Descriptive Norms but not Harm Reduction Strategies as a Mediator of Personalized Boosters After a Computerized College Drinking Intervention.

BACKGROUND: Computer-delivered programs to reduce college drinking have strong appeal but are sometimes less efficacious than their in-person counterparts. Boosters may be an ideal way to strengthen and extend the effects of computerized interventions while maintaining low cost and easy dissemination. However, little is known about how they work. Consequently, the current study aimed to explore descriptive perceived drinking norms and use of protective behavioral strategies (PBS) as potential mediators of booster effects. We also examined norms and PBS as mediators of the main intervention. The present study was a follow-up analysis of data from a randomized controlled trial (Alcohol Clin Exp Res 42, 2018, 1735) testing the efficacy of emailed boosters containing personalized feedback after a computerized alcohol intervention. METHODS: Participants were 537 (67.4% women) emerging adult college drinkers (M age = 19.65, SD = 1.67). They were randomly assigned to one of 3 conditions: general health education, alcohol intervention only, or alcohol intervention plus booster email. Participants completed assessments at baseline and follow-ups through 9 months. RESULTS: Descriptive norms were a mediator of booster efficacy where receiving the booster yielded stronger reductions in alcohol use through reduced concurrent norms; however, fully longitudinal models did not reach significance. There was also an indirect effect for the intervention where those who received the intervention experienced an increase in drinking through increased concurrent norms. However, a stronger direct effect was found where those who received the intervention experienced a stronger decrease in drinking after controlling for norms. There was no support for PBS as a mediator of booster or intervention efficacy. CONCLUSIONS: The present study was the first, to our knowledge, to demonstrate a potential mechanism of change in booster interventions. A simple, succinct reminder via email led to reductions in perceptions of how much peers drink, and this led to reductions in alcohol consumption. Our findings support the promise of utilizing brief and easily implemented targeted messaging to enhance the potency of computerized interventions for college drinkers.

Twelve Million Smokers Look Online for Smoking Cessation Help Annually: Health Information National Trends Survey Data, 2005-2017.

Background: This study quantified the potential reach of Internet smoking cessation interventions to support calculations of potential population impact (reach × effectiveness). Using a nationally representative survey, we calculated the number and proportion of adult smokers that look for cessation assistance online each year. Methods: Five waves (2005, 2011, 2013, 2015, 2017) of the National Cancer Institute's Health Information National Trends Survey were examined. The survey asked US adults whether they ever go online to use the Internet, World Wide Web, or email and had used the Internet to look for information about quitting smoking within the past 12 months. We estimated the proportion and number of (1) all US adult smokers, and (2) online US adult smokers that searched for cessation information online. Cross-year comparisons were assessed with logistic regression. Results: The proportion of all smokers who searched online for cessation information increased over the past decade (p < .001): 16.5% in 2005 (95% CI = 13.2% to 20.4%), 20.9% in 2011 (95% CI = 15.55% to 28.0%), 25.6% in 2013 (95% CI = 19.7% to 33.0%), 23.4% in 2015 (95% CI = 16.9% to 31.0%), and 35.9% in 2017 (95% CI = 24.8% to 48.9%). Among online smokers only, approximately one third searched online for cessation information each year from 2005 through 2015. In 2017, that proportion increased to 43.7% (95% CI = 29.7% to 58.7%), when an estimated 12.4 million online smokers searched for cessation help. Conclusions: More than one third of all smokers turn to the Internet for help quitting each year, representing more than 12 million US adults. Implications: This research provides contemporary estimates for the reach of Internet interventions for smoking cessation. Such estimates are necessary to estimate the population impact of Internet interventions on quit rates. The research finds more than 12 million US smokers searched online for cessation information in 2017.

Extending access to a web-based mental health intervention: who wants more, what happens to use over time, and is it helpful? Results of a concealed, randomized controlled extension study.

