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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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Kaplan, Nasser M., Yousef S. Khader, Mahmoud A. Alfaqih, Rami Saadeh und Lora Al Sawalha. „Implementation of the WHO Approved “Tailoring Antimicrobial Resistance Programs (TAP)” Reduces Patients’ Request for Antibiotics“. Antibiotics 9, Nr. 8 (12.08.2020): 507. http://dx.doi.org/10.3390/antibiotics9080507.
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The misuse of antibiotics is a worldwide public health concern. Behavioral Intervention programs that aim to reduce patients’ own request for antibiotics during their visit to primary care clinics is an attractive strategy to combat this problem. We tested the effectiveness of a behavioral modification method known as the Tailoring Antimicrobial resistance Programs (TAP) in reducing the request for antibiotics by patients visiting primary care clinics for mild upper respiratory tract infections (URTIs). A stratified cluster randomized design with two groups pre-post, comparing intervention with the control, was conducted in six health centers. TAP was implemented for eight weeks. Request for antibiotics was assessed before (period 1) and after introducing TAP (period 2). The percentage of patients or their escorts who requested antibiotics in period 1 was 59.7% in the control group and 60.2% in the intervention group. The percentage of patients who requested antibiotics did not significantly change between period 1 and 2 in the control group, who continued to receive the standard of care. The above percentage significantly decreased in the intervention group from 60.2% to 38.5% (p < 0.05). We conclude that behavioral change programs including TAP are a viable alternative strategy to address antibiotic misuse in Jordan.
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Burdick, Timothy, und Rodger Kessler. „Development and use of a clinical decision support tool for behavioral health screening in primary care clinics“. Applied Clinical Informatics 08, Nr. 02 (April 2017): 412–29. http://dx.doi.org/10.4338/aci-2016-04-ra-0068.
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SummaryObjective: Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools on clinical outcomes.Methods: A multidisciplinary team designed SBIRT workflows and CDS tools. We analyzed the outcomes using a retrospective descriptive convenience cohort with age-matched comparison group. Data extracted from the EHR were evaluated using descriptive statistics.Results: There were 2 outcomes studied: 1) development and use of new BH screening tools and workflows; and 2) the results of use of those tools by a convenience sample of 866 encounters. The EHR tools developed included a flowsheet for documenting screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including changes in psychotropic medications, updated BH terms on the problem list, or referral for BH intervention. Clinical process outcomes changed even when screening was negative.Conclusions: Modified workflows for BH screening and CDS tools with clinical recommendations can be deployed in the EHR. Using SBIRT tools changed clinical process metrics even when screening was negative, perhaps due to conversations about BH not captured in the screening flowsheet. Although there are limitations to the study, results support ongoing investigation.Citation: Burdick TE, Kessler RS. Development and use of a clinical decision support tool for behavioral health screening in primary care clinics. Appl Clin Inform 2017; 8: 412–429 https://doi.org/10.4338/ACI-2016-04-RA-0068
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Coury, Jennifer K., Jennifer L. Schneider, Beverly B. Green, Laura-Mae Baldwin, Amanda F. Petrik, Jennifer S. Rivelli, Malaika R. Schwartz und Gloria D. Coronado. „Two Medicaid health plans’ models and motivations for improving colorectal cancer screening rates“. Translational Behavioral Medicine 10, Nr. 1 (16.11.2018): 68–77. http://dx.doi.org/10.1093/tbm/iby094.
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Abstract Screening rates for colorectal cancer (CRC) remain low, especially among certain populations. Mailed fecal immunochemical testing (FIT) outreach initiated by U.S. health plans could reach underserved individuals, while solving CRC screening data and implementation challenges faced by health clinics. We report the models and motivations of two health insurance plans implementing a mailed FIT program for age-eligible U.S. Medicaid and Medicare populations. One health plan operates in a single state with ~220,000 enrollees; the other operates in multiple states with ~2 million enrollees. We conducted in-depth qualitative interviews with key stakeholders and observed leadership and clinic staff planning during program development and implementation. Interviews were transcribed and coded using a content analysis approach; coded interview reports and meeting minutes were iteratively reviewed and summarized for themes. Between June and September 2016, nine participants were identified, and all agreed to the interview. Interviews revealed that organizational context was important to both organizations and helped shape program design. Both organizations were hoping this program would address barriers to their prior CRC screening improvement efforts and saw CRC screening as a priority. Despite similar motivations to participate in a mailed FIT intervention, contextual features of the health plans led them to develop distinct implementation models: a collaborative model using some health clinic staffing versus a centralized model operationalizing outreach primarily at the health plan. Data are not yet available on the models’ effectiveness. Our findings might help inform the design of programs to deliver mailed FIT outreach.
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Wolff, Nicole, Charlotte Reimelt, Stefan Ehrlich, Heike Hölling, Sabine Mogwitz und Veit Roessner. „On the positive association between candy and fruit gum consumption and hyperactivity in children and adolescents with ADHD“. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 47, Nr. 3 (01.05.2019): 228–38. http://dx.doi.org/10.1024/1422-4917/a000609.
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Abstract. Objective: The purpose of the present study was the analysis of the association between consumption of candy and fruit gums, diagnosis of attention deficit hyperactivity disorder (ADHD), and behavioural problems. Methods: In total, 1,187 children and adolescents of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed. Results: It was observed that children and adolescents with ADHD as compared to healthy controls (HC) reported to consume more frequently and higher amounts of candy and fruit gums and that hyperactivity was associated with frequent candy and fruit gum consumption. Conclusions: Because with the present design no conclusions on causality or directionality of the found associations could be drawn, results are discussed quite broadly in the light of several previously published interpretations, also to serve as a generator for further research. One more innovative speculation is that children and adolescents with ADHD may consume more frequently candy and fruit gums in order i) to compensate for their higher needs of energy resulting from hyperactive behaviour and/or ii) to compensate for the ADHD-typical deficits in the “reward cascade”.
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Brager, Jenna, Susan M. Breitenstein, Hailey Miller und Deborah Gross. „Low-Income Parents’ Perceptions of and Engagement With a Digital Behavioral Parent Training Program: A Mixed-Methods Study“. Journal of the American Psychiatric Nurses Association 27, Nr. 1 (11.09.2019): 33–43. http://dx.doi.org/10.1177/1078390319872534.
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BACKGROUND: Parent training is a method for strengthening parenting skills, reducing child behavior problems, and promoting positive parent–child relationships. However, few parents have access to these evidence-based programs. The ezParent program, a tablet-based delivery adaptation of the group-based Chicago Parent Program, is a parent training program designed to address the needs of families raising young children in urban poverty. AIMS: This study aimed to explore (a) parents’ perceptions of the benefits and barriers associated with their use of the ezParent program and (b) the ways in which the ezParent components and perceived usability varied by program use (module completion). METHOD: An explanatory mixed-methods design was used with the overall intent to use the qualitative data to help explain in greater detail the quantitative results. RESULTS: Fifty-nine parents of 2- to 5-year-old children from two pediatric primary care clinics serving predominantly low-income and racial/ethnic minority families in Chicago (Cohort 1) and Baltimore (Cohort 2) participated in follow-up interviews. Among those interviewed, 23 (38.9.5%) parents completed all six modules and 12 parents (20.3%) completed none of the modules. However, of those 12, 8 (67%) logged in to the program and completed portions of Module 1. Parents who completed more modules reported more program benefits, and those who completed fewer modules reported more barriers. CONCLUSIONS: Exploring users’ experience with current digital applications, researchers and application developers can better design future tablet-based interventions to be both effective and acceptable by consumers.
