Thematische Bibliographien / Light design in behavioral health clinics

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Auswahl der wissenschaftlichen Literatur zum Thema „Light design in behavioral health clinics“

Autor: Grafiati

Veröffentlicht am 25. Juni 2021

Zuletzt aktualisiert am 8. Februar 2022

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Zeitschriftenartikel zum Thema "Light design in behavioral health clinics"

Verma, Sumedha, Nina Quin, Laura Astbury, Cornelia Wellecke, Joshua Wiley, Margot Davey, Shantha Rajaratnam und Bei Bei. „365 Cognitive Behavioral Therapy and Light Dark Therapy for Postpartum Insomnia Symptoms: Findings from a Randomized Controlled Trial“. Sleep 44, Supplement_2 (01.05.2021): A145. http://dx.doi.org/10.1093/sleep/zsab072.364.

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Abstract Introduction Symptoms of insomnia are common in the postpartum period and are associated with a range of negative outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioral Therapy (CBT) and Light Dark Therapy (LDT) target two different mechanisms to reduce sleep disturbance. This randomized controlled trial examined the efficacy of CBT and LDT against a treatment-as-usual (TAU) condition in reducing maternal postpartum insomnia symptoms. Methods Nulliparous women 4–12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores [ISI] >7) were included; excluded were those with: current severe health/psychiatric conditions, unsettled infant behaviors, sleep-affecting medication use and photosensitivity. Eligible women were randomized 1:1:1 to 6 weeks of CBT (CBT for insomnia and fatigue), LDT (morning bright light therapy, evening light hygiene), or TAU. Interventions were therapist-assisted and personalized through two telephone calls and included automated self-help intervention materials (i.e., emails) delivered over six weeks. Symptoms of insomnia (ISI; primary outcome), fatigue, sleepiness, depression, and anxiety were assessed at baseline, mid-intervention, post-intervention, and 1-month post-intervention. Analyses were intention-to-treat latent growth models. Results 114 women were randomized (mean age = 32.20 ± 4.62 years) and 108 women completed the intervention. Compared to TAU, symptoms of insomnia significantly reduced from baseline to post-intervention in both CBT and LDT groups (p-values <.001), with very large effect sizes (d > 1.5) at post-intervention; gains were maintained at follow-up. Fatigue symptoms significantly reduced in the CBT group (p<.0001; d = 0.85) but not LDT (p = 0.11) compared to TAU at post-intervention; gains were maintained for CBT at follow-up. Group differences in sleepiness, depression, and anxiety were nonsignificant (all p > 0.08). Conclusion Therapist-assisted self-help CBT and LDT with different therapeutic mechanisms are both efficacious for reducing maternal insomnia symptoms during the postpartum period. Findings were mixed for fatigue, sleepiness and mood. Future research on predictors of treatment responses is needed. Support (if any) Australian National Health and Medical Research Council, Department of Education RTP Scholarship. Lucimed SA supplied light therapy glasses. Funders had no role in design/implementation of the trial. ANZCTR: ACTRN12618000842268.

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Barney, Chantel C., Raymond Tervo, George L. Wilcox und Frank J. Symons. „A Case-Controlled Investigation of Tactile Reactivity in Young Children With and Without Global Developmental Delay“. American Journal on Intellectual and Developmental Disabilities 122, Nr. 5 (01.09.2017): 409–21. http://dx.doi.org/10.1352/1944-7558-122.5.409.

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Abstract Assessing tactile function among children with intellectual, motor, and communication impairments remains a clinical challenge. A case control design was used to test whether children with global developmental delays (GDD; n = 20) would be more/less reactive to a modified quantitative sensory test (mQST) compared to controls (n = 20). Reactivity was indexed by blinded behavioral coding across vocal, facial, and gross motor responses during the mQST. On average the children with GDD were significantly more reactive than controls to most tactile sensory modalities including light touch (p = .034), pin prick (p = .008), cool (p = .039), pressure (p = .037), and repeated von Frey (p = .003). The results suggest the mQST approach was feasible and highlights the GDD sample was more reactive than controls to a range of stimuli.

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Dwyer, Christopher P., Pádraig MacNeela, Hannah Durand, Laura L. O’Connor, Chris J. Main, Phoebe E. McKenna-Plumley, Robert M. Hamm et al. „Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial“. Pain Medicine 21, Nr. 5 (17.12.2019): 939–50. http://dx.doi.org/10.1093/pm/pnz284.

