with counter-change talk. CONCLUSION These findings suggest that therapy quality in early sessions operated through increased patient activation and reduced counter-change talk to reduce depression and harmful drinking respectively.
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Affiliation(s)
- Daisy R. Singla
- Department of Psychiatry, University of Toronto and Sinai Health System, Toronto, Canada
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Richard Velleman
- Department of Psychology, University of Bath, Bath, UK
- Sangath, Alto Porvorim, Goa, India
| | - Benedict Weobong
- Sangath, Alto Porvorim, Goa, India
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social & Behavioral Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Abhijit Nadkarni
- Sangath, Alto Porvorim, Goa, India
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vikram Patel
- Sangath, Alto Porvorim, Goa, India
- Department of Global Health & Social Medicine, Harvard Medical School, Cambridge, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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American Diabetes Association. 5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43:S48-65. [PMID: 31862748 DOI: 10.2337/dc20-S005] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Smart MH, Monteiro AL, Saffore CD, Ruseva A, Lee TA, Fischer MA, Pickard AS. Development of an Instrument to Assess the Perceived Effectiveness of Academic Detailing. J Contin Educ Health Prof 2020; 40:235-241. [PMID: 33284174 PMCID: PMC8051138 DOI: 10.1097/ceh.0000000000000305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Academic detailing (AD) is an effective, evidence-based education outreach method of promoting clinician behavior change. Detailer feedback is important for program evaluation but is rarely systematically collected. The study's objective was to develop a measure capturing the detailer's perception of the effectiveness of an AD program. METHODS A six-item measure with a five-level scale was initially developed from the literature review and expert panel consultation. Item constructs were usefulness, acceptability, feasibility, relevance, effectiveness of communication, and readiness to change. The measure was piloted, refined, and tested during an opioid-focused AD program that included two visits. The instrument structure was evaluated using exploratory factor analysis, measure reliability was assessed using item-item correlation (rho), corrected item-total correlation, Cronbach alpha (α), and item response theory. RESULTS The initial six-item instrument demonstrated unidimensionality. The Cronbach α for the measure was 0.74 (visit 1) and 0.79 (visit 2); one item (relevance) was redundant (α = 0.73 and 0.79 when deleted) and therefore dropped. Items related to usefulness, acceptability, and readiness to change displayed high item-item correlation (rho ≥ 0.50) and contributed the most information and seemed to operate as a single scale (ie, "likelihood to change") based on item response theory analysis. Items related to feasibility and communication were slightly different constructs and should be reported separately. DISCUSSION The five-item detailer assessment of visit effectiveness (the "DAVE") instrument provides a standardized approach to assess AD. Further study of its validity and broader use in other programs and educational outreach activities is encouraged.
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Affiliation(s)
- Mary H Smart
- Dr. Smart, Ms. Monteiro, Dr. Saffore, Ms. Ruseva, Dr. Lee, Dr. Pickard: Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL; and Dr. Fischer: Division of Pharmacoepidemiology and Pharmacoeconomics, National Resource Center for Academic Detailing, Brigham and Women's Hospital, Boston, MA
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Abstract
INTRODUCTION Advances in experimental psychology has highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. While prior research has documented the effectiveness of cognitive bias modification, such interventions tend to be highly repetitive and individuals lack motivation to train over time. Participatory action research methods have been more widely applied in psychiatry to help design interventions that are of relevant to key stakeholders and end users. This study aimed to involve both healthcare professionals and patients in the joint codesign of a gamified mobile attention bias modification intervention. METHODS AND ANALYSIS The participatory design research method adopted is that of a use-oriented design approach, in the form of a future workshop. 20 participants, comprising 10 healthcare professionals, 5 inpatients and 5 outpatients will be recruited to participate in three separate codesign workshops. In the first phase of the workshop, the participants share their critique of an attention bias modification intervention. In the second phase of the workshop, participants are asked to brainstorm features. The participants are also shown gamification approaches and are asked to consider if gaming elements could enhance the existing application. In the last phase, the participants are asked to sketch a new prototype. ETHICS AND DISSEMINATION Ethical approval has been obtained from the National Healthcare Group's Domain Specific Research Board (approval number 2018/01363). The findings arising from this study will be disseminated by means of conferences and publications.