BACKGROUND: Web-based mental health applications may be beneficial, but adoption is often low leaving optimal implementation and payment models unclear. This study examined which users were interested in extended access to a web-based application beyond an initial 3-month trial period and evaluated if an additional 3 months of access was beneficial. METHODS: This study was a concealed extension of a multi-center, pragmatic randomized controlled trial that assessed the benefit of 3 months of access to the Big White Wall (BWW), an anonymous web-based moderated, multi-component mental health application offering self-directed activities and peer support. Trial participants were 16 years of age or older, recruited from hospital-affiliated mental health programs. Participants who received access to the intervention in the main trial and completed 3-month outcome assessments were offered participation. We compared those who were and were not interested in an extension of the intervention, and re-randomized consenting participants 1:1 to receive extended access or not over the subsequent 3 months. Use of the intervention was monitored in the extension group and outcomes were measured at 3 months after re-randomization in both groups. The primary outcome was mental health recovery as assessed by total score on the Recovery Assessment Scale (RAS-r), as in the main trial. Linear mixed models were used to examine the time by group interaction to assess for differences in responses over the 3-month extension study. RESULTS: Of 233 main trial participants who responded, 119 (51.1%) indicated an interest in receiving extended BWW access. Those who were interested had significantly higher baseline anxiety symptoms compared to those who were not interested. Of the 119, 112 were re-randomized (55 to extended access, 57 to discontinuation). Only 21 of the 55 extended access participants (38.2%) used the intervention during the extension period. Change in RAS-r scores over time was not significantly different between groups (time by group, F(1,77) = 1.02; P = .31). CONCLUSIONS: Only half of eligible participants were interested in extended access to the intervention with decreasing use over time, and no evidence of added benefit. These findings have implications for implementation and payment models for this type of web-based mental health intervention. TRIAL REGISTRATION: Clinicaltrials.gov NCT02896894 . Registered retrospectively on September 12, 2016.

Facilitating the Delivery of Cognitive Remediation in First-Episode Psychosis: Pilot Study of a Home-Delivered Web-Based Intervention.

We explored the adherence to a home-delivered, computer-based, cognitive remediation protocol in a first-episode psychosis outpatient cohort. Seventeen patients underwent a cognitive training protocol for 6 months using an online platform accessible from their home under the supervision of a qualified neuropsychologist. Neuropsychological, psychopathological, and functional data were collected at baseline and postintervention, whereas qualitative appraisal of the intervention was assessed monthly. Overall, participants' evaluation of the program was positive. This was reflected in a good adherence rate with 12 (70%) of 17 patients completing 80% of the prescribed sessions. Exploratory analysis revealed significant improvements in sustained attention (p = 0.020) and verbal memory (p = 0.018). A decrease in negative symptoms and an improvement on the Clinical Global Impression were also found (p = 0.009). We believe these are encouraging results to further explore the adopted delivery approach, which could facilitate access to cognitive training earlier and to a larger group of patients.

Moderators of the efficacy of a web-based stress management intervention for college students.

High levels of stress are common among college students. Web-based interventions may be one way to teach students stress management skills. Although previous research has demonstrated the overall efficacy of web-based stress management interventions, little attention has been paid to who might benefit most from these interventions. In this study, we analyzed data from 3 prior studies (N = 782) to examine moderators of the efficacy of a web-based stress management intervention that focused on increasing perceived present control (i.e., aspects of stressors that are controllable in the present). Specific moderators assessed in regression analyses were baseline scores on outcome measures (perceived stress, stress symptoms, anxiety, depression) and the putative mechanism (perceived present control) of the intervention. Baseline symptom levels moderated the effects of the intervention on all outcomes, such that the intervention was more effective for students with more baseline symptoms. Baseline levels of present control had less consistent moderating effects, but significant interactions indicated that the intervention was more effective for those with lower levels of present control. The novel Johnson-Neyman technique was used to identify specific cutoff scores on these measures, below which the effect of the intervention was not significant, and scores on the measures associated with varying effect sizes. Findings from the Johnson-Neyman analyses can inform the development of screening criteria for future research and clinical application. Because the intervention was more effective for students with higher levels of baseline distress, it may be better suited for an indicated rather than universal prevention approach. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Personalized Boosters After a Computerized Intervention Targeting College Drinking: A Randomized Controlled Trial.

