Virtual reality in Metaverse for future mental health-helping profession: an alternative solution to the mental health challenges of the COVID-19 pandemic.

Currently, Metaverse has become a hot topic of conversation everywhere. Therefore, this can also be an accurate solution to the mental health challenges of the COVID-19 pandemic. Hopefully in the future, mental health workers can make the best use of it.

Actividad de las unidades de aparato digestivo españolas antes y durante la pandemia COVID-19: evaluación mediante la herramienta EFIC_AD de la Sociedad Española de Patología Digestiva (SEPD)

Introducción: la pandemia COVID-19 afectó intensamente el modelo asistencial sanitario. La Sociedad Española de Patología Digestiva (SEPD) ofrece a las unidades asistenciales de aparato digestivo (UAAD) una herramienta (EFIC_AD) en la que registrar y analizar su eficacia y eficiencia. Sobre esta base se ha estudiado el impacto de la pandemia sobre la actividad de esas UAAD. Métodos: estudio descriptivo basado en el registro EFIC_AD durante el periodo 2019-2021 sobre la actividad en hospitalización, consulta y exploraciones endoscópicas y no endoscópicas y el rendimiento de las salas de endoscopia. Resultados: se recogieron datos de hasta 42 centros hospitalarios (22 de ellos ≥ 500 camas). En conjunto, la actividad en 2020, respecto a 2019, descendió entre un 12,30 % para los ingresos y un 40 % para las pHmetrías (16,70 % nuevos en consulta, 14,34 % derivaciones desde Atención Primaria, 24,70 % gastroscopias, 32,50 % colonoscopias, 31,00 % ecoendoscopias, 18,20 % colangiopancreatografías retrógradas endoscópicas [CPRE], 38,00 % manometrías, 23,60 % ecografías abdominales, 36,17 % elastografías transitorias hepáticas [FibroScan®]). Los niveles de 2019 no se recuperaron completamente en 2021 excepto para los estudios de motilidad digestiva, aunque sí en la práctica los de los rendimientos de las salas de endoscopia (88,15 % en 2019, 67,77 % en 2020, 85,93 % en 2021). Conclusiones: durante 2020, la pandemia COVID-19 provocó un destacado descenso de la actividad propia de las UAAD que no se recuperó totalmente en 2021, a pesar de la normalización de los rendimientos de las salas de endoscopia (AU)

Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices.

Distance counselling holds immense potential for improving access to trauma supports for survivors of sexual violence (SV), and particularly for under-served groups who disproportionately experience violence and myriad barriers to accessing in-person supports. And yet, the evidence-base for the practice and delivery of distance counselling remains under-developed. In the context of COVID-19, where telehealth applications have undergone a rapid uptake, we undertook a scoping review of existing evidence of therapeutic and organizational practices related to the real-time (synchronous) delivery of distance counselling to survivors of SV. We based our scoping review methods on Arksey and O'Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and PRISMA reporting guidelines for scoping reviews. A comprehensive search of MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts was undertaken in October 2020, and again in March 2022. Searching, reviewing, appraisal, and data extraction was undertaken by two reviewers. In total, 1094 records were identified that resulted in 20 studies included. Descriptions, findings, and recommendations were gleaned and synthesized into potential practices using inductive thematic analysis. While many studies have an appreciative orientation to distance counselling, these benefits tend to be framed as non-universal, and conditional on survivor safety, flexibility, anonymity, survivor choice, strong and inclusive technology, and a supported workforce.Despite the limited evidence-base, we present several clusters of findings that, taken together, can be used to support current COVID-19 distance counselling initiatives with survivors, as well as guide the future development of best practices.

Uso de la Teleterapia para el Tratamiento de los Trastornos de Ansiedad, TOC y TEPT, Durante la Pandemia por COVID-19 en España / Use of Teletherapy for the Treatment of Anxiety Disorders, OCD and PTSD, During the COVID-19 Pandemic in Spain

La proporción de teletratamiento llevada a cabo por psicólogos durante la pandemia por COVID-19 para el TAG, fobia específica, agorafobia, ansiedad social, pánico, TOC y TEPT, así como si la experiencia en teleterapia tiene un efecto significativo en la demanda no han sido estudiadas. Los resultados indican que el TAG con un 69.2%, es el trastorno que más teletratamiento ha recibido y la fobia con un 60.5%, el que menos. El pánico, la ansiedad social, TEPT, TOC y agorafobia tuvieron una demanda media del 67.2%, 66.8%, 64.0%, 63.5% y 62.2%, respectivamente. La experiencia en teleterapia resultó significativa. El teletratamiento para psicólogos con experiencia aumentó una media del 93.9% respecto al 35.7% de aquellos sin experiencia. Un 22.8% de psicólogos no realizó teletramiento de la ansiedad. Estos resultados puede ser útiles para desarrollar programas específicos de prevención e intervención telemática para los trastornos de ansiedad ante futuras pandemias por coronavirus.