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Affiliation(s)
- Melvyn Wb Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Sandor Heng
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Wadden TA, Tsai AG, Tronieri JS. A Protocol to Deliver Intensive Behavioral Therapy (IBT) for Obesity in Primary Care Settings: The MODEL-IBT Program. Obesity (Silver Spring) 2019; 27:1562-1566. [PMID: 31544345 PMCID: PMC6786257 DOI: 10.1002/oby.22594] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The Centers for Medicare and Medicaid Services (CMS) initiated coverage of intensive behavioral therapy (IBT) for obesity in 2011, providing beneficiaries 14 to 15 brief, individual counseling visits in 6 months. CMS offered general recommendations for delivering IBT but did not provide an evidence-based treatment protocol, which was the objective of the present research. METHODS This review describes the evidence that CMS considered in developing its IBT benefit. It also examines weight losses produced by the intensive lifestyle intervention in the Diabetes Prevention Program (DPP), as well an adapted version of the DPP delivered (for the first 6 months) on the visit schedule recommended by CMS. This new protocol, which was evaluated in a recent randomized trial, provided 14 visits in the first 24 weeks, with 7 additional monthly visits through week 52. RESULTS As reported previously, the 50 participants with obesity assigned to the new IBT protocol lost a mean of 5.4% of their initial weight at week 24; 46% of participants lost ≥ 5% of their baseline weight. At 1 year, the mean loss was 6.1%, and 44% of participants lost ≥ 5%. CONCLUSIONS With these generally favorable results, the IBT protocol is being posted online for practitioners and researchers to use.
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Affiliation(s)
- Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Adam G. Tsai
- Kaiser Permanente Colorado; University of Colorado School of Medicine, Department of Medicine
| | - Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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Griffiths AJ, Diamond EL, Alsip J, Furlong M, Morrison G, Do B. School-wide implementation of positive behavioral interventions and supports in an alternative school setting: A case study. J Community Psychol 2019; 47:1493-1513. [PMID: 31212369 DOI: 10.1002/jcop.22203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/21/2019] [Accepted: 04/27/2019] [Indexed: 06/09/2023]
Abstract
AIMS The purpose of this 1-year case study was to identify how School-Wide Positive Behavioral Interventions and Supports (SW-PBIS) can be adapted to meet the needs of students in alternative schools and to evaluate the early impact of SW-PBIS on discipline outcomes. METHODS Suggestions for adaptations are provided at each stage of the intervention process with a focus on buy-in, training, data collection, and resource allocation. RESULTS Data from this case study included information about key components of the implementation process as well as initial outcomes. Process data revealed the importance of stakeholder buy-in, training opportunities, and potential adaptations to the framework. Outcome data from the first year of implementation indicated that the number of incident reports did not significantly differ from the baseline; however, there was a reduction in defiance-related behaviors and an increase in on-task behaviors. CONCLUSION This study contributes to the determination of the efficacy of SW-PBIS in a historically more punitive environment. Given the initial positive response and lessons learned, it is believed that, with the support of additional Tier 2 and Tier 3 interventions, SW-PBIS may be an appropriate framework to support students in alternative schools.
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Affiliation(s)
- Amy-Jane Griffiths
- Attallah College of Educational Studies, Chapman University, Orange, California
| | - Elena Lilles Diamond
- Department of Counseling and School Psychology, Lewis and Clark College College of Arts and Sciences, Portland, Oregon
| | - James Alsip
- Attallah College of Educational Studies, Chapman University, Orange, California
| | - Michael Furlong
- Department of Counseling, Clinical, and School Psychology, International Center for School-Based Youth Development, University of California Santa Barbara, Santa Barbara, California
| | - Gale Morrison
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
| | - Bich Do
- Attallah College of Educational Studies, Chapman University, Orange, California
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21
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Labaki WW, Kimmig LM, Mutlu GM, Han MK, Bhatt SP. Update in Chronic Obstructive Pulmonary Disease 2018. Am J Respir Crit Care Med 2019; 199:1462-1470. [PMID: 30958976 PMCID: PMC6835078 DOI: 10.1164/rccm.201902-0374up] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lucas M. Kimmig
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois; and
| | - Gökhan M. Mutlu
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois; and
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Mabry-Hernandez I, Scoulios N. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults. Am Fam Physician 2019; 99:771-772. [PMID: 31194494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Iris Mabry-Hernandez
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
