Protocol for a bandit-based response adaptive trial to evaluate the effectiveness of brief self-guided digital interventions for reducing psychological distress in university students: the Vibe Up study.

INTRODUCTION: Meta-analytical evidence confirms a range of interventions, including mindfulness, physical activity and sleep hygiene, can reduce psychological distress in university students. However, it is unclear which intervention is most effective. Artificial intelligence (AI)-driven adaptive trials may be an efficient method to determine what works best and for whom. The primary purpose of the study is to rank the effectiveness of mindfulness, physical activity, sleep hygiene and an active control on reducing distress, using a multiarm contextual bandit-based AI-adaptive trial method. Furthermore, the study will explore which interventions have the largest effect for students with different levels of baseline distress severity. METHODS AND ANALYSIS: The Vibe Up study is a pragmatically oriented, decentralised AI-adaptive group sequential randomised controlled trial comparing the effectiveness of one of three brief, 2-week digital self-guided interventions (mindfulness, physical activity or sleep hygiene) or active control (ecological momentary assessment) in reducing self-reported psychological distress in Australian university students. The adaptive trial methodology involves up to 12 sequential mini-trials that allow for the optimisation of allocation ratios. The primary outcome is change in psychological distress (Depression, Anxiety and Stress Scale, 21-item version, DASS-21 total score) from preintervention to postintervention. Secondary outcomes include change in physical activity, sleep quality and mindfulness from preintervention to postintervention. Planned contrasts will compare the four groups (ie, the three intervention and control) using self-reported psychological distress at prespecified time points for interim analyses. The study aims to determine the best performing intervention, as well as ranking of other interventions. ETHICS AND DISSEMINATION: Ethical approval was sought and obtained from the UNSW Sydney Human Research Ethics Committee (HREC A, HC200466). A trial protocol adhering to the requirements of the Guideline for Good Clinical Practice was prepared for and approved by the Sponsor, UNSW Sydney (Protocol number: HC200466_CTP). TRIAL REGISTRATION NUMBER: ACTRN12621001223820.

Effects of Aromatherapy on Pain and Anxiety Scores in Adult Patients Admitted to a Community Hospital on the Medical Unit or Telemetry Unit: A Pilot Study.

The purpose of the study was to determine the impact of aromatherapy intervention on pain and anxiety. The hypothesis was that the use of aromatherapy will improve pain and anxiety scores when assessed within 30 to 60 minutes of administration. The study design was a prospective comparison of aromatherapy using a pre-/postdesign study. A convenience sample of patients was recruited from both a medical unit and a telemetry unit with patients aged 18+ years from a 182-bed acute care Magnet community hospital. Pain and anxiety levels were assessed prior to administration of a medication, within 60 minutes of receiving pain medication, and within 60 minutes of receiving aromatherapy. Ninety-six percent of the participants would use aromatherapy if offered again, would use it in the future, and would recommend its use to family and friends. Both pain and anxiety improved after the aromatherapy with a P value of <.0001. This pilot study demonstrated that aromatherapy is safe and effective at reducing pain and anxiety and should be considered as a valuable adjunct to symptom management.

Exercise interventions, gait, and balance in older subjects with distal symmetric polyneuropathy: a three-group randomized clinical trial.