BACKGROUND: Problematic drinking among emerging adult college students is extensive. Computer-delivered interventions (CDIs) have strong appeal because they can be quickly delivered to large numbers of students. Although they are efficacious in the short term, CDIs are not as efficacious as in-person interventions longer term. This study examined the utility of emailed boosters containing personalized feedback after a CDI to enhance and extend reductions among emerging adult college drinkers. Sex and age were explored as potential moderators. METHODS: Participants were 537 college students (67.4% female) aged 18 to 24 years (M age = 19.65, SD = 1.67) who consumed at least 1 alcoholic drink in the past 2 weeks. They were randomly assigned to CDI-only, CDI + booster email, or an assessment-only control condition, and were assessed up to 9 months postintervention. A booster email with personalized feedback was sent to the CDI + booster email group 2 weeks after completion of the CDI. RESULTS: Moderation findings for age revealed that the booster may be an effective means to strengthen and extend intervention effects for emerging adults who are of legal drinking age. However, effects were negligible for underage drinkers. Although the booster effect for the overall sample demonstrated a trend in the expected direction, it failed to reach significance. Booster effects were not significantly moderated by sex. Intervention effects were not moderated by either age or sex. CONCLUSIONS: The present investigation contributes to a limited body of research on boosters to augment main intervention effects in college drinkers. Our study demonstrated that a brief CDI plus a simple email booster with personalized feedback resulted in significant reductions in drinking outcomes for emerging adults of legal drinking age. Efforts to further develop and refine intervention booster strategies represent a promising future direction to minimize harmful drinking among college students.

Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions.

PURPOSE OF REVIEW: This review aims to provide a comprehensive overview of the efficacy, limitations, and future of e-health treatments for anxiety. Within this, we provide detail on "first-generation" e-health approaches, such as computerized therapies. Additionally, we assess the emergence and early efficacy of newer methods of treatment delivery, including smartphone apps and virtual reality interventions, discussing the potential and pitfalls for each. RECENT FINDINGS: There is now substantial clinical research demonstrating the efficacy of internet-delivered cognitive behavioral therapy in the treatment of anxiety. However, the ability of these interventions for engaging patients in "real-world" settings is unclear. Recently, smartphone apps for anxiety have presented a more popular and ubiquitous method of intervention delivery, although the evidence base supporting these newer approaches drastically falls behind the extensive marketing and commercialization efforts currently driving their development. Meanwhile, the increasing availability of novel technologies, such as "virtual reality" (VR), introduces further potential of e-health treatments for generalized anxiety and anxiety-related disorders such as phobias and obsessive compulsive disorder, while also creating additional challenges for research. Although still in its infancy, e-health research is already presenting several promising avenues for delivering effective and scalable treatments for anxiety. Nonetheless, several important steps must be taken in order for academic research to keep pace with continued technological advances.

Utilizing Patient E-learning in an Intervention Study on Preoperative Smoking Cessation.

BACKGROUND: Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence. METHODS: In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program. RESULTS: A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3.71-14.44; P < .0001) and number of contacts with a tobacco quitline (OR, 1.60; 95% CI, 1.35-1.90; P < .0001). Presence of other smokers in the household (OR, 0.39; 95% CI, 0.21-0.72; P = .0030) and amount spent on cigarettes weekly at baseline (per $10 increase) (OR, 0.73; 95% CI, 0.61-0.87; P = .0004) were barriers to abstinence. CONCLUSIONS: Our preoperative smoking cessation program resulted in a 7-day PP abstinence of 22% at 6 months. A multifaceted intervention including a patient e-learning program may be a valuable tool to overcome some of the barriers to help surgical patients quit smoking.

The Future of Psychotherapy in Turkey: Predictions for the Next 10 Years.

Making realistic predictions about the future is important in clinical psychology as in many other disciplines. This opinion survey aimed to examine clinical psychologists' predictions for the next 10 years regarding the status of psychotherapy in Turkey in two stages, with 107 participants in one and 69 in the other. The results revealed that the techniques predicted to increase the most in the next decade were the use of eclectic therapy, mindfulness therapy, solution-focused therapy, system/family approaches, and cognitive-behavioral therapy. Among the therapeutic interventions expected to increase in popularity were Internet-based programs, smartphone applications, and problem solving. In terms of type of psychotherapists, family counselors with certificate/graduate degrees and Internet-based treatment programs were expected to become more common, whereas it was considered that shorter treatment formats and crisis intervention approaches would be preferred. In sum, the present findings provide a current overview for Turkey and a comparison with other literature findings.

Digital health: a new dimension in rheumatology patient care.