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Puspitasari, Ajeng J., Dagoberto Heredia, Elise Weber, Hannah K. Betcher, Brandon J. Coombes, Ellen M. Brodrick, Susan M. Skinner et al. „Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation“. Journal of Primary Care & Community Health 12 (Januar 2021): 215013272199688. http://dx.doi.org/10.1177/2150132721996888.
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Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.
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Saini, Shivani, und Jagwinder Singh. „A Link Between Attitudinal and Behavioral Loyalty of Service Customers“. Business Perspectives and Research 8, Nr. 2 (02.02.2020): 205–15. http://dx.doi.org/10.1177/2278533719887452.
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Past research works in the area of customer loyalty are insufficient to provide clear understanding of linkage in attitudinal and behavioral loyalty. In order to explain this linkage, present research tests the relationship between two forms of customer loyalty: attitudinal and behavioral. The study employs survey methodology to collect the responses from 600 customers of health clinics, fitness centers, beauty salons, and convenience stores. The data were collected through a structured questionnaire with a series of statements based on a 7-point Likert scale. To examine the bilateral relationships, a non-recursive model was implemented using structural equation modeling in Amos 17.0 designed for data analytics. The results reveal that attitudinal loyalty drives behavioral loyalty, while behavioral to attitudinal loyalty has been insupportable across the sample collected from diverse service categories. The study provides insights about the design of marketing strategies in targeting customers’ attitudinal loyalty, so that positive behavioral responses can be obtained to sustain the growth and profitability. This research adds value to the growing body of literature on customer loyalty by identifying the relationships between two broad dimensions: attitudinal and behavioral. The study empirically substantiates that an attitude–behavior relationship is significant to achieve true customer loyalty.
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Stocks, Greg, und Sean Slater. „Training in positive behavioural support: increasing staff self-efficacy and positive outcome expectations“. Tizard Learning Disability Review 21, Nr. 2 (04.04.2016): 95–102. http://dx.doi.org/10.1108/tldr-04-2015-0020.
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Purpose – The purpose of this paper is to investigate the impact of a six-and-a-half day, Positive Behaviour Support (PBS) informed training course on staff’s self-efficacy and outcome expectations of managing challenging behaviour (CB). Training programmes for other non-psychology staff were deemed necessary due to the high demand for services and the specialist knowledge held by other professionals or carers. Design/methodology/approach – A repeated measures design was used to capture changes in specific self-efficacy and outcome expectations before and after the training programme. A questionnaire methodology was employed. Findings – Staff self-efficacy and positive outcome expectations increased on all four measured variables following training: understanding of CB, working out the functions of CB, developing and implementing a PBS plan, and managing CB for the benefit of the service user. Research limitations/implications – These findings are considered in light of previous research suggesting an impact on staff practice and burnout. Practical implications – The findings suggest that the training model delivers changes in staff cognition and may be useful in other locations where demand for services is likely to increase in the future. Originality/value – This research considers the impact of a medium length PBS training on staff cognition, evidencing the model’s utility in the current service context.
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Morris, Christopher J., Taylor E. Purvis, Joseph Mistretta und Frank A. J. L. Scheer. „Effects of the Internal Circadian System and Circadian Misalignment on Glucose Tolerance in Chronic Shift Workers“. Journal of Clinical Endocrinology & Metabolism 101, Nr. 3 (01.03.2016): 1066–74. http://dx.doi.org/10.1210/jc.2015-3924.
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Abstract Context: Shift work is a risk factor for diabetes. The separate effects of the endogenous circadian system and circadian misalignment (ie, misalignment between the central circadian pacemaker and 24-hour environmental/behavioral rhythms such as the light/dark and feeding/fasting cycles) on glucose tolerance in shift workers are unknown. Objective: The objective of the study was to test the hypothesis that the endogenous circadian system and circadian misalignment separately affect glucose tolerance in shift workers, both independently from behavioral cycle effects. Design: A randomized, crossover study with two 3-day laboratory visits. Setting: Center for Clinical Investigation at Brigham and Women's Hospital. Patients: Healthy chronic shift workers. Intervention: The intervention included simulated night work comprised of 12-hour inverted behavioral and environmental cycles (circadian misalignment) or simulated day work (circadian alignment). Main Outcome Measures: Postprandial glucose and insulin responses to identical meals given at 8:00 am and 8:00 pm in both protocols. Results: Postprandial glucose was 6.5% higher at 8:00 pm than 8:00 am (circadian phase effect), independent of behavioral effects (P = .0041). Circadian misalignment increased postprandial glucose by 5.6%, independent of behavioral and circadian effects (P = .0042). These variations in glucose tolerance appeared to be explained, at least in part, by different insulin mechanisms: during the biological evening by decreased pancreatic β-cell function (18% lower early and late phase insulin; both P ≤ .011) and during circadian misalignment presumably by decreased insulin sensitivity (elevated postprandial glucose despite 10% higher late phase insulin; P = .015) without change in early-phase insulin (P = .38). Conclusions: Internal circadian time affects glucose tolerance in shift workers. Separately, circadian misalignment reduces glucose tolerance in shift workers, providing a mechanism to help explain the increased diabetes risk in shift workers.
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Travert, Anne-Sophie, Kristi Sidney Annerstedt und Meena Daivadanam. „Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions—A Review of Reviews“. International Journal of Environmental Research and Public Health 16, Nr. 8 (24.04.2019): 1454. http://dx.doi.org/10.3390/ijerph16081454.
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A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals’ behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.
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Bao, Chenzhang, und Indranil Bardhan. „Antecedents of patient health outcomes in dialysis clinics: a national study“. Journal of Centrum Cathedra 10, Nr. 1 (10.07.2017): 25–48. http://dx.doi.org/10.1108/jcc-09-2016-0015.
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Purpose The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and dialysis practice characteristics. The dialysis industry is facing a major transition from a volume-based health care system to a value-based cost-efficient care model, in the USA. Under the bundled Prospective Payment System, the treatment-based payment model is subject to meeting quality thresholds as defined by clinical process measures including dialysis adequacy and anemia management. Few studies have focused on studying these two processes and their association with the quality of patient health outcomes. Design/methodology/approach In this study, the authors focus on identifying the determinants of patient health outcomes among freestanding dialysis clinics, using a large cross-sectional data set of 4,571 dialysis clinics in the USA. The authors use econometric analyses to estimate the association between dialysis facility characteristics and practice patterns and their association with dialysis process measures and hospitalization risk. Findings The authors find that reusing dialyzers and increasing the number of dialysis stations is associated with higher levels of clinical quality. This research indicates that deploying more nurses on-site allows patients to avail adequate dialysis, while increasing the supply of physicians can hurt anemia control process. In addition, the authors report that offering peritoneal dialysis and late night shifts are not beneficial practices in terms of their impact on the hospitalization risk. Research limitations/implications While early studies of dialysis care mainly focused on the associations between practice patterns and patient outcomes, this research reveals the underlying mechanisms of these relationships by exploring the mediation effects of clinical dialysis processes on patient outcomes. The results indicate that dialysis process measures mediate the impact of the operational characteristics of dialysis centers on patient hospitalization rates. Practical implications This study offers several managerial insights for owners and operators of dialysis clinics with respect to the association between managerial and clinical practices that they deploy within dialysis clinics and their impact on clinical quality measures as well as hospitalization risk of patients. Managers can draw on this study to optimize staffing levels in their dialysis clinics, and implement innovative clinical practices. Social implications Considering the growth in healthcare expenditures in developing and developed countries, and specifically for costly diagnoses such as dialyses, this study offers several insights related to the inter-relationships between dialysis practice patterns and their clinical quality measures. Originality/value This study makes several major contributions. First, the authors address the extant gap in the literature on the relationships between dialysis facility and practice characteristics and clinical outcomes, while specifically highlighting the role of clinical process measures as antecedents of patient hospitalization ratio, a key metric used to measure performance of dialysis clinics. Second, this study sheds light on the underlying mechanisms that serve as enablers of the dialysis adequacy and anemia management. To the best of the authors’ knowledge, this is the first study to explore these relationships in the dialysis industry. The authors’ approach provides a new direction for future studies to explore the pathways that may impact clinical quality measures in the delivery of dialysis services.