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Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Recommendations Statement. Am Fam Physician 2019; 99:Online. [PMID: 31194493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Kliemann N, Croker H, Johnson F, Beeken RJ. Development of the Top Tips Habit-Based Weight Loss App and Preliminary Indications of Its Usage, Effectiveness, and Acceptability: Mixed-Methods Pilot Study. JMIR Mhealth Uhealth 2019; 7:e12326. [PMID: 31094352 PMCID: PMC6533874 DOI: 10.2196/12326] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/29/2019] [Accepted: 02/10/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Ten Top Tips (10TT) is an intervention based on the habit formation theory that promotes a set of weight management behaviors alongside advice about repetition in a consistent context. Overall, 3 studies have demonstrated that the 10TT can support individuals to lose weight when delivered in a leaflet format. Delivery of 10TT via new technology such as a mobile app could potentially improve its effectiveness and make it more convenient, appealing, and wide reaching. OBJECTIVE This study aimed to provide preliminary indications of the usage, effectiveness, and acceptability of an Android app of the 10TT intervention (Top Tips only app) and a second version including self-regulatory strategies for dealing with tempting foods (Top Tips plus app). METHODS The 3-month pilot randomized adults with overweight or obesity to (1) Top Tips only app, (2) Top Tips plus app, or (3) waiting list condition. Automated data from app users were collected. Validated questionnaires assessed self-regulatory skills, weight loss (kg), and behaviors at baseline and 3 months. Users' feedback on their experience using the app was assessed using open questions. RESULTS A total of 81 participants took part in the pilot; 28 participants were randomized to the Top Tips only app, 27 to the Top Tips plus app, and 26 to the waiting list condition. On average, participants viewed a mean of 43.4 (SD 66.9) screens during a mean of 24.5 (SD 44.07) log-ins and used the app for 124.2 (SD 240.2) min over the 3-month period. Participants randomized to the Top Tips only app reported the greatest improvement in self-regulatory skills (mean 0.59, SD 1.0), weight loss (mean 4.5 kg, SD 5.2), and adherence to the target behaviors (mean 0.59, SD 0.49) compared with the Top Tips plus (meanself-regulation 0.15, SD 0.42; meanweight -1.9, SD 3.9; and meanbehaviors 0.29, SD 0.29) and waiting list condition (meanself-regulation -0.02, SD 0.29; meanweight -0.01, SD 0.51; and meanbehaviors 0.08, SD 0.38). Participants who reported the largest improvements, on average, viewed pages 2 to 3 times more, had 2 to 3 times more log-ins, logged their weight 2 to 3 times more, and achieved the tips more than those who reported smaller changes in these outcomes. According to users' feedback, engagement with the app could be increased by making the app more interactive and allowing more tailoring. CONCLUSIONS This study suggests that the Top Tips app could potentially be a useful intervention for promoting eating self-regulatory skills, weight loss, and weight management behaviors among adults with overweight or obesity. Future research should develop the app further based on user feedback and test it in larger sample sizes. TRIAL REGISTRATION ISRCTN Registry ISRCTN10470937; http://www.isrctn.com/ISRCTN10470937 (Archived by Webcite at http://www.webcitation.org/76j6rQibI).
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Affiliation(s)
- Nathalie Kliemann
- Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Fiona Johnson
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Thomas JG, Bond DS, Raynor HA, Papandonatos GD, Wing RR. Comparison of Smartphone-Based Behavioral Obesity Treatment With Gold Standard Group Treatment and Control: A Randomized Trial. Obesity (Silver Spring) 2019; 27:572-580. [PMID: 30779333 PMCID: PMC6430643 DOI: 10.1002/oby.22410] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/20/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to determine whether weight losses from a primarily smartphone-based behavioral obesity treatment (SMART) differed from those of a more intensive group-based behavioral obesity treatment (GROUP) and a control condition (CONTROL). METHODS A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP-based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self-monitoring via paper diaries with written feedback; SMART-based treatment with online lessons, self-monitoring, and feedback plus monthly weigh-ins; or a CONTROL condition with self-monitoring via paper diaries with written feedback and monthly weigh-ins. RESULTS Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m2 ), 18-month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5-7.4) in GROUP, 5.5 kg (95% CI: 3.9-7.1) in SMART, and 6.4 kg (95% CI: 3.7-9.2) in CONTROL. CONCLUSIONS Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group-based approach.
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Affiliation(s)
- J. Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Dale S. Bond
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Hollie A. Raynor
- University of Tennessee, Department of Nutrition, Knoxville, TN, USA
| | | | - Rena R. Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
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Lemmon R, Hampton A. Nonpharmacologic treatment of chronic pain: What works? J Fam Pract 2018; 67:474-483. [PMID: 30110500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Which therapies should you recommend for chronic low back pain, osteoarthritis, or fibromyalgia? This review-with 3 handy tables-summarizes the evidence.
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Affiliation(s)
- Russell Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, USA.