The new digital health innovations have opened up several opportunities to help the clinicians, patients and other caregivers of rheumatology healthcare system in maximizing efficiencies resulting in better patient outcomes. In the global context, digital health technology has the potential to bridge the distance gap between all the key stakeholders involved in rheumatology health care. In this review, we update on the recent advances in the field of digital health and highlight unique features of these technologies which would help in routine care. Application of technology in any form to enable, facilitate or enhance the quality of care is the foundation of digitised care. The components could be smartphone apps, sensors, video, social media platforms or messenger platforms, wearables or a combination of these enabling healthcare delivery and overcoming the constraints of distance, location and time. Digital therapeutics have started evolving and an important step in this direction is the involvement of FDA in the approval process. Speciality specific apps, personalised patient education as per disease status, remote specialist consultations or virtual health coach to guide on lifestyle modifications are some of the developments which have been facilitated by increased digitization in all walks of life. Assisted care with the help of robots rendering care in the hospitals or an intelligent robot guiding a patient by voice and visual sense at home are already at the threshold of entering the mainstream of patient care. Wearable devices equipped with powerful sensors are coming handy in keeping a watch on patient symptoms all the time and providing useful insights on disease progression, clinical response or complications. In chronic care such as rheumatology the implications, possibilities and benefits seem unprecedented. Real time data analytics and artificial intelligence are helping the clinicians, healthcare systems and policy makers optimise the resources and improve patient outcomes. Digitization of healthcare has gained momentum in the recent years and it is envisaged that it could be a catalyst to change, bridge the quality of care and most important democratise the healthcare access across the globe. However, more data, efficacy and objective results are needed which would be fulfilled by ongoing observational studies, clinical trials, systematic review and meta-analysis to further establish the role of digital health in the realms of patient care.

Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis.

BACKGROUND: To examine whether number of physical therapy (PT) visits or amount of use of an internet-based exercise training (IBET) program is associated with differential improvement in outcomes for participants with knee osteoarthritis (OA). METHODS: A secondary analysis was performed using data from participants in 2 arms of a randomized control trial for individuals with symptomatic knee OA: PT (N = 135) or IBET (N = 124). We examined associations of number of PT visits attended (up to 8) or number of days the IBET website was accessed during the initial 4-month study period with changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain and function subscales, as well as a 2-min Step Test, at 4-month and 12-month follow-up. RESULTS: Participants with more PT visits experienced greater improvement in WOMAC total score (estimate per additional visit = - 1.18, CI 95% = - 1.91, 0.46, p <  0.001) and function subscore (estimate = - 0.80, CI 95% = - 1.33, - 0.28, p <  0.001) across follow-up periods. For WOMAC pain subscale, the association with number of PT visits varied significantly between 4- and 12-month follow-up, with a stronger relationship at 4-months. There was a non-significant trend for more PT visits to be associated with greater improvement in 2-min Step Test. More frequent use of the IBET website was not associated with greater improvement for any outcome, at either time point. CONCLUSION: Increased number of PT visits was associated with improved outcomes, and some of this benefit persisted 8 months after PT ended. This provides guidance for PT clinical practice and policies. TRIAL REGISTRATION: NCT02312713 , posted 9/25/2015.

Improving Cognitive Function in Patients with Stroke: Can Computerized Training Be the Future?

BACKGROUND: Cognitive impairment after stroke is common and can cause disability with a high impact on quality of life and independence. Cognitive rehabilitation is a therapeutic approach designed to improve cognitive functioning after central nervous system's injuries. Computerized cognitive rehabilitation (CCR) uses multimedia and informatics resources to optimize cognitive compromised performances. The aim of this study is to evaluate the effects of pc cognitive training with Erica software in patients with stroke. METHODS: We studied 35 subjects (randomly divided into 2 groups), affected by either ischemic or hemorrhagic stroke, having attended from January 2013 to May 2015 the Laboratory of Robotic and Cognitive Rehabilitation of Istituto di Ricerca e Cura a Carattere Scientifico Neurolesi in Messina. Cognitive dysfunctions were investigated through a complete neuropsychological battery, administered before (T0) and after (T1) each different training. RESULTS: At T0, all the patients showed language and cognitive deficits, especially in attention process and memory abilities, with mood alterations. After the rehabilitation program (T1), we noted a global cognitive improvement in both groups, but a more significant increase in the scores of the different clinical scales we administered was found after CCR. CONCLUSIONS: Our data suggest that cognitive pc training by using the Erica software may be a useful methodology to increase the post-stroke cognitive recovery.