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Johnson, Adrienne L., Anthony H. Ecker, Terri L. Fletcher, Natalie Hundt, Michael R. Kauth, Lindsey A. Martin, Geoffrey M. Curran und Jeffrey A. Cully. „Increasing the impact of randomized controlled trials: an example of a hybrid effectiveness–implementation design in psychotherapy research“. Translational Behavioral Medicine 10, Nr. 3 (26.11.2018): 629–36. http://dx.doi.org/10.1093/tbm/iby116.
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Abstract Randomized controlled trials (RCTs) are the gold standard for clinical research. However, significant delays between completion of RCTs and adoption of evidence-based practices into clinical settings remain. Engagement of stakeholders and implementation-focused outcomes to augment traditional RCTs hold the potential to increase the impact of RCT outcomes for clinical practice and more rapidly lead to the adoption of evidence-based practices in clinical settings. The purpose of this study is to discuss hybrid effectiveness–implementation designs and use a project example to highlight important methodological considerations to enhance the impact of RCTs. A hybrid effectiveness–implementation study assessed the effectiveness and implementation potential of brief cognitive behavioral therapy (bCBT) for rural Veterans. A patient-randomized trial (bCBT vs. enhanced usual care) explored the impact on depression symptoms. Implementation elements included engagement of stakeholders and a multifaceted provider training and support program to increase bCBT use by providers in Veterans Health Administration (VA) community-based outpatient clinics. Implementation outcomes included the number of providers who adopted bCBT, provider fidelity, and delivery outcomes (e.g., use of measurement-based care, treatment engagement, and completion). Hybrid designs offer opportunities to improve the alignment between research and practice, potentially improving dissemination of evidence-based interventions and reducing known delays in the translation from research to practice. Expansion of traditional RCTs through collaborative stakeholder contributions and stakeholder/consumer-informed implementation approaches is critical to improve adoption postproject. Although hybrid designs offer significant benefits related to generalizability and adoption, these approaches involve complex procedures and processes and often come at the cost of reduced internal study controls.
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Mariotti, P., G. Delia Marca, L. Iuvone, S. Vernacotola, R. Ricci, G. F. Mennunl und S. Mazza. „Sleep Disorders in Sanfilippo Syndrome: A Polygraphic Study“. Clinical Electroencephalography 34, Nr. 1 (Januar 2003): 18–22. http://dx.doi.org/10.1177/155005940303400108.
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Objective: A high prevalence of sleep disorders is reported in patients affected by Mucopolysaccharidosis III (Sanfilippo syndrome). These disorders have never been investigated by prolonged, objective, and instrumental evaluations. The present work is based on sleep duration and structure in Sanfilippo patients. Study design: The features of sleep/wake cycle in 6 Sanfilippo patients and 6 healthy controls were evaluated by means of sleep diaries and 48 hour ambulatory EEG and polygraphic recordings. Statistical analysis was performed by means of the U-test (Mann-Whitney). Results: Four out of six Sanfilippo patients, the oldest patients in our sample, showed an extremely irregular sleep pattern, with several sleep episodes of inconstant duration, irregularly distributed along 24 hours. The two younger patients showed sleep maintenance insomnia with several nocturnal awakenings. Conclusions: These results suggest that sleep disruption in Sanfilippo syndrome consists of an irregular sleep/wake pattern, which at its onset might appear as a disorder of initiating or maintaining sleep. This could explain why some patients do not respond to conventional hypnotics. The present observation might suggest attempting therapies aimed at resynchronization, such as behavioral treatment, light therapy or melatonin.
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Tirelli, Umberto, Ernesto Zanet, Michele Spina und Mariagrazia Michieli. „Cancer survivorship: Is there a role for cancer survivor clinics?“ Journal of Clinical Oncology 34, Nr. 3_suppl (20.01.2016): e272-e272. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.e272.
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e272 Background: The population of survivors of cancer is increasing worldwide. In Italy, 2,243,953 patients (4% of the Italian population) survived after a cancer diagnosis in 2006. The drafting of survivorship care plans (SCPs), consisting of a written treatment summary and a follow-up care plan, is regarded by both the Institute of Medicine and the American Society of Clinical Oncology as an essential step in the care of survivors of cancer. However, Salz et al. in 2013 reported in Cancer that although oncology providers have positive feelings regarding SCPs, only 52% of them ever provided any component of an SCP to their patients. Ultimately, the lack of integration of SCPs into clinical practice is due to the absence of definite guidance regarding what constitutes standards of care for survivors of cancer. Methods: We propose the establishment of cancer survivor clinics (CSCs), which consist of health professionals (i.e., medical oncologists; radiation therapists; psychologists; nurses; and other physicians such as cardiologists, gynecologists, and urologists) dedicated to the care of survivors of cancer who we have previously defined as disease and treatment free for at least 5 years and that is established within our Institution since 2013. Results: The number of these CSCs should be planned in relation to the estimated number of survivors of cancer in each country and designed within the medical oncology departments. Conclusions: CSCs should assess: 1) the occurrence of any known side effects from cancer or its treatment (i.e., neurocognitive problems, premature menopause, infertility, cardiorespiratory system dysfunctions, and chronic fatigue); 2) the concomitant presence of comorbidities and their influence on the patient’s general health status; 3) psychological disturbances (i.e., fear of cancer recurrence, anxiety, depression, and body image perception disorders); and 4) problems regarding social and employment reintegration. Moreover, CSCs should provide screening guidelines for cancer recurrence and second primary tumors, design proper clinical follow-up pathways, promote behavioral changes (i.e., smoking cessation and alcohol intake reduction), and improve screening and prevention programs for the relatives of cancer survivors.
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Shareh, Hossein, und Zahra Robati. „Effect of Cognitive-Behavioral Group Therapy on Pain Self-efficacy, Fatigue, Life Expectancy and Depression in Patients With Multiple Sclerosis: A Randomized Controlled Clinical Trial“. Iranian Journal of Psychiatry and Clinical Psychology 26, Nr. 4 (01.01.2021): 418–31. http://dx.doi.org/10.32598/ijpcp.26.3.225.11.
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Objectives: The present study aims to investigate the effect of Cognitive-Behavioral Group Therapy (CBGT) on pain self-efficacy, fatigue, life expectancy and depression in patients with Multiple Sclerosis (MS). Methods: In this quasi-experimental clinical trial with a pretest/posttest design, 68 patients with MS referred to MS clinics and MS Association of Razavi Khorasan Province, Iran were selected using a convenience sampling technique, and were then assigned into intervention and control groups. The intervention group received ten 2-hour weekly sessions of CBGT, while the control group received no treatment. In the pretest and posttest phases, Pain Self-Efficacy Questionnaire (PSEQ), Fatigue Severity Scale (FSS), Snyder’s Adult Hope Scale (AHS) and Beck Depression Inventory-Second Edition (BDI-II) were completed by all subjects. The collected data were analyzed using ANCOVA and t-test. Results: The CBGT significantly improved pain self-efficacy (P=0.001) and life expectancy (P=0.001) and reduced fatigue (P=0.02) and depression (P=0.003) in the intervention group compared to the control group. Conclusion: CBGT can increase pain self-efficacy, life expectancy and reduce fatigue and depression in patients with MS.