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Abstract Background Chronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians’ adherence to biopsychosocial guidelines is low. Objective The current study examined the effects of a flags approach–based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients. Design Randomized controlled trial (trial registration number: ISRCTN53670726). Setting University classroom. Subjects Medical students and GP trainees. Methods Using 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31). Results Results revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research. Conclusions Short flags approach–based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues.

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LeBaron, Virginia, Rachel Bennett, Ridwan Alam, Leslie Blackhall, Kate Gordon, James Hayes, Nutta Homdee et al. „Understanding the Experience of Cancer Pain From the Perspective of Patients and Family Caregivers to Inform Design of an In-Home Smart Health System: Multimethod Approach“. JMIR Formative Research 4, Nr. 8 (26.08.2020): e20836. http://dx.doi.org/10.2196/20836.

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Background Inadequately managed pain is a serious problem for patients with cancer and those who care for them. Smart health systems can help with remote symptom monitoring and management, but they must be designed with meaningful end-user input. Objective This study aims to understand the experience of managing cancer pain at home from the perspective of both patients and family caregivers to inform design of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system. Methods This was a descriptive pilot study using a multimethod approach. Dyads of patients with cancer and difficult pain and their primary family caregivers were recruited from an outpatient oncology clinic. The participant interviews consisted of (1) open-ended questions to explore the overall experience of cancer pain at home, (2) ranking of variables on a Likert-type scale (0, no impact; 5, most impact) that may influence cancer pain at home, and (3) feedback regarding BESI-C system prototypes. Qualitative data were analyzed using a descriptive approach to identity patterns and key themes. Quantitative data were analyzed using SPSS; basic descriptive statistics and independent sample t tests were run. Results Our sample (n=22; 10 patient-caregiver dyads and 2 patients) uniformly described the experience of managing cancer pain at home as stressful and difficult. Key themes included (1) unpredictability of pain episodes; (2) impact of pain on daily life, especially the negative impact on sleep, activity, and social interactions; and (3) concerns regarding medications. Overall, taking pain medication was rated as the category with the highest impact on a patient’s pain (=4.79), followed by the categories of wellness (=3.60; sleep quality and quantity, physical activity, mood and oral intake) and interaction (=2.69; busyness of home, social or interpersonal interactions, physical closeness or proximity to others, and emotional closeness and connection to others). The category related to environmental factors (temperature, humidity, noise, and light) was rated with the lowest overall impact (=2.51). Patients and family caregivers expressed receptivity to the concept of BESI-C and reported a preference for using a wearable sensor (smart watch) to capture data related to the abrupt onset of difficult cancer pain. Conclusions Smart health systems to support cancer pain management should (1) account for the experience of both the patient and the caregiver, (2) prioritize passive monitoring of physiological and environmental variables to reduce burden, and (3) include functionality that can monitor and track medication intake and efficacy; wellness variables, such as sleep quality and quantity, physical activity, mood, and oral intake; and levels of social interaction and engagement. Systems must consider privacy and data sharing concerns and incorporate feasible strategies to capture and characterize rapid-onset symptoms.

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Gillman, Andrea, Di Zhang, Susan Jarquin, Jordan F. Karp, Jong-Hyeon Jeong und Ajay D. Wasan. „Comparative Effectiveness of Embedded Mental Health Services in Pain Management Clinics vs Standard Care“. Pain Medicine 21, Nr. 5 (15.11.2019): 978–91. http://dx.doi.org/10.1093/pm/pnz294.

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Abstract Objective Embedded behavioral medicine services are a common component of multidisciplinary chronic pain treatment programs. However, few studies have studied whether these services are associated with improved treatment outcomes. Methods Using a retrospective, matched, two-cohort study design, we examined patient-reported outcomes (PROs), including Patient-Reported Outcomes Measurement Information System pain, mental health, and physical function measures, collected at every clinic visit in every patient. Changes from baseline through 12 months were compared in those receiving embedded Behavioral Medicine in addition to usual care to a Standard Care group seen in the same pain practice and weighted via propensity scoring. Results At baseline, Behavioral Medicine patients had worse scores on most pain, mental health, and physical health measures and were more likely to be female, a member of a racial minority, and have lower socioeconomic status. Regardless of having a worse clinical pain syndrome at baseline, at follow-up both Behavioral Medicine (N = 451) and Standard Care patients (N = 8,383) showed significant and comparable improvements in pain intensity, physical function, depression, and sleep disturbance. Behavioral Medicine patients showed significantly greater improvements in their global impressions of change than the Standard Care patients. Conclusions Despite worse pain and physical and psychological functioning at baseline, Behavioral Medicine patients showed improvements comparable to patients not receiving these services. Further, Behavioral Medicine patients report higher global impressions of change, indicating that embedded mental health services appear to have the additive value of amplifying the benefits of multimodal pain care.