| | - Adrienne Hampton
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, USA
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Montgomery P, Grant S, Mayo-Wilson E, Macdonald G, Michie S, Hopewell S, Moher D. Reporting randomised trials of social and psychological interventions: the CONSORT-SPI 2018 Extension. Trials 2018; 19:407. [PMID: 30060754 PMCID: PMC6066921 DOI: 10.1186/s13063-018-2733-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are used to evaluate social and psychological interventions and inform policy decisions about them. Accurate, complete, and transparent reports of social and psychological intervention RCTs are essential for understanding their design, conduct, results, and the implications of the findings. However, the reporting of RCTs of social and psychological interventions remains suboptimal. The CONSORT Statement has improved the reporting of RCTs in biomedicine. A similar high-quality guideline is needed for the behavioural and social sciences. Our objective was to develop an official extension of the Consolidated Standards of Reporting Trials 2010 Statement (CONSORT 2010) for reporting RCTs of social and psychological interventions: CONSORT-SPI 2018. METHODS We followed best practices in developing the reporting guideline extension. First, we conducted a systematic review of existing reporting guidelines. We then conducted an online Delphi process including 384 international participants. In March 2014, we held a 3-day consensus meeting of 31 experts to determine the content of a checklist specifically targeting social and psychological intervention RCTs. Experts discussed previous research and methodological issues of particular relevance to social and psychological intervention RCTs. They then voted on proposed modifications or extensions of items from CONSORT 2010. RESULTS The CONSORT-SPI 2018 checklist extends 9 of the 25 items from CONSORT 2010: background and objectives, trial design, participants, interventions, statistical methods, participant flow, baseline data, outcomes and estimation, and funding. In addition, participants added a new item related to stakeholder involvement, and they modified aspects of the flow diagram related to participant recruitment and retention. CONCLUSIONS Authors should use CONSORT-SPI 2018 to improve reporting of their social and psychological intervention RCTs. Journals should revise editorial policies and procedures to require use of reporting guidelines by authors and peer reviewers to produce manuscripts that allow readers to appraise study quality, evaluate the applicability of findings to their contexts, and replicate effective interventions.
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Affiliation(s)
- Paul Montgomery
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Sean Grant
- Behavioral & Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, 90407-2138 CA USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, 615 North Wolfe Street, E6036, Baltimore, 21205 MD USA
| | | | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, London, WC1E 7HB UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa, K1H 8L6 ON Canada
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Grant S, Mayo-Wilson E, Montgomery P, Macdonald G, Michie S, Hopewell S, Moher D. CONSORT-SPI 2018 Explanation and Elaboration: guidance for reporting social and psychological intervention trials. Trials 2018; 19:406. [PMID: 30060763 PMCID: PMC6066913 DOI: 10.1186/s13063-018-2735-z] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The CONSORT (Consolidated Standards of Reporting Trials) Statement was developed to help biomedical researchers report randomised controlled trials (RCTs) transparently. We have developed an extension to the CONSORT 2010 Statement for social and psychological interventions (CONSORT-SPI 2018) to help behavioural and social scientists report these studies transparently. METHODS Following a systematic review of existing reporting guidelines, we conducted an online Delphi process to prioritise the list of potential items for the CONSORT-SPI 2018 checklist identified from the systematic review. Of 384 international participants, 321 (84%) participated in both rating rounds. We then held a consensus meeting of 31 scientists, journal editors, and research funders (March 2014) to finalise the content of the CONSORT-SPI 2018 checklist and flow diagram. RESULTS CONSORT-SPI 2018 extends 9 items (14 including sub-items) from the CONSORT 2010 checklist, adds a new item (with 3 sub-items) related to stakeholder involvement in trials, and modifies the CONSORT 2010 flow diagram. This Explanation and Elaboration (E&E) document is a user manual to enhance understanding of CONSORT-SPI 2018. It discusses the meaning and rationale for each checklist item and provides examples of complete and transparent reporting. CONCLUSIONS The CONSORT-SPI 2018 Extension, this E&E document, and the CONSORT website ( www.consort-statement.org ) are helpful resources for improving the reporting of social and psychological intervention RCTs.
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Affiliation(s)
- Sean Grant
- Behavioral & Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138 USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E6036, Baltimore, MD 21205 USA
| | - Paul Montgomery
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | | | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
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Capezuti E, Sagha Zadeh R, Woody N, Basara A, Krieger AC. An Integrative Review of Nonpharmacological Interventions to Improve Sleep among Adults with Advanced Serious Illness. J Palliat Med 2018; 21:700-717. [PMID: 29337603 PMCID: PMC6909694 DOI: 10.1089/jpm.2017.0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings. OBJECTIVE We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness. METHODS We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016. RESULTS From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind-body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak. CONCLUSIONS Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.
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Affiliation(s)
- Elizabeth Capezuti
- School of Nursing, Hunter College and The Graduate Center, City University of New York, New York, New York
| | - Rana Sagha Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, New York
| | - Nicole Woody
- Healthcare Strategy and Operations Consultant, New York, New York
| | - Aleksa Basara
- Department of Economics, Health Design Innovations Laboratory, Department of Design and Environmental Analysis, Cornell University, Ithaca, New York
| | - Ana C. Krieger
- Departments of Medicine, Neurology, and Genetic Medicine, Center for Sleep Medicine, Weill Cornell Medical Center, New York, New York
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Behavior Guidance for the Pediatric Dental Patient. Pediatr Dent 2017; 39:246-59. [PMID: 29179365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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31
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Chung E, Katz DJ, Love C. Adult male stress and urge urinary incontinence - A review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Physician 2017; 46:661-666. [PMID: 28892597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Male urinary incontinence adversely affects health-related quality of life and is associated with significant psychosexual and financial burden. The two most common forms of male incontinence are stress urinary incontinence (SUI) and overactive bladder (OAB) with concomitant urge urinary incontinence (UUI). OBJECTIVE The objectives of this article are to briefly review the current understandings of the pathophysiological mechanisms in SUI and OAB/UUI, and offer a set of practical, action-based recommendations and treatment strategies. DISCUSSION The initial evaluation of male urinary incontinence usually occurs in general practice, and the basic work-up aims to identify reversible causes. First-line treatment is conservative management, such as lifestyle interventions, pelvic floor muscle training with or without biofeedback, and bladder retraining. Treatment options include male slings and artificial urinary sphincter surgery for men with persistent SUI, and medical therapy, intravesical botulinum toxin, sacral neuromodulation or surgery in refractory cases for those with predominant OAB/UUI.