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Moulana, Mohadetheh, Crystal S. Lim und Anju P. Sukumaran. „High risk of psychological disorders: anxiety and depression in adolescent girls with polycystic ovary syndrome“. Endocrinology&Metabolism International Journal 8, Nr. 3 (29.06.2020): 73–77. http://dx.doi.org/10.15406/emij.2020.08.00282.
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Study objective: This study is aimed to assess the prevalence of psychological disorders among different racial/ethnic group of normal weight and overweight adolescents with polycystic ovary syndrome (PCOS)from a state in southeastern US. Design, setting, and participants: The data of 157,459 adolescents were collected through “the Patient Cohort Explorer” system at the University of Mississippi Medical Center (UMMC) from January 2013 to December 2019.Unidentified patients were searched with diagnosis code for PCOS, age, race/ethnicity, and associated diagnosis including weight gain, anxiety, depression, ADHD, and behavioral concerns. Interventions: None. Main outcome measures: Prevalence of PCOS and psychological disorders. Results: A total of 712 adolescents with PCOS were diagnosed in clinics during the period of study. Collected data indicated that prevalence of PCOS in adolescents seen in clinics was less than 1% with no significant difference by race or ethnicity. Almost 45% of patients suffered from one or more psychological disorders. (Anxiety: 18%, Depression: 16%, ADHD: 9%). Conclusions: Results from this study provide the first evidence of prevalence of PCOS and psychological disorders in adolescents with PCOS in a southern state. Our findings of a high prevalence of psychological disorders suggest that early screening for mental health symptoms must be considered during primary care clinical assessment of adolescents with PCOS. Left undiagnosed and/or untreated, chronic anxiety and depression may exacerbate mental health issues in this vulnerable population.
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Rodriguez, Violeta J., Antonio Chahine, Aileen de la Rosa, Tae Kyoung Lee, Nicholas V. Cristofari, Deborah L. Jones, Robert Zulu, Ndashi Chitalu und Stephen M. Weiss. „Identifying factors associated with successful implementation and uptake of an evidence-based voluntary medical male circumcision program in Zambia: the Spear and Shield 2 Program“. Translational Behavioral Medicine 10, Nr. 4 (16.05.2019): 970–77. http://dx.doi.org/10.1093/tbm/ibz048.
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Abstract Voluntary medical male circumcision has been shown to provide a 50%–70% reduction in the risk of HIV infection without contributing to behavioral disinhibition of safer sexual practices. This study examined the interim implementation and dissemination data of Spear and Shield 2, an HIV risk-reduction program in Zambia. The purpose of this interim review was to identify contextual challenges to implementation and implement midcourse corrections associated with sustainability of program delivery. Using a mixed-methods design, quantitative evaluations of organizational functioning, barriers to implementation, burnout, and organizational readiness, as well as qualitative data utilizing the Consolidated Framework for Implementation Research (CFIR), were examined to evaluate program implementation. Participants were 184 health care providers from 46 clinics in Zambia. Successful implementation was associated with better community and leader support, and employee readiness and motivation. Quantitative assessments were not related to implementation and provided a limited picture of implementation outcomes. Results suggest that the qualitative data underlying the CFIR constructs provided a nuanced, contextual assessment of implementation, and dissemination outcomes. The CFIR may be valuable in informing the implementation of evidence-based interventions in other parts of Zambia.
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Foo, Chai Nien, Manohar Arumugam, Rampal Lekhraj, Munn-Sann Lye, Sherina Mohd-Sidik und Zubaidah Jamil Osman. „Effectiveness of Health-Led Cognitive Behavioral-Based Group Therapy on Pain, Functional Disability and Psychological Outcomes among Knee Osteoarthritis Patients in Malaysia“. International Journal of Environmental Research and Public Health 17, Nr. 17 (26.08.2020): 6179. http://dx.doi.org/10.3390/ijerph17176179.
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Background: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia. Methods: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat. Results: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI −1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing. Conclusion: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.
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Abraham, Traci H., Kathy Marchant-Miros, Michael B. McCarther, Michelle G. Craske, Geoffrey M. Curran, Lisa K. Kearney, Carolyn Greene, Jan A. Lindsay und Michael A. Cucciare. „Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach“. JMIR Mental Health 5, Nr. 3 (22.08.2018): e10277. http://dx.doi.org/10.2196/10277.
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Background A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. Objective The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. Methods An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. Conclusions The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.
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Rosen, Craig S., C. Adrian Davis, David Riggs, Jeffery Cook, Alan L. Peterson, Stacey Young-McCaughan, Katherine Anne Comtois et al. „Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS) to increase evidence based psychotherapy in military behavioral health clinics: Design of a cluster-randomized stepped-wedge implementation study“. Contemporary Clinical Trials 93 (Juni 2020): 106008. http://dx.doi.org/10.1016/j.cct.2020.106008.
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McCreary, Michael, Armen C. Arevian, Madeline Brady, Ana E. Mosqueda Chichits, Lily Zhang, Lingqi Tang und Bonnie Zima. „A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study“. JMIR Mental Health 6, Nr. 4 (23.04.2019): e12358. http://dx.doi.org/10.2196/12358.
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Background National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. Objective The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. Methods Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. Results A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. Conclusions Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. Trial Registration ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW)
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Yakov, Svetlana, Badari Birur, Melissa F. Bearden, Barbara Aguilar, Kinjal J. Ghelani und Rachel E. Fargason. „Sensory Reduction on the General Milieu of a High-Acuity Inpatient Psychiatric Unit to Prevent Use of Physical Restraints: A Successful Open Quality Improvement Trial“. Journal of the American Psychiatric Nurses Association 24, Nr. 2 (17.10.2017): 133–44. http://dx.doi.org/10.1177/1078390317736136.
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BACKGROUND: Impaired sensory gating in patients with acute mental illness predisposes to overstimulation and behavioral dyscontrol. OBJECTIVE: Explore use of sensory reduction interventions on a high-acuity inpatient milieu to reduce high assault/restraint rates. DESIGN: A multidisciplinary team using failure mode and effect analysis to explore high restraint use between 4:00 p.m. and 7:00 p.m. observed patient/staff overstimulation contributed to behavioral escalations. The team implemented sensory reduction/integration improvements over a 5-month period to prevent excessive restraint use. RESULTS: Restraint rates dropped immediately following light and sound reduction interventions and by 72% at 11 months postimplementation. Mann-Whitney statistics for unpaired 6-month comparisons, 1-year pre- and postintervention showed significant reductions: Assault rates (median pre = 1.37, post = 0.18, U = 4, p = .02); Restraint rates (median pre = 0.50, post = 0.06, U = 0, p = .002). CONCLUSION: Sensory reduction during a high-stress time period on a high-acuity psychiatric unit was associated with a reduction in assaults and restraints.
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Eshaghi Farahmand, Seyed Reza, Hassan Ahadi, Maryam Kalhornia Golkar und Mastoreh Sedaghat. „Comparison of the Effectiveness of Music Therapy and Cognitive Behavioral Therapy on Quality of Life, Craving and Emotion Regulation in Patients Under Methadone Maintenance Therapy“. Iranian Journal of Psychiatry and Clinical Psychology 26, Nr. 2 (01.07.2020): 170–87. http://dx.doi.org/10.32598/ijpcp.26.2.3212.1.