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Funderburk, LesLee, Thomas Cardaci, Andrew Fink, Keyanna Taylor, Jane Rohde und Debra Harris. „Healthy Behaviors through Behavioral Design–Obesity Prevention“. International Journal of Environmental Research and Public Health 17, Nr. 14 (14.07.2020): 5049. http://dx.doi.org/10.3390/ijerph17145049.

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Evidence for behavior modification for improved health outcomes was evaluated for nutrition, physical activity (PA), and indoor environmental quality (IEQ). The databases searched included LISTA, PubMed, and Web of Science, with articles rated using an a priori baseline score of 70/100 to establish inclusion. The initial search produced 52,847 articles, 63 of which were included in the qualitative synthesis. Thirteen articles met inclusion for nutrition: cafeteria interventions, single interventions, and vending interventions. Seventeen articles on physical activity were included: stair use, walking, and adjustable desks. For IEQ, 33 articles met inclusion: circadian disruption, view and natural light, and artificial light. A narrative synthesis was used to find meaningful connections across interventions with evidence contributing to health improvements. Commonalities throughout the nutrition studies included choice architecture, increasing the availability of healthy food items, and point-of-purchase food labeling. Interventions that promoted PA included stair use, sit/stand furniture, workplace exercise facilities and walking. Exposure to natural light and views of natural elements were found to increase PA and improve sleep quality. Overexposure to artificial light may cause circadian disruption, suppressing melatonin and increasing risks of cancers. Overall, design that encourages healthy behaviors may lower risks associated with chronic disease.

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Caton, Lauren, Hannah Cheng, Hélène Chokron Garneau, Tammy Fisher, Briana Harris-Mills, Brian Hurley, Sandra Newman und Mark P. McGovern. „COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics“. Journal of General Internal Medicine 36, Nr. 4 (28.01.2021): 998–1005. http://dx.doi.org/10.1007/s11606-020-06436-3.

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Abstract Background With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. Objective To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. Design A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. Participants We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. Main Measures The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. Key Results A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. Conclusions Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.

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Graham, Andrea K., Carolyn J. Greene, Thomas Powell, Pauli Lieponis, Amanda Lunsford, Chris D. Peralta, L. Casey Orr et al. „Lessons learned from service design of a trial of a digital mental health service: Informing implementation in primary care clinics“. Translational Behavioral Medicine 10, Nr. 3 (Juni 2020): 598–605. http://dx.doi.org/10.1093/tbm/ibz140.

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Abstract Implementing a digital mental health service in primary care requires integration into clinic workflow. However, without adequate attention to service design, including designing referral pathways to identify and engage patients, implementation will fail. This article reports results from our efforts designing referral pathways for a randomized clinical trial evaluating a digital service for depression and anxiety delivered through primary care clinics. We utilized three referral pathways: direct to consumer (e.g., digital and print media, registry emails), provider referral (i.e., electronic health record [EHR] order and provider recommendation), and other approaches (e.g., presentations, word of mouth). Over the 5-month enrollment, 313 individuals completed the screen and reported how they learned about the study. Penetration was 13%, and direct to consumer techniques, most commonly email, had the highest yield. Providers only referred 16 patients through the EHR, half of whom initiated the screen. There were no differences in referral pathway based on participants’ age, depression severity, or anxiety severity at screening. Ongoing discussions with providers revealed that the technologic implementation and workflow design may not have been optimal to fully affect the EHR-based referral process, which potentially limited patient access. Results highlight the importance of designing and evaluating referral pathways within service implementation, which is important for guiding the implementation of digital services into practice. Doing so can ensure that sustained implementation is not left to post-evaluation bridge-building. Future efforts should assess these and other referral pathways implemented in clinical practice outside of a research trial.

