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1.
Journal of the American Academy of Child and Adolescent Psychiatry ; 61(10 Supplement):S150, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2179857

RESUMO

Objectives: Adolescent depression's impact is far-reaching, such as an elevated risk of suicide, comorbidities, and functioning impairments. Engaging mobile technology can enhance treatment adherence, and reduce costs and wait times for mental health care. SparkRx is a 5-week, self-guided, CBT-based digital therapeutic app designed to treat adolescents' depressive symptoms. An RCT (NCT04524598) evaluated SparkRx's clinical effectiveness by comparing SparkRx to a psychoeducation control app (Ctrl). Method(s): A total of 160 eligible adolescents (101 female, aged 13-21 years) with self-reported depressive symptoms were recruited nationwide. They were randomized to use SparkRx or Ctrl for 5 weeks and completed a Patient Health Questionnaire-8 (PHQ-8) weekly. Participants (and caregivers if <18) completed pre- and postintervention assessments. Intention-to-treat analyses (ITT) of all participants with moderate to severe baseline symptom severity (PHQ-8 >=10;N = 121) and per protocol (PP) analyses of only those completing all weekly assessments (N = 83) assessed intervention related depressive symptom changes. We examined engagement with SparkRx (daily active users [DAUs], modules completed and number of mood logs and behavioral activations (BAs) scheduled/completed) and symptom change moderators (gender, baseline severity, concurrent treatment, concurrent treatment changes, age, and ADHD diagnosis). Result(s): SparkRx users had clinically meaningful reductions in depressive symptoms (mu = 5.18 in ITT;mu = 5.98 in PP). ITT (SparkRx vs Ctrl) did not reach statistical significance. PP showed that SparkRx significantly reduced depressive symptoms vs Ctrl (p =.023). SparkRx's median DAUs was 41.95%. On average, SparkRx users completed 63.49% of modules, 19.73 (8.32) mood logs, and 8.71 (5.04) BAs (scheduled 9.86 [5.74]). Mixed linear effects models showed no moderating effects. Conclusion(s): SparkRx was shown to reduce adolescent depressive symptoms and was engaging. Limitations included a sample size that was not fully powered. These claims have not been reviewed by the US FDA with regard to SparkRx's safety or efficacy. In October 2021, Limbix released the initial version of SparkRx under FDA's "Enforcement Policy for Digital Health Devices For Treating Psychiatric Disorders During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency." DDD, ADOL, CBT Copyright © 2022

2.
Psychiatric Times ; 39(10):40-45, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2156864
3.
J Intellect Disabil Res ; 66(8-9): 677-689, 2022 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1968153

RESUMO

BACKGROUND: The COVID-19 pandemic has significantly impacted family caregivers of adults with intellectual and developmental disabilities (IDD). This study evaluated a virtual course for family caregivers from across Canada, focused on supporting the mental health and well-being of adults with IDD and their families. The evaluation examined the feasibility and acceptability of the course, as well as the impact of the intervention on participants' overall health and well-being. METHODS: The 6-week virtual course, informed by a parallel Extension for Community Healthcare Outcomes (ECHO) course for service providers, combined didactic instruction with applied activities. A total of 126 family caregiver course participants consented to be part of the research evaluation delivered over three cycles between October 2020 and April 2021. Attendance was measured at each weekly session. Satisfaction was assessed weekly and post-program. Learning, self-efficacy, and well-being were assessed pre- and post-course, and again at follow-up (8 weeks post-course). Mixed-effects models assessed changes between and within individuals across time. RESULTS: Participants had consistent attendance, low-dropout rates, and reported high satisfaction, with 93% of participants reporting that their expectations for the course were met. Compared with pre-course, participants reported improved self-efficacy and well-being post-course, which were maintained at follow-up. CONCLUSIONS: An interactive and applied virtual education course delivered to a large group of family caregivers of adults with IDD was both feasible and acceptable. It positively impacted participants' well-being by offering much needed mental health support and creating a peer-led community of practice.


Assuntos
COVID-19 , Cuidadores , Adulto , Cuidadores/psicologia , Criança , Deficiências do Desenvolvimento/psicologia , Deficiências do Desenvolvimento/terapia , Humanos , Saúde Mental , Pandemias
4.
National Institute for Health and Care Research. Health and Social Care Delivery Research ; 5:5, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-1875382