[Computer-assisted therapy and video games in psychosocial rehabilitation for schizophrenia patients]. / L'utilisation des thérapies assistées par ordinateur et des jeux vidéo à visée thérapeutique dans les soins de réhabilitation psychosociale chez les sujets souffrant de schizophrénie, revue de la littérature.

OBJECTIVES: Video games and virtual reality have recently become used by clinicians for training or information media or as therapeutic tools. The purpose is to review the use of these technologies for therapy destined for schizophrenia patients. METHODS: We conducted a review in October 2016 using Pubmed, Scopus and PsychInfo using the following Medical Subject Headings (MESH): "video games", "virtual reality" and "therapy, computer-assisted/methods", each associated with "schizophrenia". Papers were included in the review if: (a) they were published in an English, Spanish or French-language peer-reviewed journal, (b) the study enrolled patients with schizophrenia or schizo-affective disorder, (c) the patients used a therapeutic video game or therapeutic virtual reality device. RESULTS: Eighteen publications were included. The devices studied are mainly therapeutic software developed specifically for therapeutic care. They can be classified according to their therapeutic objectives. These targets corresponded to objectives of psychosocial rehabilitation: improvement of residual symptomatology, cognitive remediation, remediation of cognition and social skills, improvement of everyday life activities, support for occupational integration. Very different devices were proposed. Some researchers analysed programs developed specifically for patients with schizophrenia, while others were interested in the impact of commercial games. Most of the studies were recent, preliminary and European. The impact of these devices was globally positive, particularly concerning cognitive functions. CONCLUSIONS: Computer-assisted therapy, video games and virtual reality cannot replace usual care but could be used as adjunctive therapy. However, recommending their use seems premature because of the recent and preliminary character of most studies. Moreover, a link is still lacking between this field of research in psychiatry and other fields of research, particularly game studies. Finally, it might be interesting to analyse more precisely the neuropsychological impact of existing commercial games which could potentially be useful for psychosocial rehabilitation.

Development of a web-based executive functioning intervention for adolescents with epilepsy: The Epilepsy Journey.

INTRODUCTION: Youth with epilepsy exhibit significant deficits in executive functioning (EF), yet there are few interventions to improve EF for adolescents. The aims of the current study were to develop an individually-tailored intervention, called Epilepsy Journey, to improve aspects of EF through an iterative, patient-centered process including focus groups and usability testing. METHODS: Five adolescents and caregivers participated in focus groups. This input was used to develop ten learning modules based on subscales of the Behavioral Rating Inventory of Executive Functions and key issues that may impact EF in adolescents. Six adolescents participated in usability testing and a usability expert conducted a heuristic evaluation. Demographic information, chart reviews and measures of EF were also completed. RESULTS: Focus group participants and their parents reported difficulties with memory, attention, organization, monitoring, initiation, impulsivity, emotional control, sleep, awareness in schools and managing stress. They also identified successful strategies to address memory and organizational difficulties. Usability testing of the resultant Epilepsy Journey modules revealed problems with navigation and identified features that promoted usability, including progress bars and interactive modules. Program modifications were made after each usability trial resulting in a relatively brief, interactive and readily navigable program. Perceived utility was high with all but one participant. Participants rated the content as helpful and indicated they would recommend Epilepsy Journey to others. CONCLUSIONS: Feedback from the focus group and usability testing yielded a feasible, acceptable, relevant and user-friendly web-based intervention for adolescents with epilepsy. The Epilepsy Journey program will be further tested in an open pilot with adolescents with epilepsy and associated EF deficits.

Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions.

Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic "Big Data" that promises to inform learning theory and behavioral therapy in general.

[Hypoglossal nerve stimulation in patients with CPAP failure : Evolution of an alternative treatment for patients with obstructive sleep apnea]. / Hypoglossusnervstimulation bei CPAP-Versagen : Evolution einer Alternativbehandlung für Patienten mit obstruktiver Schlafapnoe.