The distribution of teletreatment carried out by psychologists during the COVID-19 pandemic for GAD, specific phobia, agoraphobia, social anxiety, panic, OCD and PTSD, and whether experience in teletherapy has an significant effect on demand have not been studied. The results indicate that GAD with 69.2% has been the disorder that has received the most teletherapy and phobia with 60.5%, the least. Panic, social anxiety, PTSD, OCD, and agoraphobia had a demand of 67.2%, 66.8%, 64.0%, 63.5%, and 62.2%, respectively. The experience in teletherapy was significant. Tele-treatment for experienced psychologists increased an average of 93.9% compared to 35.7% for those without experience. 22.8% of psychologists did not carry out anxiety teletherapy. These results may be useful to develop specific prevention and telematic intervention programs for anxiety disorders in the face of future coronavirus pandemics

Eye MG 3D Application - A comprehensive ocular anatomy and pathophysiology 3D atlas with real-time true color confocal images to enhance ophthalmology education and e-Counseling.

Concepts pertaining to ophthalmology have lots of theoretical frameworks. Neophyte residents and novice surgeons may have to mentally visualize these concepts during the initial days of training. Only a powerful cognitive tool such as a three-dimensional (3D) eyeball model, with real-time TrueColor confocal images (and not animated images or models), can fill in these intellective mental gaps. Giving the users (i.e., residents and students) the power to choose and visualize various parts of the eye, with multiple magnitudes of zoom, is mandatory for optimal e-learning. To make ophthalmic concept learning better, we have developed a 3D app Eye MG 3D (patent pending) comprising ocular anatomy and pathophysiological 3D models, built on an advanced interactive 3D touch interface, by using patient's real-time confocal images to serve as a new-age pedagogical tool and e-counseling. According to our knowledge, there are no applications to date that incorporate real-time high-resolution multimodal confocal fundus images and photoreal visuals for interactive and immersive 3D learning.

Telerehabilitación en alta latitud sur. Resultados de una implementación de tratamiento para personas en situación de discapacidad durante la pandemia de COVID-19 / Telerehabilitation in the high southern latitude. Results of a treatment implementation for people with disabilities during the COVID-19 pandemic

La situación sanitaria generada por la aparición de la COVID-19 ha precipitado el uso de nuevas tecnologías y la adaptación de los servicios de rehabilitación de todo tipo. Objetivo: Describir la implementación de un sistema de telerehabilitación en pacientes con diferentes diagnósticos de discapacidad que viven en alta latitud sur, durante la pandemia de COVID-19. Métodos: Se implementó un sistema de terapias personalizadas guiadas mediante videoconferencia para pacientes con diferentes diagnósticos de discapacidad. Los pacientes se agruparon en tres grupos etarios (menores, adultos, adultos mayores) y seis tipos de diagnóstico clínico (afecciones originadas en el periodo perinatal, enfermedades del sistema circulatorio, enfermedades del sistema nervioso, enfermedades del sistema osteomuscular y del tejido conjuntivo, tratamientos mentales y del comportamiento y otro tipo de diagnósticos). Se evaluó el diagnóstico del paciente, el tipo de atención requerida, el número de sesiones y el nivel de satisfacción de cada usuario en función de la telerehabilitación que recibieron. Resultados: Participaron 101 pacientes con edad promedio de 31±26 años, siendo el 52,5% de estos del sexo masculino. Todos ellos logran manejar tecnologías mínimas requeridas para la atención por telerehabilitación. Existe un grado de asociación entre el diagnóstico del paciente y el grupo etario (p<0,05), así como también entre el diagnóstico y el tipo de atención requerida (p<0,05). Tras la implementación, los usuarios y usuarias evalúan positivamente la terapia a distancia. Conclusiones: La telerehabilitación puede ser implementada en pacientes con discapacidad en zonas de alta latitud sur, respetando las diferentes etapas del proceso, para asegurar una correcta ejecución.