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Objectives: The purpose of this study was to compare the effectiveness of Music Therapy and Cognitive Behavioral Therapy on Quality of Life (QoL), craving, and emotional regulation in patients under methadone maintenance therapy. Methods: The method of the study was quasi-experimental and multi-group pre-test and post-test design. The statistical population consisted of all clients treated with methadone maintenance therapy in addiction treatment clinics affiliated with Tehran Health Organization in 2018. Then 54 people of whom (18 in each group) were selected through purposeful sampling in two experimental groups (Music-Therapy and Cognitive Behavioral Therapy) and a control group was included. The data was collected using the Cognitive Emotion Regulation Questionnaire, the Quality of Life Questionnaire, and Craving Questionnaire. The ANCOVA was used for data analysis. Results: The results showed that both Music Therapy and Cognitive Behavioral Therapy Improved the QoL, emotion regulation in the experimental group compared to the control group and significantly reduced craving (P<0.01). The results of the follow-up test showed that the mean scores of the experimental groups in the study variables were significantly different from the control group. Conclusion: There was a significant difference between the treatment groups in terms of their effect on the QoL and negative cognitive emotion regulation so that Cognitive Behavioral Therapy was more effective in regulating negative emotions and enhancing the QoL but there was no significant difference in regulating for positive emotions and reducing craving. These results suggest that both treatments significantly increase the QoL, emotional regulation, and it reduces craving.
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Bonsu, Frank, Felix Afutu, Nii Nortey Hanson-Nortey, Mary-Anne Ahiabu und Joshua Amo-Adjei. „Satisfaction of tuberculosis patients with health services in Ghana“. International Journal of Health Care Quality Assurance 30, Nr. 6 (14.08.2017): 545–53. http://dx.doi.org/10.1108/ijhcqa-10-2016-0146.
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Purpose Within human services, client satisfaction is highly prioritised and considered a mark of responsiveness in service delivery. A large body of research has examined the concept of satisfaction from the perspective of service users. However, not much is known about how service providers construct client satisfaction. The purpose of this paper is to throw light on healthcare professionals’ perspectives on patient satisfaction, using tuberculosis (TB) clinics as a case study. Design/methodology/approach In-depth interviews were conducted with 35 TB clinic supervisors purposively sampled from six out of the ten regions of Ghana. An unstructured interview guide was employed. The recorded IDIs were transcribed, edited and entered into QSR NVivo 10.0 and analysed inductively. Findings Respondents defined service satisfaction as involving education/counselling (on drugs, nature of condition, sputum production, caregivers and contacts of patients), patient follow-up, assignment of reliable treatment supporters as well as being attentive and receptive to patients, service availability (e.g. punctuality at work, availability of commodities), positive assurances about disease prognosis and respect for patients. Practical implications Complementing opinions of health service users with those of providers can offer key performance improvement areas for health managers. Originality/value To the best of the authors’ knowledge, this is a first study that has examined healthcare providers’ views on what makes their clients satisfied with the services they provide.
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Jalalianhosseini, Mahshid, Kara Freihoefer, Nancy Doyle und Amanda Simpson. „The Impact of Infusion Center Layout on Workflow and Satisfactions in Two Cancer Infusion Centers: A Case Study on Staff and Patients“. HERD: Health Environments Research & Design Journal 13, Nr. 3 (29.11.2019): 70–83. http://dx.doi.org/10.1177/1937586719888221.
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Objective: The objective of this empirical research is to compare nurses’ operational workflow and nurses’ and patients’ satisfactions of two different infusion center designs. One center has a traditional open bay design and the other has semi-private bays. This study also intends to gather baseline data to compare to a future post-occupancy evaluation of a new infusion center where the two existing centers will be combined. Background: The increasing number of patients with cancer diagnosis who refer to infusion centers highlights the importance of design of these centers. Method: The mixed-method approach of this study involves shadowing nurses and surveying nurses and patients. Data collection captured nurses’ activities, activity durations, and nurses’ and patients’ satisfaction with the design of clinics. Results: Comparison of shadowing data indicated that although the infusion centers have different layouts, there are no significant differences in the activities or time spent by nurses in different areas among the centers. Staff, however, have different satisfaction levels with visual and speech privacy, ability to concentrate without distraction, collaboration with other staff, and the process of medication delivery. Patients also had slightly different satisfaction levels with their ability to communicate with staff and design of bays. Conclusion: This research sheds light on operational workflows and satisfaction of staff and patients in two different infusion center design. Considering the limited studies on these settings, this study serves as baseline data to compare to other studies on cancer infusion centers and addresses issues of benchmarking and staff and patient satisfaction.
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Horn, Eva M., und Steven F. Warren. „Facilitating the Acquisition of Sensorimotor Behavior with a Microcomputer-Mediated Teaching System: An Experimental Analysis“. Journal of the Association for Persons with Severe Handicaps 12, Nr. 3 (September 1987): 205–15. http://dx.doi.org/10.1177/154079698701200306.
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The effects of a combined neuromotor/behavioral approach on the acquisition of basic motor skills by young children with severe and multiple disabilities was examined. Two children, 17 and 24 months of age, were provided training via a microcomputer-mediated teaching system. Specific questions addressed were: (a) Do basic motor skills improve as a result of direct training using a neuromotor/behavioral approach? (b) Does generalization occur to other settings? (c) Do students demonstrate maintenance of the target skills once training has been terminated? (d) Can the microcomputer-mediated teaching system accurately reinforce and measure students' performance of the target motor behaviors? A multiple probe across behaviors design was used. Results indicated that the children increased the frequency and duration of the target behaviors in both the training and generalization settings. Maintenance of the effects was also demonstrated. These findings are discussed in light of the efficacy of using a neuromotor/behavioral training approach. Issues related to the implementation of a microcomputer-mediated teaching system in a classroom setting are also discussed.
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Barnhart, Janice M., Natania D. Wright, Katherine Freeman, Frank Silagy, Nereida Correa und Elizabeth A. Walker. „Risk Perception and its Association with Cardiac Risk and Health Behaviors among Urban Minority Adults: The Bronx Coronary Risk Perception Study“. American Journal of Health Promotion 23, Nr. 5 (Mai 2009): 339–42. http://dx.doi.org/10.4278/ajhp.07072574.
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Purpose. Examine the relationship among risk perceptions, health behaviors, and a measure for actual risk of coronary heart disease (CHD). Design. Cross-sectional survey. Setting/Subjects. Adults from three outpatient medical clinics with at least one CHD risk factor. Measures. Perceived risk using the new Coronary Risk, Individual Perception (CRIP) scale, an index of CHD risk, and summary scores for self-reported diet and exercise. Analysis. Bivariate associations using Spearman rank and Kruskal-Wallis; multiple regression models for outcomes (health behaviors). Results. The 16-item CRIP scale had acceptable internal consistency (α = 0.76; interitem total correlation = 0.34 ± 0.17). The response rate was 80.3%, and the mean age of 256 respondents was 56.6 (± 9.9) years; 70 % were women, 63% Hispanic, and 27% black. CRIP scores were inversely associated with low fat/high fiber intake (r = −0.17; p = .007) and exercise (r = −0.19; p = .003). Among respondents with three or more CHD risk factors (n = 132), 44 % perceived themselves to be at low risk for CHD. In multivariable models, men with high CRIP scores had higher fat intake than women (p = .02), but men exercised more (p = .04). Conclusions. In this study, gender moderated the relationship between risk perception and health behaviors, and many respondents underestimated their risk of CHD. Behavioral intervention research aimed at reducing cardiometabolic risk in minority populations should resolve differences between perceived and actual risk of CHD to foster lifestyle changes and examine temporal relationships between risk perception and health behaviors.
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Stumbo, Scott P., Bobbi Jo H. Yarborough, Micah T. Yarborough und Carla A. Green. „Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses“. American Journal of Health Promotion 32, Nr. 8 (15.04.2018): 1730–39. http://dx.doi.org/10.1177/0890117118763233.