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Belizan, Maria, Juan P. Alonso, Analía Nejamis, Joaquín Caporale, Mariano G. Copo, Mario Sánchez, Adolfo Rubinstein und Vilma Irazola. „Barriers to hypertension and diabetes management in primary health care in Argentina: qualitative research based on a behavioral economics approach“. Translational Behavioral Medicine 10, Nr. 3 (04.04.2019): 741–50. http://dx.doi.org/10.1093/tbm/ibz040.

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Abstract Despite efforts to improve detection and treatment of adults with hypertension and diabetes in Argentina, many public healthcare system users remain undiagnosed or face barriers in managing these diseases. The purpose of this study is to identify health system, provider, and user-related factors that may hinder detection and treatment of hypertension and diabetes using a traditional and behavioral economics approach. We did qualitative research using in-depth semistructured interviews and focus groups with healthcare providers and adult users of Public Primary Care Clinics. Health system barriers included inadequate care accessibility; poor integration between primary care clinics and local hospitals; lack of resources; and gender bias and neglect of adult chronic disease. Healthcare provider–related barriers were inadequate training; lack of availability or reluctance to adopt Clinical Practice Guidelines; and lack of counseling prioritization. From a behavioral economics perspective, bottlenecks were related to inertia and a status quo, overconfidence, and optimism biases. User-related barriers for treatment adherence included lack of accurate information; resistance to adopt lifelong treatment; affordability; and medical advice mistrust. From a behavioral economics perspective, the most significant bottlenecks were overconfidence and optimism, limited attention, and present biases. Based on these findings, new interventions that aim to improve prevention and control of chronic conditions can be proposed. The study provides empirical evidence regarding the barriers and bottlenecks in managing chronic conditions in primary healthcare settings. Results may contribute to the design of behavioral interventions targeted towards healthcare provision for the affected population.

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Hendijani, Rosa, und Diane P. Bischak. „The effect of social relationships on the rates of referral to specialists“. International Journal of Operations & Production Management 36, Nr. 4 (04.04.2016): 384–407. http://dx.doi.org/10.1108/ijopm-02-2015-0086.

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Purpose – In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of patient referral from general practitioners (GPs) to specialists toward centralized ones. From a queueing theory perspective, centralized referral systems can decrease waiting time by reducing the variation in the referral process. However, from a social psychological perspective, a close relationship between referring physician and specialist, which is characteristic of decentralized referral systems, may safeguard against high referral rates; since GPs refer patients directly to the specialists whom they know, they may be reluctant to damage that relationship with an inappropriate referral. The purpose of this paper is to examine the effect upon referral behavior of a relationship between physicians, as is found in a decentralized referral system, vs a centralized referral system, which is characterized by an anonymous GP-specialist relationship. In a controlled experiment where family practice residents made decisions concerning referral to specialists, physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by the design of the service system and will, in turn, affect system performance. Design/methodology/approach – The authors used a controlled experiment to test the research hypotheses. Findings – Physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by system attributes and will, in turn, affect system performance. Research limitations/implications – The current study has some limitations, however. First, the sample consisted only of family practice residents and did not have the knowledge and experience of GPs regarding the referral process. Second, the authors used hypothetical patient case descriptions instead of real-world patients. Repeating this experiment with primary care physicians in real setting would be beneficial. Practical implications – The study indicates that decentralized referral systems may act (rightly or wrongly) as a restraint on the rate of referrals to specialists. Thus, an implementation of a centralized referral system should be expected to produce an increase in referrals simply due to the change in the operational system setup. Even if centralized referral systems are more efficient and can facilitate the referral process by creating a central queue rather than multiple single queues for patients, the removal of social ties such as long-term social relationships that are developed between GPs and specialists in decentralized referral systems may act to counterbalance these theoretical gains. Social implications – This study provide support for the idea that non-clinical factors play an important role in referrals to specialists and hence in the quality of provided care, as was suggested by previous studies in this area (Hajjaj et al., 2010; Reid et al., 1999). The design of the service system may inadvertently influence some doctors to refer too many patients to specialists when there is no need for a specialist visit. In high-utilization health systems, this may cause some patients to be delayed (or even denied) in obtaining specialist access. Healthcare systems may be able to implement behavioral-based techniques in order to mitigate the negative consequences of a shift to centralized referral systems. One approach would be to try to create a feeling of close relationship among doctors in centralized referral systems. High communication and frequent interaction among GPs and specialists can boost the feelings of teamwork and personal efficacy through social comparison (Schunk, 1989, 1991) and vicarious learning (Zimmerman, 2000), which can in turn motivate GPs to take control of the patient care process when appropriate, instead of referring patients to specialists. Originality/value – The authors’ study is the first examining the effect of social relationships between GPs and specialists on the referral patterns. Considering the significant implications of referral decisions on patients, doctors, and the healthcare systems, the study can shed light into a better understanding of the social and behavioral aspects of the referral process.