OBJECTIVE: Older patients with a distal symmetric polyneuropathy are at markedly increase risk for falls and fall-related injuries. Despite this, few studies have investigated the effect of exercise regimens on gait and balance in this high-risk group. DESIGN: One hundred older patients with distal symmetric polyneuropathy were randomized to one of three interventions: functional balance training, Tai Chi, or education-only control. The subjects in each group received instruction in ten 1-hr weekly sessions. Outcome measures were determined at baseline and the end of the 10-wk intervention. Gait, balance, and falls self-efficacy were assessed with various well established clinical (Berg Balance Scale, 8 Foot Up and Go Test, and Modified Falls Efficacy Scale) and laboratory-based measures (three-dimensional gait analysis and NeuroCom limits of stability and sensory organization tests). RESULTS: The Tai Chi subjects demonstrated a decreased (faster) Timed Up and Go and increased stride length and time spent in single limb support at the end of intervention as compared with baseline. The functional balance training group demonstrated a significant increase in ankle plantar flexor power and near significant decreases in step width and step width variability. No changes in the education-only control group were observed. CONCLUSIONS: Older patients with distal symmetric polyneuropathy may benefit from Tai Chi and/or functional balance training, with the former improving functional mobility and gait and the latter possibly improving trunk stabilization and forward progression (Lythgo N, Cofré LE: Relationship between ankle plantar flexor power and EMG muscle activity during gait. 30th Annual Conference of Biomechanics in Sports [Melbourne, 2012]. Available at: https://ojs.ub.uni-konstanz.de/cap/article/viewFile/5320/4891). Whether these laudable changes can be maintained or translate into decreased risk for falls and fall-related injuries is unknown.

The Saratoga WarHorse project: a case study of the treatment of psychological distress in a veteran of Operation Iraqi Freedom.

OBJECTIVE: We theorized that ability to direct and control a horse will lead to a sense of empowerment, facilitate a relationship between horse and veteran, lead to a decrease in anxiety, and improve physical and social functioning. METHODS: This case study utilizes the Connection methodology: nonverbal language of the horse in a predictable, sequential, and repeatable method. Psychological testing occurred immediately pre- and post-Connection with follow-up occurring at 2, 4, 6, and 12 wks post-Connection. PARTICIPANT: Twice-deployed combat medic who served in Operation Iraqi Freedom (OIF). SETTING: Saratoga Springs, New York. PRIMARY OUTCOME MEASURES: Beck Depression Inventory-II (BDI-II); Posttraumatic Stress Disorder Checklist (PCL-C); the Response to Stressful Experiences Scale (RSES); the Quality of Life Inventory (QOLI); and the Modified Social Support Survey (MSSS). RESULTS: The participant demonstrated significant improvement in measures of psychological functioning (eg, over 12 wks); both PCL-C and RSES scores decreased 58% and 44%, respectively. Participant further reported an increase in sleep quality. CONCLUSION: The results of this case study strongly support the potential for the intervention and indicate the need for a controlled, randomized study that might more stringently investigate the impact of the intervention.

The role of military chaplains in mental health care of the deployed service member.

This research utilized a cross-sectional design secondarily analyzing data from active duty military health care personnel who anonymously completed the "2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel." Sample for this analysis of Operation Iraqi Freedom/Operation Enduring Freedom deployed mental health seeking service members was N = 447. Religiosity/spirituality and psychological distress experienced by active duty military personnel who sought help from military mental health providers (MH), military chaplains (CHC) or both (CHC & MH) were explored and compared. Greater psychosocial distress seen in the CHC & MH group could be a reflection of a successful collaborative model for mental health care that is currently promoted by the military where chaplains are first line providers in an effort to provide services to those in greatest need and ultimately provide them with care from a trained mental health professional. Research and evaluation of chaplain training programs and collaborative models is recommended.

Guided imagery in cardiac surgery.

Clinical research has demonstrated that guided imagery, a simple form of relaxation, can reduce preoperative anxiety and postoperative pain among patients undergoing surgical procedures. In 1998, the cardiac surgery team implemented a guided imagery program to compare cardiac surgical outcomes between two groups of patients: with and without guided imagery. Data from the hospital financial cost/accounting database and patient satisfaction data were collected and matched to the two groups of patients. A questionnaire was developed to assess the benefits of the guided imagery program to those who elected to participate in it. Patients who completed the guided imagery program had a shorter average length of stay, a decrease in average direct pharmacy costs, and a decrease in average direct pain medication costs while maintaining high overall patient satisfaction with the care and treatment provided. Guided imagery is now considered a complementary means to reduce anxiety, pain, and length of stay among our cardiac surgery patients.