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Affiliation(s)
- Eric Chung
- MBBS, is a urological surgeon, Princess Alexandra Hospital and St Andrew's Hospital, Brisbane, Queensland
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APPROVED: Revisions to Behavioral Health Care Outcome Measures Standard. Jt Comm Perspect 2017; 37:10-1. [PMID: 30168925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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33
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Anderson ML, Wolf Craig KS, Ziedonis DM. Barriers and Facilitators to Deaf Trauma Survivors' Help-Seeking Behavior: Lessons for Behavioral Clinical Trials Research. J Deaf Stud Deaf Educ 2017; 22:118-130. [PMID: 27881479 PMCID: PMC6083920 DOI: 10.1093/deafed/enw066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/30/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
Deaf individuals experience significant obstacles to participating in behavioral health research when careful consideration is not given to accessibility during the design of study methodology. To inform such considerations, we conducted an exploratory secondary analysis of a mixed-methods study that originally explored 16 Deaf trauma survivors' help-seeking experiences. Our objective was to identify key findings and qualitative themes from consumers' own words that could be applied to the design of behavioral clinical trials methodology. In many ways, the themes that emerged were not wholly dissimilar from the general preferences of members of other sociolinguistic minority groups-a need for communication access, empathy, respect, strict confidentiality procedures, trust, and transparency of the research process. Yet, how these themes are applied to the inclusion of Deaf research participants is distinct from any other sociolinguistic minority population, given Deaf people's unique sensory and linguistic characteristics. We summarize our findings in a preliminary "Checklist for Designing Deaf Behavioral Clinical Trials" to operationalize the steps researchers can take to apply Deaf-friendly approaches in their empirical work.
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Affiliation(s)
| | - Kelly S. Wolf Craig
- University of Massachusetts Medical School
- Connecticut Department of Developmental Services
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APPROVED: Phase I Revisions to Update Behavioral Health Care Requirements. Jt Comm Perspect 2017; 37:8-9. [PMID: 30168924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
OBJECTIVE This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained. DATA SOURCES EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies. REVIEW METHODS Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data. RESULTS Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3-6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (-0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were. CONCLUSIONS A small but significant effect was found for current interventions and benefits can be sustained. Interventions that include behaviour change techniques appear more effective at improving real-world walking habits than exercise alone.
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Affiliation(s)
- Caroline M Stretton
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Suzie Mudge
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Nicola M Kayes
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Kathryn M McPherson
- 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
- 2 Health Research Council of New Zealand, Auckland, New Zealand
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Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: Recommendation Statement. Am Fam Physician 2016; 93:Online. [PMID: 27175725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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37
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Huismans F. [Reaction on '20 years dialectical behavior therapy in the Netherlands: who cares?']. Tijdschr Psychiatr 2016; 58:85-87. [PMID: 26779760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Alcántara C, Klesges LM, Resnicow K, Stone A, Davidson KW. Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine. Am J Prev Med 2015; 49:S184-93. [PMID: 26296553 PMCID: PMC4560448 DOI: 10.1016/j.amepre.2015.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/05/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care-focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)--a multidisciplinary scientific organization committed to improving population health through behavior change--we review the USPSTF mandate and current recommendations for behavioral counseling interventions and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care-focused behavioral counseling interventions. This perspective highlights five areas for further development, including (1) behavioral counseling-focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care-based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice.
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Affiliation(s)
- Carmela Alcántara
- Department of Medicine, Columbia University Medical Center, New York, New York.