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Dissertationen zum Thema "Light design in behavioral health clinics"

Svanberg, Mira. „The right light at the right time for bipolar patients. An exploratory study of light environments for patients with bipolar disease in behavioral health clinics“. Thesis, KTH, Ljusdesign, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-297963.

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Research has showed that different light scenarios have a profound effect on hospitalized bipolar patients. Different light situations decrease the hospital stay for patients during both manic and depressive episodes. Nevertheless, a field study carried out during this thesis work of two arbitrary patient rooms in Swedish behavioral health clinics showed no incorporation of this knowledge in the light design of the rooms. Both patient rooms had insufficient light levels both in terms of circadian recommendations and perceived brightness. Hence this thesis suggests an improved light design for patient rooms housing bipolar patients. The basis of the improved design is to incorporate a dynamic, circadian lighting that varies depending on the patient's need and diagnosed episode.

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Lyan, Dmitriy Eduard. „Performance dynamics in military behavioral health clinics“. Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/90690.

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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, June 2013.
Cataloged from PDF version of thesis. "June 2012."
Includes bibliographical references (pages 113-116).
The prevalence of Post Traumatic Stress Disorder (PTSD) and other related behavioral health conditions among active duty service members and their families has grown over 100% in the past six years and are now estimated to afflict 18% of the total military force. A 2007 DoD task force on mental health concluded that the current military psychological health care system is insufficient to meet the needs of the served population. In spite of billions of dollars committed to hundreds of programs and improvement initiatives since then, the system continues to experience provider shortages, surging costs, poor access to and quality of care as well as persistently high service-related suicide rates. We developed a model to study how the resourcing policies and incentive structures interact with the operations of military behavioral health clinics and contribute to their ability to provide effective care. We show that policies and incentives skewed towards increased patient loads and improvement in access to initial care result in a number of vicious cycles that reinforce provider shortages, increase costs and decrease access to care. Additionally we argue that insufficient informational feedback contributes to incorrect attributions and the persistence of ineffective policies. Finally we propose a set of policies and enabling performance metrics that can contribute to sustained improvement in system performance by turning death spirals into virtuous cycles leading to higher provider and patient satisfaction, better quality of care and more efficient resource utilization contributing to better healthcare outcomes and increased levels of medical readiness.
by Dmitriy Eduard Lyan.
S.M. in Engineering and Management

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Bücher zum Thema "Light design in behavioral health clinics"

Taylor, Joseph J., und Robert Ostroff. National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program. Herausgegeben von Ish P. Bhalla, Rajesh R. Tampi, Vinod H. Srihari und Michael E. Hochman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190625085.003.0024.

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This chapter will summarize what is considered to be the first randomized controlled trial to directly compare psychotherapeutic and psychopharmacological interventions for unipolar nonpsychotic depression. More specifically, the authors were interested in the degree to which cognitive behavioral therapy, interpersonal therapy, imipramine and a placebo condition ameliorated symptoms of depression in patients from outpatient psychiatric clinics at three academic medical centers in the United States. The chapter will discuss the design and implementation of the study before focusing on the results and their implications. The last section of the chapter will list similar studies and present a hypothetical clinical case that requires the reader to apply basic concepts learned from the study.

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Buchteile zum Thema "Light design in behavioral health clinics"

LaFleur, Latifey B., und Irvin G. Esters. „Role of University-Based Training Clinics“. In Advances in Psychology, Mental Health, and Behavioral Studies, 131–44. IGI Global, 2019. http://dx.doi.org/10.4018/978-1-5225-8226-7.ch005.