Obstructive sleep apnea (OSA) is a common disease in western industrialized countries with increasing prevalence. Gold standard of therapy is nocturnal positive pressure ventilation by continuous positive airway pressure (CPAP). Due to complications and side effects of ventilation, therapy adherence is limited. Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep. The aim of this work is to provide an overview of the history and current state of scientific knowledge of this therapy in the treatment of OSA. Currently, two systems are available on the market: respiratory-driven hypoglossal nerve stimulation (Inspire Medical Systems) and continuous hypoglossal nerve stimulation (ImThera Medical). For respiratory-driven hypoglossal nerve stimulation, a solid body of evidence is available and the therapy has been investigated in numerous multicenter clinical studies with regard to safety and efficacy. Only a small number of publications is available for continuous hypoglossal nerve stimulation. At the end of the last century, promising clinical results were shown in the first patients treated with hypoglossal nerve stimulation. Consequent technological and scientific development of respiratory-driven hypoglossal nerve stimulation in recent years led to its implementation in today's clinical routine. This therapy significantly broadens the spectrum of therapies in the treatment of OSA, especially for patients with CPAP intolerance.

[Ambient assisted living - an overview]. / Ambient Assisted Living - ein Überblick.

Ambient assisted living (AAL) technologies are mainly developed to support elderly people in their own homes and facilitate a longer, self-determined life. In addition to providing a demographic prognosis for Germany, the present publication includes the definition, classification and current market situation of AAL. Lastly, the benefit of AAL technologies to the insurance industry and the subsequent steps to be taken are addressed.

Benchmarking routine psychological services: a discussion of challenges and methods.

BACKGROUND: Policy developments in recent years have led to important changes in the level of access to evidence-based psychological treatments. Several methods have been used to investigate the effectiveness of these treatments in routine care, with different approaches to outcome definition and data analysis. AIMS: To present a review of challenges and methods for the evaluation of evidence-based treatments delivered in routine mental healthcare. This is followed by a case example of a benchmarking method applied in primary care. METHOD: High, average and poor performance benchmarks were calculated through a meta-analysis of published data from services working under the Improving Access to Psychological Therapies (IAPT) Programme in England. Pre-post treatment effect sizes (ES) and confidence intervals were estimated to illustrate a benchmarking method enabling services to evaluate routine clinical outcomes. RESULTS: High, average and poor performance ES for routine IAPT services were estimated to be 0.91, 0.73 and 0.46 for depression (using PHQ-9) and 1.02, 0.78 and 0.52 for anxiety (using GAD-7). Data from one specific IAPT service exemplify how to evaluate and contextualize routine clinical performance against these benchmarks. CONCLUSIONS: The main contribution of this report is to summarize key recommendations for the selection of an adequate set of psychometric measures, the operational definition of outcomes, and the statistical evaluation of clinical performance. A benchmarking method is also presented, which may enable a robust evaluation of clinical performance against national benchmarks. Some limitations concerned significant heterogeneity among data sources, and wide variations in ES and data completeness.

[Technical innovations in deep brain stimulation]. / Technische Innovationen in der tiefen Hirnstimulation.

Although first introduced about 25 years ago deep brain stimulation (DBS) technology is still evolving at a high rate and most innovations have been developed as a result of pressure from increasing commercial competition. Technical innovations from recent years include rechargeable generators and new stimulation paradigms. Current and upcoming developments mainly aim at prediction of stimulation and unwanted side effects and hence improvement in safety and treatment efficacy. Some of the future keynote DBS technologies are summarized in this survey.

[Technological advances in neurorehabilitation]. / Avances tecnológicos en neurorrehabilitación.

Neurological rehabilitation arose as formal method in the 60's, for the therapeutic treatment of patients with stroke or spinal cord injury, which develop severe sequelae that affect their motor and sensory abilities. Although the Central Nervous System has plasticity mechanisms for spontaneous recovery, a high percentage of patients should receive specialized therapies to regain motor function, such as Constraint Induced Movement Therapy or Upright physical Therapy. The neurorehabilitation has undergone drastic changes over the last two decades due to the incorporation of computer and robotic electronic devices, designed to produce positive changes in cortical excitability of the cerebral hemisphere damaged and so to improve neuroplasticity. Among equipment, we can mention those for electrotherapy devices, apparatus for transcranial magnetic stimulation, the robotic lower limb orthoses, robot for upper limb training, systems for functional electrical stimulation, neuroprosthesis and brain computer interfaces. These devices have caused controversy because of its application and benefits reported in the literature. The aim of Neurorehabilitation technologies is to take advantage of the functional neuromuscular structures preserved, and they compensate or re-learn the functions that previously made the damaged areas. The purpose of this article is to mention some clinical applications and benefits that these technologies offer to patients with neuronal injury.