The health situation after the emergence of COVID-19 has precipitated the use of new technologies and the adaptation of rehabilitation services of all kinds. Objective: To describe the implementation of a telerehabilitation system in patients with different diagnoses of disability living in the high southern latitude during the COVID-19 pandemic. Methods: A system of personalized therapies guided by videoconference was implemented for patients with varying diagnoses of disability. The patients were grouped into three age groups (Minors; Adults; Older Adults) and six types of clinical diagnosis (conditions originating in the perinatal period, diseases of the circulatory system, diseases of the nervous system, diseases of the musculoskeletal system, and connective tissue, mental and behavioural treatments and other diagnoses). The patient's diagnosis, the type of care required, the number of sessions, and the level of satisfaction of each user were evaluated based on the telerehabilitation they received. Results: 101 patients with an average age of 31±26 years participated, 52.5% were male. All of them managed to handle the minimum technologies required for telerehabilitation care. There is a degree of association between the patient's diagnosis and the age group (p<.05), as well as between the diagnosis and the type of care required (p<.05). After implementation, users positively evaluated distance therapy. Conclusions: Telerehabilitation can be implemented in patients with disabilities in areas of high southern latitude, respecting the different stages of the process, to ensure it is correctly delivered.

Stratified Care vs Stepped Care for Depression: A Cluster Randomized Clinical Trial.

Importance: Depression is a major cause of disability worldwide. Although empirically supported treatments are available, there is scarce evidence on how to effectively personalize psychological treatment selection. Objective: To compare the clinical effectiveness and cost-effectiveness of 2 treatment selection strategies: stepped care and stratified care. Design, Setting, and Participants: This multisite, cluster randomized clinical trial recruited participants from the English National Health Service from July 5, 2018, to February 1, 2019. Thirty clinicians working across 4 psychological therapy services were randomly assigned to provide stratified (n = 15) or stepped (n = 15) care. In stepped care, patients sequentially access low-intensity guided self-help followed by high-intensity psychotherapy. In stratified care, patients are matched with either low- or high-intensity treatments at initial assessment. Data were analyzed from May 18, 2020, to October 13, 2021, using intention-to-treat principles. Interventions: All clinicians used the same interview schedule to conduct initial assessments with patients seeking psychological treatment for common mental disorders, but those in the stratified care group received a personalized treatment recommendation for each patient generated by a machine learning algorithm. Eligible patients received either stratified or stepped care (ie, treatment as usual). Main Outcomes and Measures: The preregistered outcome was posttreatment reliable and clinically significant improvement (RCSI) of depression symptoms (measured using the 9-item Patient Health Questionnaire). The RCSI outcome was compared between groups using logistic regression adjusted for baseline severity. Cost-effectiveness analyses compared incremental costs and health outcomes of the 2 treatment pathways. Results: A total of 951 patients were included (618 women among 950 with data available [65.1%]; mean [SD] age, 38.27 [14.53] years). The proportion of cases of RCSI was significantly higher in the stratified care arm compared with the stepped care arm (264 of 505 [52.3%] vs 134 of 297 [45.1%]; odds ratio, 1.40 [95% CI, 1.04-1.87]; P = .03). Stratified care was associated with a higher mean additional cost per patient (£104.5 [95% CI, £67.5-£141.6] [$139.83 (95% CI, $90.32-$189.48)]; P < .001) because more patients accessed high-intensity treatments (332 of 583 [56.9%] vs 107 of 368 [29.1%]; χ2 = 70.51; P < .001), but this additional cost resulted in an approximately 7% increase in the probability of RCSI. Conclusions and Relevance: In this cluster randomized clinical trial of adults with common mental disorders, stratified care was efficacious and cost-effective for the treatment of depression symptoms compared with stepped care. Stratified care can improve depression treatment outcomes at a modest additional cost. Trial Registration: isrctn.org Identifier: ISRCTN11106183.