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This chapter will focus on the formation and operation of a university-based play therapy clinic. Attention to the role of the clinic in experiential training, which is an important part of counselor and play therapy preparation will be addressed as well. The mission, functions, and benefits of a university-based play therapy training clinic will be explored in depth and suggestions for forming and administering the clinic will be made. Further, the authors will discuss the effect of a play therapy clinic on training, credentialing, and the promotion of play therapy along with the influence of accrediting entities such as CACREP. Finally, to assist interested programs in the development of a play therapy training clinic, components such as funding, space, design, equipment/materials, administration, and ethical considerations are discussed.

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„Outside those who have tried it, few appreciate the difficulties of behav-ioral scientists attempting to teach in medical settings. The problem for those who are primarily engaged in and who identify themselves with research is not as great. It seems that however antagonizing the research results some-times turn out to be for mainstream medical care and the health professions, behavioral science researchers are of substantial value in medical centers if only because of their comparative superiority and leadership in research design and methodology. The problems of those who primarily teach, how-ever, are enormous, and stem from several sources: from the demands in-herent in the educational context of the medical center (usually a tertiary care base striving to prepare technical specialists), and from the three most relevent groups involved-the medical faculty, students, and often from their own colleagues. Explorations of these difficulties together with a reexamina-tion of the role of behavioral science in medical education have become popular subjects. Useful discussions can be found in the December 1973 Special Issue of Social Science and Medicine, Hunt, 1974; Williams et al., 1974; Sluzki, 1974; Volpe, 1974; Routh & Clarke, 1976; Cohen & Kelner, 1976; and Wexler, 1976. A most penetrating analysis from a sociologist's viewpoint is provided by Jeffries, 1974. The presence of increasing numbers of behavioral scientists in care delivery settings such as kidney dialysis units, pediatric hospitals, primary care clinics, and family practice centers is beginning to contribute examples of how services and teaching can work hand in hand. From these experiences, especial-ly those in family practice programs (e.g., Johnson et al., 1977), a number of observations are beginning to provide the basis for consensus on several issues. These are the subject of another paper in preparation. In closing this discussion, I shall suggest only that the clinical behavioral scientist model advocated here provides a hopeful response to increasing pressure from a major prevailing issue: what and how to teach in order to make behavioral science "clinically relevent," i.e., to help health providers achieve immediate goals and to "actually demonstrate in concrete situatons that (our) knowl-edge and skills can improve the quality of health care" (Cohen & Kelner, 1976, p. 27).* This approach to teaching is admittedly labor intensive and deliberately clinically biased. It also requires that "student" and "teacher" work closely together to construct the ground rules for their relationships, two by two and“. In Family Medicine, 70–72. Routledge, 2014. http://dx.doi.org/10.4324/9781315060781-13.

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Konferenzberichte zum Thema "Light design in behavioral health clinics"

Tao, Gregory D., Hallie S. Cho, Daniel Frey und Amos G. Winter. „Design of a Low-Cost Autoclave for Developing World Health Clinics“. In ASME 2012 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/detc2012-71435.

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Incidence of surgical site infection is 2–5 times higher in developing nations as compared to developed nations. A low-cost, easy to use autoclave was designed to address the unique technical, behavioral, and market challenges present in rural, health posts of the developing world. A thorough stakeholder analysis was performed very early in the design process to address non-technical needs for sustained user adoption as well as manufacturability and scalability. Twelve partnering clinics in Nepal trialed these autoclaves from July until December 2012. Usage statistics and follow-up observations highlight important factors for successful adoption. These findings were used to improve the autoclave design. The goal of this paper is to detail a case study and methodology to incorporate multiple stakeholder needs into the early design process.

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Zavrel, Erik A., und Matthew R. Ebben. „An Active Distal Limb Warming Device for Insomnia Treatment“. In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3469.