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Purpose: Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Design: Cross-sectional; mixed methods. Setting: An integrated health system and a network of federally qualified health centers and safety net clinics. Participants: Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Measures: Semi-structured interviews and surveys. Analysis: Thematic analysis for qualitative data; frequencies for quantitative data. Results: More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Conclusions: Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
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Delaney, Rebecca K., Brittany Sisco-Taylor, Angela Fagerlin, Peter Weir und Elissa M. Ozanne. „A systematic review of intensive outpatient care programs for high-need, high-cost patients“. Translational Behavioral Medicine 10, Nr. 5 (Oktober 2020): 1187–99. http://dx.doi.org/10.1093/tbm/ibaa017.
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Abstract Five percent of the patient population accounts for 50% of U.S. healthcare expenditures. High-need, high-cost patients are medically complex for numerous reasons, often including behavioral health needs. Intensive outpatient care programs (IOCPs) are emerging, innovative clinics which provide patient-centered care leveraging multidisciplinary teams. The overarching goals of IOCPs are to reduce emergency department visits and hospitalizations (and related costs), and improve care continuity and patient outcomes. The purpose of this review was to examine the effectiveness of IOCPs on multiple outcomes to inform clinical care. A systematic search of the literature was conducted to identify articles. Six studies were included that varied in rigor of research design, analysis, and measurement of outcomes. Most studies reported results on healthcare utilization (n = 4) and costs (n = 3), with fewer reporting results on patient-reported and health-related outcomes (n = 2). Overall, there were decreasing trends in emergency department visits and hospitalizations. However, results on healthcare utilization varied based on time of follow-up, with shorter follow-up times yielding more significant results. Two of the three studies that evaluated costs found significant reductions associated with IOCPs, and the third was cost-neutral. Two studies reported improvements in patient-reported outcomes (e.g., satisfaction, depression, and anxiety). Overall, these programs reported positive impacts on healthcare utilization and costs; however, few studies evaluated patient characteristics and behaviors (e.g., engagement in care) which may serve as key mechanisms of program effectiveness. Future research should examine patient characteristics, behaviors, and clinic engagement metrics to inform clinical practice.
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Spoth, Richard, und David M. Dush. „A Multicomponent Minimal Intervention Health Promotion Program: Preliminary Results“. International Quarterly of Community Health Education 8, Nr. 2 (Juli 1987): 139–56. http://dx.doi.org/10.2190/j3lk-2yhq-ajr5-g79v.
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This article reports two preliminary studies examining whether a minimal intervention cardiac risk education program incorporating behavioral components to enhance self-efficacy could effectively change health behaviors. The first study utilized a quasi-experimental design in evaluating workshop outcome among 131 AFL-CIO union members. A MANCOVA performed on self-report and physiological outcome measures suggested a significant difference between treatment and waiting list control groups, primarily in the area of nutrition. In the second true experimental study, participants were 307 “at-risk” employees of a local school system. A MANCOVA at a four month follow-up revealed significant differences in several reported health behaviors including Type A behavior, smoking, and nutrition. Results also showed the program's effectiveness was consistent across sex, age, and severity of participants' health risk. Implications for further research on the cost-effectiveness of brief health promotion interventions are discussed in light of the observed impact and the high level (80%) of employee interest and participation.
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Pestka, Debbie, Lindsay Sorge, Jordan Mendkoff, Caitlin Frail, Kylee Funk, Todd Sorensen, Mary Roth McClurg und Jennifer Carroll. „Assessing the State of Comprehensive Medication Management in a Sample of Primary Care Clinics“. INNOVATIONS in pharmacy 10, Nr. 1 (17.01.2019): 5. http://dx.doi.org/10.24926/iip.v10i1.1611.
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OverviewComprehensive medication management (CMM) is an important tool to address medication-related morbidity and mortality and reduce health care costs. Medication therapy problems (MTPs) are a significant and costly barrier to improving patient outcomes1 and with more than half of all Americans taking at least one prescription drug,2 the need to manage and optimize patients’ medications is greater than ever.
This report examines select practice and practitioner characteristics of the primary care clinics that participated in the research project, Enhancing Performance in Primary Care Medical Practice through Implementation of Comprehensive Medication Management. To be eligible to participate, sites had to have: established relationships with care team providers, a way of electronically identifying patients most in need of CMM, reporting processes in place for CMM data, read/write access in the electronic medical record, and an established CMM practice or a commitment to providing CMM. Because of these inclusion criteria, most participating clinics had CMM services in place for several years and were mature in their design and delivery of services.
Site characteristics around the following areas were assessed: pharmacist and clinic demographics, delivery of pharmacy services, collaboration, billing and payment for CMM, and measuring CMM outcomes. The results of this report shed light on how CMM is being delivered in a sample of established CMM practices and therefore may provide benefit to those practitioners interested in building their own CMM practice.
Article Type: Original Research
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Quigley, Robert Lawrence, Lisbeth Claus und Ashley Nixon. „Behavioral health morbidity for those studying or working internationally“. Journal of Global Mobility 3, Nr. 4 (14.12.2015): 418–35. http://dx.doi.org/10.1108/jgm-10-2014-0051.
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Purpose – The increase in prevalence of behavioral health issues among college and university students is burdening the scholastic sector both domestically and internationally. More American students participate in study abroad programs than ever before. These provide educational institutions with additional duty of care challenges and responsibilities especially when it comes to their health status while studying or working abroad. The requests for assistance to an assistance service provider of students from US universities studying abroad were compared to international assignees from US employers in terms of closing diagnoses and case outcome types. The purpose of this paper is to indicate that there are differences in diagnoses and case outcomes between students studying abroad and employees working abroad. Students are more likely than international assignees to be diagnosed with behavioral health issues, to be referred to a health provider (rather than being treated through in-patient care) and to be evacuated or repatriated. It is recommended that US universities change their duty of care practice from the “inform and prepare” to a higher level benchmark, commonly practiced in the US corporate sector, of “assess, assist and protect.” Design/methodology/approach – US employers and universities often contract with a service provider for international travel assistance for their traveling employees/students. The sample consisted of case records of a large assistance service provider based on request for assistance (RFAs) by international assignees and students from its different US client organizations (US employers and universities) over a 24-month period (January 1, 2010 to December 31, 2011), with all client travel originating in the USA and traveling abroad. A two-year framework was used to include a larger sample of short- and long-term international assignees. The individual requesting assistance (student or international assignee) was the primary unit of analysis. The multiple case records can be viewed as a “case study” of an assistance provider (Yin, 2014). According to Yin’s case study design typology, this research used a single case (embedded) design. It is a single case study of client records from a global assistance provider of medical and security services for international travelers. The case study was embedded because it involved more than one unit of analysis. The case study included 17,071 records from two different subunits: 831 students studying abroad from 82 US universities and 16,240 US international assignees working for 889 US employers requesting assistance for health-related issues from the global service provider. The US client organizations included universities with study abroad programs and employers of different sizes and industries who have global mobility programs. Findings – The hypotheses related to different diagnoses and outcomes based on RFAs while working or studying internationally were confirmed in spite of the fact the age and gender (important antecedents of morbidity) were controlled. Compared to international assignees, students are more likely to be diagnosed with behavioral health issues, more likely to be referred to a health provider (rather than being treated) and more likely to be evacuated/repatriated. This not only shows the importance of behavioral issues among students while studying abroad but also indicates that the corporate organizational support structures for international assignees are different than those universities provide to students. Research limitations/implications – This study assessed how RFAs by students studying abroad differed from international assignees working in corporate organizations. With this type of case study, the mode of generalization is “analytic” rather than “statistical.” In analytic generalization, the empirical results of