Apoio psicológico ao universitário: a expressão do sofrimento em oficinas virtuais / Psychological support to the college student: the suffering expression in virtual workshops / Apoyo psicológico a estudiante universitario: la expresión del sufrimiento en talleres virtuales

Este artigo apresenta uma proposta metodológica de apoio psicológico no Ensino Superior, desenvolvida por meio de rodas de conversa presenciais e oficinas realizadas em ambiente virtual, voltadas a estudantes que apresentam algum grau de sofrimento que possa culminar em questões de saúde mental e a subsequente evasão nesse nível da educação no Brasil. Tem por objetivo descrever os procedimentos metodológicos e avaliar seus resultados, considerando a adesão, o tipo de participação nas diferentes etapas propostas e a avaliação de uma das participantes, em entrevista individual, presencial. Constatou-se que a fase presencial da pesquisa representou uma dificuldade aos estudantes que tinham interesse na participação, mas não aderiram à proposta. Na fase virtual, fica evidenciado que escrever, para alguns estudantes, pode representar uma maneira possível para que sentimentos e pensamentos sejam expressos de modo intenso, também promovendo a troca entre participantes e o consequente ganho coletivo. (AU)

This paper presents a methodological proposal for psychological support in Higher Education, developed through face-to-face conversation circles and workshops held in a virtual environment, aimed at students who present some degree of suffering that may culminate in mental health issues and the subsequent evasion in this level of education in Brazil context. This research aims to describe the methodological procedures and evaluate their results, considering the adherence, the type of participation in the different stages proposed and the evaluation of one of the participants, in individual, face-to-face interviews. It was found that the presential phase of the research represented a difficulty for students who were interested in participating but did not adhere to the proposal. In the virtual phase, it is evident that writing, for some students, may represent a possible way for feelings and thoughts to be expressed intensely, also promoting the exchange between participants and the consequent collective benefit or growth.(AU)

Este artículo presenta una propuesta metodológica para el apoyo psicológico en la educación superior, desarrollada a través de círculos de conversación cara a cara y talleres realizados en ambiente virtual, dirigida a estudiantes que tienen un cierto grado de sufrimiento que puede culminar en problemas de salud mental y deserción en este contexto de nivel educativo en el contexto brasileño. El objetivo de esta investigación es describir los procedimientos metodológicos y evaluar sus resultados, considerando la adherencia, el tipo de participación en las diferentes etapas propuestas y la evaluación de una de las participantes en entrevista individual cara a cara. Se encontró que la fase presencial de la investigación representó una dificultad para los estudiantes que aún interesados en participar, no han adherido a la propuesta. En la fase virtual, es evidente que la escritura, para algunos estudiantes, puede representar una posible forma de expresar con intensidad sentimientos y pensamientos, promoviendo también el intercambio entre los participantes y la consecuente obtención de logros colectivos. (AU)

ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES: The management of diabetes insipidus and hyponatraemia.

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. Hyponatraemia in COVID-19 is common with a prevalence of 20-30% and is mostly due to SIAD or hypovolaemia. It mirrors disease severity and is an early predictor of mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3-5%, especially in ICU, and derives from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.

Notas sobre o fazer de uma psicóloga escolar na pandemia / Notas sobre la actuación de un psicólogo escolar en la pandemia / Notes on the work of a school psychologist during the pandemic / Notes sur l'action d'un psychologue scolaire dans la pandémie

Sabemos que o ato de educar é uma prática social discursiva, imergindo a criança na linguagem e a tornando capaz de fazer laço social. Entretanto, o ensino a distância (EAD) impôs-se como realidade atual. Como consequência, as restrições sociais e esse novo modo de estar na escola impactaram a saúde mental de alunos, de pais e de professores, e o psicólogo escolar foi convidado a ajudar na construção de formas possíveis de atravessamento do mal-estar. Este artigo, portanto, propõe reflexões acerca do meu trabalho como psicóloga escolar de orientação psicanalítica. Atuando em uma escola particular, durante uma pandemia que afastou os alunos da escola, defendo que a escola seja um 'lugar de vida' (Kupfer, 2010), constituindo-se como palco de construção de sentidos para experiências prazerosas e desafiadoras.

Sabemos que el acto de educar es una práctica social discursiva, que sumerge el niño en el lenguaje y lo hace capaz de crear un vínculo social. Sin embargo, la educación a distancia (EAD) se ha convertido en una realidad actual. Como consecuencia, las restricciones sociales y esta nueva forma de estar en la escuela impactaron la salud mental de alumnos, padres y profesores y el psicólogo educativo fue invitado a ayudar en la construcción de posibles vías de traspaso del malestar. Este artículo, por lo tanto, propone reflexiones sobre mi trabajo como psicólogo de orientación psicoanalítica en una escuela. Actuando en una institución privada, durante una pandemia que sacó a los estudiantes de la escuela, defiendo que la escuela es un 'lugar de vida' (Kupfer, 2010), constituyéndose como un escenario para la construcción de significados para experiencias placenteras y desafiantes.