| | - Lisa M Klesges
- School of Public Health, University of Memphis, Memphis, Tennessee
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Amy Stone
- Society of Behavioral Medicine, Milwaukee, Wisconsin
| | - Karina W Davidson
- Department of Medicine, Columbia University Medical Center, New York, New York; New York Presbyterian Hospital, New York, New York
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Katekaru M, Minn CE, Pobutsky AM. Weight reduction among people with severe and persistent mental illness after health behavior counseling and monitoring. Hawaii J Med Public Health 2015; 74:146-149. [PMID: 25954602 PMCID: PMC4407458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The high prevalence of obesity and associated chronic conditions in persons with severe and persistent mental illness has contributed to a mortality rate that is nearly two times higher than the overall population. In 2008, the Central O'ahu Community Mental Health Center of the Hawai'i State Department of Health, Adult Mental Health Division began an unfunded, health counseling intervention pilot project to address such concerns for the health of persons with severe and persistent mental illness. This article reviews the results of this intervention. Forty-seven persons with schizophrenia or related disorders were included in the intervention which involved health counseling and monitoring of weight as a risk factor for chronic disease. After five years of counseling and monitoring, medical chart reviews were conducted for each person for data on weight change. Analysis showed weight loss and improvements in body mass index. The results of this project show potential for long-term counseling and monitoring as an intervention for obesity in persons with severe and persistent mental illness.
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Affiliation(s)
| | - Carol E Minn
- University of Hawai'i at Manoa, Honolulu, HI (MK, AP)
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40
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Copeland L, McNamara R, Kelson M, Simpson S. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. Patient Educ Couns 2015; 98:401-11. [PMID: 25535015 DOI: 10.1016/j.pec.2014.11.022] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/08/2014] [Accepted: 11/25/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Motivational interviewing (MI) has been identified as an effective treatment for health behaviors. Understanding the mechanisms of MI could have practical implications for MI delivery. This review is the first to examine mechanisms within MI that affect health behavior outcomes and summarizes and evaluates the evidence. METHODS A systematic literature search was conducted in PSYCHINFO, MEDLINE and EMBASE to identify studies that delivered individual MI in the context of health behaviors, excluding addictions, and investigated mechanisms of MI. Effect sizes were calculated. RESULTS 291 studies were identified and 37 met the inclusion criteria. Few of the 37 studies included, conducted mediation analyses. MI spirit and motivation were the most promising mechanisms of MI. Although self-efficacy was the most researched, it was not identified as a mechanism of MI. Study quality was generally poor. CONCLUSION Although this review has indicated possible mechanisms by which MI could influence health behavior outcomes, it also highlights that more high quality research is needed, looking at other possible mechanisms or causal pathways within health behavior outcomes. PRACTICE IMPLICATIONS MI spirit possibly plays an important role within MI and may potentially be used to evoke change talk which links to outcomes.
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Affiliation(s)
- Lauren Copeland
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK.
| | - Rachel McNamara
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology & Engagement, Cardiff University School of Medicine, Cardiff, UK.
| | - Mark Kelson
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology & Engagement, Cardiff University School of Medicine, Cardiff, UK.
| | - Sharon Simpson
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology & Engagement, Cardiff University School of Medicine, Cardiff, UK.
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van den Bosch LMC, Sinnaeve R. [Dialectical behaviour theory in the Netherlands: implementation and consolidation]. Tijdschr Psychiatr 2015; 57:719-727. [PMID: 26479251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND More and more evidence-based treatments for severe personality disorders are becoming available. Nevertheless, there are problems with the implementation of these treatments and it is proving difficult to keep the treatment programmes running. However, teams which offer dialectical behavior therapy (DBT) seem to survive. AIM To find out which factors enable dbt teams to survive. METHOD Twenty-five Dutch DBT teams received a questionnaire about factors that could be influencing the continuation of the DBT treatment programmes. The questionnaire consisted of 9 open questions, 2 multiple-choice questions and 26 closed questions. RESULTS The results show that the continued existence of the treatment programmes is due largely to the commitment of both the team and its managers. They all feel embedded in the organisation as a whole, feel connected with one another and are supportive of the method. CONCLUSION A well-functioning consultation team seems to be of crucial importance for the continued existence of the DBT programme. We believe that independent external supervision is essential to keep the dbt teams alert and aware of current trends and developments.
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Ingenhoven T. [20 years dialectical behavior therapy in the Netherlands: who cares?]. Tijdschr Psychiatr 2015; 57:728-729. [PMID: 26479252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Shire SY, Kasari C. Train the trainer effectiveness trials of behavioral intervention for individuals with autism: a systematic review. Am J Intellect Dev Disabil 2014; 119:436-451. [PMID: 25148057 DOI: 10.1352/1944-7558-119.5.436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This systematic review examines train the trainer (TTT) effectiveness trials of behavioral interventions for individuals with autism spectrum disorder (ASD). Published methodological quality scales were used to assess studies including participant description, research design, intervention, outcomes, and analysis. Twelve studies including 9 weak quality quasi-experimental studies, 2 single-subject experimental design studies of moderate and weak quality, and 1 high quality randomized control trial were included. Overall, author reported effect sizes and calculation of improvement rate difference for SSRDs indicate positive effects of intervention across participant outcomes including cognition, language, and autism symptoms postcommunity delivered interventions primarily based in applied behavior analysis. Effects varied by children's developmental level.