the case study are compared to a previously developed theory (Yin, 2004, p. 38). As a result, the authors are striving to generalize the particular empirical results of students and international assignees to the broader institutional theory. Practical implications – The research has implications for further research. First, these results can be replicated with other samples of students studying abroad. If replications result in similar findings, indicating that students have increased risk of being diagnosed with behavioral health conditions, this finding can be probed for a better understanding of both process and outcome. For instance, future research can delineate the specific behavioral health diagnoses the students are receiving, which can have important implications for behavioral health care providers, educational duty of care considerations, as well as direct future research in this area. An additional area of critical importance for future research will be elucidating the students’ systemic experience of increased stress associated by studying abroad, the subsequent psychological and physiological responses, as well as how students are impacted by this stress. There are also some systemic stresses that are unique to the study/work abroad context. Many of the administrative requirements (such as required paperwork for travel, visas, travel scholarships, funding, vaccinations, health care, etc.) are taken care of for international assignees by their employers through the global mobility division. They are not necessarily done by universities for their students. Students are largely responsible for these themselves although with some guidance through the study abroad program staff. Researchers can also examine how cultural adjustment models apply to students studying abroad. For instance, how might changes in anticipatory adjustment impact student development of behavioral health conditions, including both individual factors such as pre-travel training, as well as organizational factors such as selection systems designed to identify those that could need additional behavioral health support while they are abroad. Likewise, in-country adjustment can also be evaluated in future research to identify individual, organizational and cultural aspects that could be associated with increased behavioral health diagnoses in students. Such research can shed more light on this understudied population, illuminating the steps that university can take, with regard to duty of care concerns, to ensure students have safe and beneficial experiences abroad. Social implications – The population of corporate international assignees is emotionally more mature and more experienced in world travel and therefore more likely to be adaptable to the challenges of traveling and living abroad than the study abroad population of students. As more students enroll in study abroad programs, the absence of an infrastructure to support behavioral health issues at the time of enrollment, while on-site and upon return will only result in more exposure for both students and educational institutions. E-learning tools, and even anonymous student self-exams can assist in determining fitness for study abroad. Simultaneously, colleges and universities must educate their local and distant faculty/team leaders, host institutions as well as other students to recognize and react appropriately to a behavioral health crisis. Adherence to such a strategy will certainly help to mitigate the risk of a failed study abroad experience. Although this study is limited to US students traveling overseas, behavioral health is an issue with students globally. American institutions hosting foreign students should, therefore, re-evaluate their existing domestic resources to accommodate the psychological needs of their visiting international students. It is the authors recommendation that, prior to travel, students should develop greater self-awareness, with or without the assistance of a professional. Implementing these recommendations will move university duty of care practice from the “inform and prepare” to a higher level benchmark, commonly practiced in the corporate sector, of “assess, assist and protect.” Originality/value – With regard to case outcomes, students had lower odds of experiencing severe outcomes, such as in- and out-patient care, than international assignees. Similarly, students had lower odds of being evacuated or repatriated than international assignees.
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Cordone, Susanna, Serena Scarpelli, Valentina Alfonsi, Luigi De Gennaro und Maurizio Gorgoni. „Sleep-Based Interventions in Alzheimer’s Disease: Promising Approaches from Prevention to Treatment along the Disease Trajectory“. Pharmaceuticals 14, Nr. 4 (19.04.2021): 383. http://dx.doi.org/10.3390/ph14040383.
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The multifactorial nature of Alzheimer’s disease (AD) has led scientific researchers to focus on the modifiable and treatable risk factors of AD. Sleep fits into this context, given the bidirectional relationship with AD confirmed by several studies over the last years. Sleep disorders appear at an early stage of AD and continue throughout the entire course of the pathology. Specifically, sleep abnormalities, such as more fragmented sleep, increase in time of awakenings, worsening of sleep quality and primary sleep disorders raise with the severity and progression of AD. Intervening on sleep, therefore, means acting both with prevention strategies in the pre-clinical phase and with treatments during the course of the disease. This review explores sleep disturbances in the different stages of AD, starting from the pre-clinical stage. Particular attention is given to the empirical evidence investigating obstructive sleep apnea (OSA) disorder and the mechanisms overlapping and sharing with AD. Next, we discuss sleep-based intervention strategies in the healthy elderly population, mild cognitive impairment (MCI) and AD patients. We mention interventions related to behavioral strategies, combination therapies, and bright light therapy, leaving extensive space for new and raising evidence on continuous positive air pressure (CPAP) treatment effectiveness. Finally, we clarify the role of NREM sleep across the AD trajectory and consider the most recent studies based on the promising results of NREM sleep enhancement, which use innovative experimental designs and techniques.
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French, Michael T., Ioana Popovici und Johanna Catherine Maclean. „Do Alcohol Consumers Exercise More? Findings from a National Survey“. American Journal of Health Promotion 24, Nr. 1 (September 2009): 2–10. http://dx.doi.org/10.4278/ajhp.0801104.
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Purpose. Investigate the relationship between alcohol consumption and physical activity because understanding whether there are common determinants of health behaviors is critical in designing programs to change risky activities. Design. Cross-sectional analysis. Setting. United States. Subjects. A sample of adults representative of the U.S. population (N = 230,856) from the 2005 Behavioral Risk Factor Surveillance System. Measures. Several measures of drinking and exercise were analyzed. Specifications included numerous health, health behavior, socioeconomic, and demographic control variables. Results. For women, current drinkers exercise 7.2 more minutes per week than abstainers. Ten extra drinks per month are associated with 2.2 extra minutes per week of physical activity. When compared with current abstainers, light, moderate, and heavy drinkers exercise 5.7, 10.1, and 19.9 more minutes per week. Drinking is associated with a 10.1 percentage point increase in the probability of exercising vigorously. Ten extra drinks per month are associated with a 2.0 percentage point increase in the probability of engaging in vigorous physical activity. Light, moderate, and heavy drinking are associated with 9.0, 14.3, and 13.7 percentage point increases in the probability of exercising vigorously. The estimation results for men are similar to those for women. Conclusions. Our results strongly suggest that alcohol consumption and physical activity are positively correlated. The association persists at heavy drinking levels.
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DuBose, Jennifer, Lorissa MacAllister, Khatereh Hadi und Bonnie Sakallaris. „Exploring the Concept of Healing Spaces“. HERD: Health Environments Research & Design Journal 11, Nr. 1 (18.12.2016): 43–56. http://dx.doi.org/10.1177/1937586716680567.
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Evidence-based design (EBD) research has demonstrated the power of environmental design to support improved patient, family, and staff outcomes and to minimize or avoid harm in healthcare settings. While healthcare has primarily focused on fixing the body, there is a growing recognition that our healthcare system could do more by promoting overall wellness, and this requires expanding the focus to healing. This article explores how we can extend what we know from EBD about health impacts of spatial design to the more elusive goal of healing. By breaking the concept of healing into antecedent components (emotional, psychological, social, behavioral, and functional), this review of the literature presents the existing evidence to identify how healthcare spaces can foster healing. The environmental variables found to directly affect or facilitate one or more dimension of healing were organized into six groups of variables—homelike environment, access to views and nature, light, noise control, barrier-free environment, and room layout. While there is limited scientific research confirming design solutions for creating healing spaces, the literature search revealed relationships that provide a basis for a draft definition. Healing spaces evoke a sense of cohesion of the mind, body, and spirit. They support healing intention and foster healing relationships.
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Mortezaei Shemirani, Shohreh, Bagher Sanaei Zaker, Biuok Tajeri, Sheida Sodagar und Farahnaz Meschi. „Comparing the Effects of Acceptance and Commitment Group Therapy and Cognitive-Behavioral Group Therapy on Life Habits, Disordered Eating Behavior, and Health-Promoting Lifestyle in Obese Women“. Journal of Arak University Medical Sciences 23, Nr. 6 (01.02.2021): 944–57. http://dx.doi.org/10.32598/jams.23.6.6165.1.