RESUMO

BACKGROUND: National audits aim to reduce variations in quality by stimulating quality improvement. However, varying provider engagement with audit data means that this is not being realised. AIM: The aim of the study was to develop and evaluate a quality dashboard (i.e. QualDash) to support clinical teams' and managers' use of national audit data. DESIGN: The study was a realist evaluation and biography of artefacts study. SETTING: The study involved five NHS acute trusts. METHODS AND RESULTS: In phase 1, we developed a theory of national audits through interviews. Data use was supported by data access, audit staff skilled to produce data visualisations, data timeliness and quality, and the importance of perceived metrics. Data were mainly used by clinical teams. Organisational-level staff questioned the legitimacy of national audits. In phase 2, QualDash was co-designed and the QualDash theory was developed. QualDash provides interactive customisable visualisations to enable the exploration of relationships between variables. Locating QualDash on site servers gave users control of data upload frequency. In phase 3, we developed an adoption strategy through focus groups. 'Champions', awareness-raising through e-bulletins and demonstrations, and quick reference tools were agreed. In phase 4, we tested the QualDash theory using a mixed-methods evaluation. Constraints on use were metric configurations that did not match users' expectations, affecting champions' willingness to promote QualDash, and limited computing resources. Easy customisability supported use. The greatest use was where data use was previously constrained. In these contexts, report preparation time was reduced and efforts to improve data quality were supported, although the interrupted time series analysis did not show improved data quality. Twenty-three questionnaires were returned, revealing positive perceptions of ease of use and usefulness. In phase 5, the feasibility of conducting a cluster randomised controlled trial of QualDash was assessed. Interviews were undertaken to understand how QualDash could be revised to support a region-wide Gold Command. Requirements included multiple real-time data sources and functionality to help to identify priorities. CONCLUSIONS: Audits seeking to widen engagement may find the following strategies beneficial: involving a range of professional groups in choosing metrics;real-time reporting;presenting 'headline' metrics important to organisational-level staff;using routinely collected clinical data to populate data fields;and dashboards that help staff to explore and report audit data. Those designing dashboards may find it beneficial to include the following: 'at a glance' visualisation of key metrics;visualisations configured in line with existing visualisations that teams use, with clear labelling;functionality that supports the creation of reports and presentations;the ability to explore relationships between variables and drill down to look at subgroups;and low requirements for computing resources. Organisations introducing a dashboard may find the following strategies beneficial: clinical champion to promote use;testing with real data by audit staff;establishing routines for integrating use into work practices;involving audit staff in adoption activities;and allowing customisation. LIMITATIONS: The COVID-19 pandemic stopped phase 4 data collection, limiting our ability to further test and refine the QualDash theory. Questionnaire results should be treated with caution because of the small, possibly biased, sample. Control sites for the interrupted time series analysis were not possible because of research and development delays. One intervention site did not submit data. Limited uptake meant that assessing the impact on more measures was not appropriate. FUTURE WORK: The extent to which national audit dashboards are used and the strategies national audits use to encourage uptake, a realist review of the impact of dashboards, and rigorous evaluations of the impact of dashboards and the effectiveness of adoption strategies should be explored. STUDY REGISTRATION: This study is registered as ISRCTN18289782. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research;Vol. 10, No. 12. See the NIHR Journals Library website for further project information.

5.
Am J Transplant ; 22 Suppl 2: 204-309, 2022 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1735849

RESUMO

This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased. On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020. Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men.


Assuntos
COVID-19 , Obtenção de Tecidos e Órgãos , Adulto , COVID-19/epidemiologia , Criança , Feminino , Sobrevivência de Enxerto , Humanos , Fígado , Masculino , Pandemias , SARS-CoV-2 , Doadores de Tecidos , Estados Unidos/epidemiologia , Listas de Espera
8.
Antiviral Therapy ; 25(SUPPL 1):A57, 2020.
Artigo em Inglês | EMBASE | ID: covidwho-1106940

RESUMO

Objectives: The evolving outbreak of coronavirus 2019 (COVID-19) may impact people with HIV (PWH) in unique ways, beyond the increased risk of medical complications. Social distancing measures resulting in social isolation and interruptions in medical care may disproportionately affect PWH. The purpose of this study is to capture and understand how COVID-19 is affecting PWH in a low-income, multiethnic urban health centre in Houston, Texas. Methods: Cross-sectional survey of adult PWH who attend Thomas Street Health Center for outpatient care and volunteered to complete a short telephone questionnaire. Descriptive statistics were calculated for all patient characteristics and survey responses. Results: Of the 188 participants, 26% were women, 3.9% were transgender women, 33% were non-Hispanic Black and 57.4% Hispanic. The median (interquartile range) age was 49 (40-56) years;73% had 1 or more comorbidities. Overall, most (82%) people had not experienced difficulty accessing HIV medicines;25% of patients reported difficulty accessing medical care and failing to attend clinic due to fear of exposure to COVID-19. Most (82.8%) reported being affected by COVID-19 in their daily life;14% reported being extremely affected. 64% feared getting COVID-19, though a minority feared they were at increased risk of becoming sick, a finding especially true among Black (22.4%) and Hispanic individuals (33.9%) compared with White participants (15.4%). Nearly half (48.4%) reported increased anxiety. More than a third (37.8%) reported feeling depressed, more frequently reported among Black (46.6%) compared with Hispanic individuals (34.8%) and White participants (23%);31% felt more alone;90% reported not seeking behavioural health resources. Only 10% reported increased use in alcohol or illegal substances. One in four did not have access to an electronic device for a telemedicine visit. Of the 14% who had lost their job after the pandemic started, 61% were Hispanic. Conclusions: PWH experienced a wide range of effects from the COVID-19 pandemic. It is important to recognize the socioeconomical and psychological implications that will be seen in disadvantaged communities of PWH as a consequence of COVID-19.

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