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The defining characteristics of insomnia are widely recognized as difficulty falling asleep, difficulty staying asleep, and sleep that is non-restorative [1]. Insomnia is among the most common health complaints: about 10% of the adult population complains of a chronic insomnia problem [2]. With aging, increasingly disturbed sleep and less satisfaction with sleep quality are reported [3]. This common problem has wide ranging physiological, cognitive, and behavioral consequences including higher healthcare utilization [4–6]. Current major treatment options for insomnia (hypnotic medications and non-pharmacological behavioral interventions) suffer side effects and shortcomings. Thermoregulation plays a key role in promoting and maintaining sleep. At night, core body temperature (CBT) drops while distal skin temperature (DST) increases. It was previously believed that the nighttime drop in CBT was the most important promoter of sleep. However, recent research has shown that it is in fact the increase in DST (with net body heat loss owing to the large distal skin surface area) which is associated with an increase in sleepiness, whereas a decrease in DST (with resulting net body heat retention) is associated with a decrease in sleepiness [7]. The amount of distal vasodilation, as measured by the distal-proximal skin temperature gradient (DPG), is more predictive of sleep onset than subjective sleepiness ratings, CBT, or dim light melatonin onset. In fact, “the degree of dilation of blood vessels in the skin of the hands and feet, which increases heat loss at these extremities, is the best physiological predictor for the rapid onset of sleep” [8]. The link between distal skin warming and sleep propensity is further strengthened by the fact that warm water immersion of hands and feet has been found to decrease sleep onset latency (SOL) and pre-sleep warm baths have long been prescribed as an insomnia treatment. In a recent study, we used a multiple sleep latency test (MSLT) to perform multiple nap trials throughout the day, with the participants’ hands and feet immersed in warm water prior to each nap. We found that both mild and moderate warming of the hands and feet prior to a nap significantly reduced SOL compared to a baseline MSLT without warming [9]. We also previously conducted a trial of temperature biofeedback for insomnia treatment in which we demonstrated SOL reduction using muscle relaxation techniques to induce distal vasodilation, increase blood flow to the extremities, and modulate temperature of hands and feet [10]. Additionally, it has been shown that regardless of circadian variation throughout the day, finger temperature shows a rapid increase immediately before sleep onset [11]. Lastly, people with primary vascular dysregulation (a condition caused by abnormal vasoconstriction that results in cold hands and feet) exhibit significantly increased SOL and greater difficulty falling asleep following nocturnal arousal [12]. Thus, some presentations of insomnia may be secondary to distal vasodilation failure. The motivation for an active distal limb warming device as a treatment for insomnia is based on the established functional link between distal vasodilation and sleep induction [13]. Somewhat counterintuitively then, heating of hands and feet can induce distal vasodilation, promote net body heat loss, and facilitate sleep onset [14, 15].

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Boyle, Paul M., und Brent C. Houchens. „Hands-On Water Purification Experiments Using the Adaptive WaTER Laboratory for Undergraduate Education and K-12 Outreach“. In ASME 2008 Fluids Engineering Division Summer Meeting collocated with the Heat Transfer, Energy Sustainability, and 3rd Energy Nanotechnology Conferences. ASMEDC, 2008. http://dx.doi.org/10.1115/fedsm2008-55108.

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A bench-top educational system, the Adaptive Water Treatment for Education and Research (WaTER) Laboratory, has been developed as part of a year-long capstone design project. The Adaptive WaTER Lab teaches students about the effectiveness of various water purification techniques. Stackable housings employ six different filtration and purification methods including: sediment filtration, carbon filtration, chemical disinfection, reverse osmosis, forward osmosis, and ultraviolet light disinfection. Filtration pressure is supplied by a hand or foot pump, and two rechargeable batteries are required for the UV sterilization unit. The advantages and limitations of each technique are investigated, with learning performance criteria measured by knowledge of: material costs, contaminant removal or neutralization capabilities (from large sediment to bacteria and viruses to chemicals), robustness and longevity, and power requirements and efficiencies. Finally, suitable combinations of treatment techniques are studied for specific contamination issues, with the ultimate goal of producing potable water. The importance of sustainable water use is also discussed. Background information and suggested experiments are introduced through accompanying educational packets. This system has had a successful impact on undergraduate education. The metrics of success include a published journal article, an awarded EPA P3 educational grant and a pending patent for the undergraduates involved in the development of the Lab. Other undergraduates are currently involved in a design for manufacturability study. Finally, the Lab has served as a demonstration tool in a new interdisciplinary engineering course “Integrated Approaches to Sustainable Development.” The Adaptive WaTER Lab has also been used in hands-on outreach to over 300 underrepresented K-12 students in the Houston area. Two high school students borrowed the original prototype of the Lab to use in an Earth Day demonstration, and one student recently worked on an individual project using the Lab. Because the Lab is portable and requires only human and solar power (to recharge the batteries via a solar backpack), it is also ideal for educational efforts in developing nations. Labs are currently being produced for outreach and donation via three international projects to install water purification systems and/or educational Labs in schools and clinics in Mexico, Lesotho and Swaziland, in collaboration with the Beyond Traditional Borders and Rice 360 health initiatives.

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