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Background and Aim: Despite numerous advances in treating various diseases and increased life expectancy, obesity will be the leading cause of hopelessness in the next 100 years. The present study aimed to compare the effects of Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Therapy (CBT) on lifestyle habits, disordered eating behavior, and health-promoting lifestyle in obese women. Methods & Materials: The statistical population consisted of all women referring to obesity clinics in district 2 of Tehran City, Iran, in 2019. Forty-Five patients were selected by convenience sampling method and replaced in 3 groups of 15 (two experimental & one control groups). The study participants were assessed using the Assessment of Life Habits Scale (LIFE-H)), the Eating Attitudes Test (EAT), and the Health Promoting Lifestyle Profile-II (HPLP-II). The ACT group underwent nine 90-minute sessions and the CBT group received eight 90-minute sessions. The control group received no training. The collected data were analyzed using Mixed Design and repeated-measures Analysis of Variance (ANOVA) in SPSS. Ethical Considerations This study was approved by the Research Ethics Committee of Islamic Azad University, Karaj Branch (Code: IR.IAU.K.REC.1398.039). Results: The present research results signified that ACT and CBT were effective on the habits of eating disorders and health-promoting lifestyles in the explored obese women. The achieved changes remained stable until the follow-up phase (P<0.001). Moreover, ACT was more successful than CBT in improving the components of life habits and health responsibilities in the study subjects (P<0.001). Conclusion: Considering the significant effect of group-based ACT and CBT, it is recommended to use these methods to increase the mental health of obese individuals.
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Wiggermann, Neal, Bruce Bradtmiller, Sue Bunnell, Cathy Hildebrand, John Archibeque, Sheila Ebert, Matthew P. Reed und Monica L. H. Jones. „Anthropometric Dimensions of Individuals With High Body Mass Index“. Human Factors: The Journal of the Human Factors and Ergonomics Society 61, Nr. 8 (29.04.2019): 1277–96. http://dx.doi.org/10.1177/0018720819839809.
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Objective: This study presents anthropometric data for individuals with high body mass index (BMI). Modified anthropometric dimensions were also developed to address the challenges of obtaining accurate and repeatable data for this population segment. Background: The prevalence of obesity affects approximately 40% of the U.S. adult population. Anthropometric data are needed to guide product design and safety, but few individuals with high BMI have been measured in available datasets. Method: Anthropometric data for a convenience sample of 288 adults with high BMI (≥30 kg/m2) were collected. To increase participation and minimize participant discomfort, measurements were collected at three bariatric weight loss clinics and one academic research institution. Results: The current obese cohort are heavier than the U.S. general population, with a difference in mean body weight of 47 kg for women and 56 kg for men. The obese cohort are also heavier and have a higher BMI compared with the NIOSH (National Institute for Occupational Safety and Health) truck driver population. Waist circumferential measures of the current obese cohort were larger than women or men in either population compared, a result indicative of meaningful body shape differences. Conclusion: To our knowledge, this study is the first to collect anthropometric data for the obese population segment and conduct comparisons to the U.S. general population and available occupational databases. The obese cohort differed substantially with respect to the distributions of anthropometric variables. Application: These data provide insights about the obese population segment that are relevant to product design, and establish a foundation for future data collection efforts.
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Kang, Duck-Hee, Na-Jin Park und Traci McArdle. „Cancer-Specific Stress and Mood Disturbance: Implications for Symptom Perception, Quality of Life, and Immune Response in Women Shortly after Diagnosis of Breast Cancer“. ISRN Nursing 2012 (20.12.2012): 1–7. http://dx.doi.org/10.5402/2012/608039.
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Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time.
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Keller, Michelle S., Sara McCleskey, Allison Mays und Catherine Sarkisian. „41896 Surveying knowledge of quality of dementia care among Latino caregivers“. Journal of Clinical and Translational Science 5, s1 (März 2021): 85. http://dx.doi.org/10.1017/cts.2021.620.
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ABSTRACT IMPACT: This qualitative study describes health system barriers to high-quality care for Latino older adults with Alzheimer’s Disease and Related Dementias OBJECTIVES/GOALS: Compared to non-Latino Whites, Latino older adults are more likely to receive low-quality dementia care such as high-risk medications or services. Caregivers play a critical role in managing medical care for persons with dementia (PWD). Yet little is known about the perceptions and knowledge of dementia quality of care among Latino caregivers of PWD. METHODS/STUDY POPULATION: We used a qualitative research design and conducted interviews with Latino caregivers of PWD and caregiver advocates. We recruited both from community organizations, senior centers, and clinics. Our interview guide focused on experiences of caregiving, interactions with medical system, and knowledge and experiences managing behavioral and eating problems. We used Grounded Theory methodology for coding and analysis, focusing on contrasting and comparing experiences within and between caregivers and caregiver advocates. RESULTS/ANTICIPATED RESULTS: Preliminary results from interviews with two caregivers and two caregiver advocates illustrate that caregivers of persons with dementia have a difficult time receiving high quality care from primary care clinicians. All participants noted that many primary care doctors didn’t know how to diagnose ADRD and dismissed critical symptoms as part of old age. Caregivers also reported that they wished they had more information on what to expect with ADRD disease progression, noting they received little information from the formal medical care system. With respect to behavioral problems, caregiver advocates noted that primary care doctors often did not provide non-pharmacological alternatives to behavioral problems. DISCUSSION/SIGNIFICANCE OF FINDINGS: Findings from our pilot study demonstrate that there is a clear need to train primary care physicians who serve Latino older adults on ADRD care. Improved diagnosis and management could improve outcomes among Latino older adults with dementia.
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Maschi, Mohammad Sadegh, Sheida Sodagar, Farhad Jomehri, Marjan Hosseinzadeh Taghvai und Mojgan Forootan. „Effects of Cognitive-Behavioral Therapy on Pain Intensity and Stress Coping Styles in Patients With Gastric Wound“. Journal of Arak University Medical Sciences 23, Nr. 6 (01.02.2021): 860–71. http://dx.doi.org/10.32598/jams.23.6.6164.1.
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Background and Aim: Patients with the symptoms of gastrointestinal diseases and ulcers constitute a large number of patients referring to general and internal clinics. Furthermore, preliminary studies on gastric ulcers highlighted the role of psychological factors in the development of a susceptible gastric ulcer. The current study aimed to determine the effects of Cognitive-Behavioral Therapy (CBT) on pain intensity and stress coping styles in patients with gastric ulcers. Methods & Materials: This was an experimental study with a pretest-posttest-follow-up and a control group design. The statistical population included all patients with a gastric ulcer who were referred to public health centers in Tehran City, Iran, in the winter of 2018. Among the volunteers participating in the study, 30 patients with gastric ulcers were selected by the convenience sampling method. Next, they were randomly assigned to the experimental and control groups (n=15/group). Measurement tools included the McGill Pain Questionnaire (MPQ) and the Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990). The experimental group subjects participated in eight 90-minute sessions of CBT. However, the controls received no psychological treatment in this period. For data analysis, repeated-measures Analysis of Variance (ANOVA) and post-hoc tests were applied. Ethical Considerations: This study was approved by the Research Ethics Committee of the Islamic Azad University, Karaj Branch (Code: IR.IAU.K.REC.1397.85). Results: The present research results signified that CBT improved problem-oriented coping styles (P<0.01) and decreased emotion-focused coping styles (P<0.01) and avoidance (P<0.01) in the test group. Besides, the mean scores of pain intensity decreased in the experimental group, compared to the controls (P<0.01). Conclusion: The provided CBT was effective on pain intensity and stress coping styles in patients with gastric ulcers.