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Feldman MB, Silapaswan A, Schaefer N, Schermele D. Is there life after DEBI? Examining health behavior maintenance in the diffusion of effective behavioral interventions initiative. Am J Community Psychol 2014; 53:286-313. [PMID: 24499926 DOI: 10.1007/s10464-014-9629-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The evidence-based interventions that are identified, packaged, and disseminated by the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention as part of the Diffusion of Effective Behavioral Interventions (DEBI) initiative-commonly referred to the "DEBIs"-currently represent a primary source of HIV prevention interventions for community-based providers. To date, little attention has focused on whether the intended outcomes of the DEBIs, i.e., reductions in HIV-related risk behaviors, are maintained over time. This review summarized evidence for the sustainability of the effects of the DEBIs on HIV sexual risk behavior and intravenous drug use from studies of original and adapted DEBIs. Evidence of intervention decay or a lack of any intervention effect was identified in several original and adapted versions of the DEBIs included in this review. Recommendations include modifications to current criteria for inclusion in the DEBI portfolio, in addition to the development of remediation strategies to address intervention decay. Further, theoretical models that specify the processes that underlie the maintenance of health behaviors over time should be used in developing HIV prevention interventions.
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McVilly K, Webber L, Paris M, Sharp G. Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour. J Intellect Disabil Res 2013; 57:716-727. [PMID: 22845772 DOI: 10.1111/j.1365-2788.2012.01603.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II (BSP-QEII) was developed to monitor and assess BSPs prepared by teachers to support children with disability in the school system. This study investigated the application of the BSP-QEII to the assessment of BSPs for adults with ID in community support services. METHOD The inter-rater reliability of the BSP-QEII was assessed. The utility of the BPS-QEII was then investigated with reference to a time series study of matched pairs of BSPs, developed for the same clients over a period of approximately 3 years. Differences in plan quality measured across a number of service and systemic variables were also investigated. RESULTS The BSP-QEII was found to have good inter-rater reliability and good utility for audit purposes. It was able to discriminate changes in plan quality over time. Differences in plan quality were also evident across different service types, where specialist staff had or had not been involved, and in some instances where a statutory format for the plan had or had not been used. There were no differences between plans developed by government and community sector agencies, nor were there any regional differences across the jurisdiction. CONCLUSIONS The BSP-QEII could usefully be adopted as an audit tool for measuring the quality of BSPs for adults with ID. In addition to being used for research and administrative auditing, the principles underpinning the BSP-QEII could also be useful to guide policy and educational activities for staff in community based services for adults with ID.
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Affiliation(s)
- K McVilly
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
| | - L Webber
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
| | - M Paris
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
| | - G Sharp
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
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McVilly K, Webber L, Sharp G, Paris M. The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability. J Intellect Disabil Res 2013; 57:703-715. [PMID: 22845742 DOI: 10.1111/j.1365-2788.2012.01602.x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability. METHOD A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics. RESULTS The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme. CONCLUSIONS The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.
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Affiliation(s)
- K McVilly
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
| | - L Webber
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
| | - G Sharp
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
| | - M Paris
- School of Psychology, Deakin University, Melbourne, Victoria, AustraliaOffice of the Senior Practitioner, Department of Human Services, Melbourne, Victoria, Australia
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Magill M, Longabaugh R. Efficacy combined with specified ingredients: a new direction for empirically supported addiction treatment. Addiction 2013; 108:874-81. [PMID: 23072622 PMCID: PMC3566277 DOI: 10.1111/add.12013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 07/16/2012] [Accepted: 10/10/2012] [Indexed: 11/28/2022]
Abstract
AIMS With the increased need for sanctioning behavioral addiction treatments to guide key stakeholders, focus has shifted to developing and applying criteria for establishing empirically supported treatments (EST). Among the many criteria offered, demonstration of incremental efficacy over a placebo or comparison in at least two independent randomized clinical trials (RCTs) has been the gold standard. While necessary, the present EST criteria are not sufficient. The present work: (i) argues for empirically supported specificity in behavioral addiction treatment, (ii) explores the limitations of empirical support for EST efficacy without evidence of specificity and (iii) discusses implications and recommendations for ultimately raising the bar for status as an EST. METHODS The authors review relevant literature on ESTs, evidence-based practice and clinical trial design in the addictions and related disciplines. RESULTS We clarify that the additional bar of specificity does not denote uniqueness in causal processes and we argue that specificity should not be inferred only via the nature of the experimental contrast. Rather, a treatment has specificity if its active ingredients are identified and validated empirically as predictors of subsequent treatment-related outcomes. Within this new definition, there are implications for clinical research and other key stakeholders. CONCLUSIONS A heightened centrality of empirically supported addiction treatment ingredients moving forward will advance clinical knowledge and evaluation methodology at a far greater pace.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Chronis-Tuscano A, Clarke TL, O'Brien KA, Raggi VL, Diaz Y, Mintz AD, Rooney ME, Knight LA, Seymour KE, Thomas SR, Seeley J, Kosty D, Lewinsohn P. Development and preliminary evaluation of an integrated treatment targeting parenting and depressive symptoms in mothers of children with attention-deficit/hyperactivity disorder. J Consult Clin Psychol 2013; 81:918-25. [PMID: 23477479 DOI: 10.1037/a0032112] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE More than 50% of mothers of children with attention-deficit/hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. METHOD Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. RESULTS The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. CONCLUSIONS This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Pane HT, White RS, Nadorff MR, Grills-Taquechel A, Stanley MA. Multisystemic therapy for child non-externalizing psychological and health problems: a preliminary review. Clin Child Fam Psychol Rev 2013; 16:81-99. [PMID: 23385370 PMCID: PMC3800084 DOI: 10.1007/s10567-012-0127-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the "presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness" (Henggeler et al. in J Am Acad Child Psy 38:1331-1345, p. 1332, 1999b). Additionally, youth with "serious emotional disturbance (SED)" defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were "currently in or at imminent risk of a costly out-of-home placement" (Rowland et al. in J Emot Behav Disord 13:13-23, pp. 13-14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes.
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Affiliation(s)
- Heather T Pane
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX 77030, USA.
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Yoon U, Kwok LL, Magkidis A. Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: a systematic review of randomized controlled trials. Metabolism 2013; 62:303-14. [PMID: 22959500 DOI: 10.1016/j.metabol.2012.07.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/14/2012] [Accepted: 07/16/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Every year over 3.8 million people are dying of diabetes and its complications. Lifestyle intervention was suggested to have beneficial effects in preventing and reducing diabetes incidence. Interventions in patients with impaired glucose tolerance (IGT), who belong to a high risk group in developing diabetes, are supposed to be especially effective. According to the evidence hierarchy, a 1a level of evidence is missing and therefore a systematic review verifying the efficacy of lifestyle intervention is needed. MATERIALS/METHODS Systematic review: The electronic database PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment database were searched. Main inclusion criteria were randomized controlled trials, impaired glucose tolerance, lifestyle intervention with control group and observation time >6 months. Outcome measures were all diabetes events, as defined by the authors of each study, all-cause mortality, diabetes mortality, and quality adjusted life years (QALY). Two independent reviewers abstracted the studies by title, abstract and full-text analysis. Furthermore the reporting quality of each study was assessed by using the CONSORT criteria (Consolidated Standards of Reporting Trials) and the methodological quality by SIGN 50 instrument (Scottish Intercollegiate Guidelines Network methodology checklist for randomized controlled trials). The primary outcome measure was diabetes incidence. Secondary outcome measures were overall mortality, disease-specific mortality, quality adjusted life years (QALY), and clinical parameters; body mass index (BMI), weight change, blood pressure, blood parameter, smoking, alcohol consumption. RESULTS 7 trials which included 25 relevant publications were identified. Kappa Cohens for title-analysis were К=0.77, (CI=0.71-0.83), abstract-analysis К=0.81 (CI=0.64-0.92) and full-text analysis К=0.78 (CI=0.57-0.98). Overall 5663 patients were analyzed with primary follow-up time: India (3y), Japan (4y), Sweden (5y), Da Qing (6y), SIM (3y), DPP (5y), DPS (4y) and drop-out rate ranges from 5% to 28%. Diabetes incidence ranges from 3% to 46% in the intervention group and 9.3% to 67.7% in the control group. The India study reported ARR=16%, RRR=29% (p=0.018), Japan: ARR=6.3%, RRR=65% (p<0.001), Sweden: ARR=4%, RRR=25% (p=not significant), Da Qing: ARR=22%, RRR=32% (p<0.05), SLIM: ARR=20%, RRR=53% (p=0.025), DPP: ARR=15%, RRR=58% (significant, no p-value reported), and DPS: ARR=12%, RRR=52% (significant, no p-value reported). Mortality and morbidity were only analyzed in Da Qing study which showed no statistical differences (overall mortality: HRR 0.96, CI 0.65-1.41, CVD-mortality: HRR 0.83; CI 0.48-1.40, CVD event: HRR 0.98; CI 0.71-1.37). CONCLUSION Under consideration of heterogeneity in lifestyle interventions and follow up time of the included studies, this systematic review illustrated that lifestyle intervention can have a beneficial effect on the incidence of diabetes in patients with impaired glucose tolerance. However, several studies found the effect of lifestyle intervention decreased after intervention was terminated. No long-term benefit in mortality and morbidity was found. Development of standardized lifestyle intervention program is strongly needed and further long-term intervention trials using this program are crucial in evidencing the long-term efficacy.
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Affiliation(s)
- Uzung Yoon
- Berlin School of Public Health, Charité, Seestr. 73, 13347 Berlin, Germany.
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