It is already known that the act of educating is a social discursive practice, immersing the child in language and making them capable of stablishing social bonds. However, distance learning has become an imposed reality. As a consequence, social restrictions and this new way of being at school impacted the mental health of students, parents and teachers and the school psychologist was invited to support the construction of possible ways of dealing with hardship. This article, therefore, proposes reflections on my work as a school psychologist of psychoanalytical approach. Acting in a private school, during a pandemic that removed students from school, I claim that the school is a 'life place' (Kupfer, 2010), a stage where subjects can construct meanings for pleasant and challenging experiences.

On sait que l'acte d'éduquer est une pratique discursive sociale que introduit l'enfant dans le langage et le rend capable de faire un lien social. Néanmoins l'enseignement à distance est devenu une réalité nécessaire. En conséquence les restrictions sociales et une nouvelle façon d'être à l'école(EAD) ont eu un impact sur la santé mentale des élèves, des parents et des enseignants et le psychologue scolaire a été invité dans la pandémie à aider le sujet à construire des voies possibles pour traverser le malaise. Cet article propose des réflexions sur mon travail comme psychologue scolaire d'orientation psychanalytique dans une école privée de Rio de Janeiro lors d'une pandémie qui a éloigné des milliers d'élèves de l'école. Je soutiens avec Kupfer (2010) que l'école est un «lieu de vie¼ car elle constitue une étape pour la construction de sens d'expériences agréables et désagréables.

Orientação educacional com psicanálise: um lugar de escuta em tempos de escola remota / Orientación educativa con psicoanálisis: un lugar de escucha en tiempos de escuela / Educational guidance with psychoanalysis: a place of listening in times of remote school / Orientation pédagogique avec la psychanalyse: un lieu d'écoute en période d'école éloignée

O presente artigo traz, a partir da análise das falas dos atendimentos realizados pela orientação educacional no período de ensino remoto, efeitos e reflexões que um espaço de escuta pode produzir durante a pandemia de COVID-19. De modo virtual, a busca pelo Serviço de Orientação Educacional seguiu acontecendo, e trouxe pontos que nos são caros para pensar a parentalidade na atualidade. À luz da psicanálise, discute-se dois apontamentos a partir dos atendimentos realizados: o primeiro localiza-se justamente na demanda que é levada à escola, sinalizando um apelo ao saber sobre a criança à quem supõe-se saber sobre toda criança. O segundo diz respeito ao discurso dos pais sobre o filho - que revela algo para além daquilo que se apresenta.

Este artículo trae, a partir del análisis discursivo de la asistencia prestada por la orientación educativa en el período de la educación a distancia, los efectos y reflexiones que pueden producir un espacio de escucha durante la pandemia de COVID-19. De manera virtual, la búsqueda del Servicio de Orientación Educativa continuó y trajo puntos que nos son valiosos para pensar en la paternidad hoy en día. A la luz del psicoanálisis, se discuten dos apuntes en función de los servicios prestados: el primero se encuentra precisamente en la demanda que se lleva a la escuela, señalando una apelación para saber sobre el niño de aquel que debe supuestamente saber sobre todos los niños. El segundo se refiere al discurso de los padres sobre el niño, que revela algo más allá de lo que se presenta.

This present article brings trough the discursive analysis of the services provide from the educational guidance in the remote teaching period, effects and reflections that a listening space can provide during the COVID-19 pandemic. In a virtual mode, the search for the Educational Guidence Service kept happening and brought up valuable points to us to think about parenthood these days. In the light of psychoanalyses it is discussed two different notes from the services provided: the first one is precisely located on the demand that is taken to school, signaling an appeal to know about the child from whom it is supposed to know about every child. The second one is about the parents' speech about the child, that reveals somenthing beyond that what is presented.

Ce présent article apporte, à partir de l'analyse discursive de l'assistance fournie par l' orientation pédagogique dans la période d'enseignement à distance, des effets et des réflexions qu'un espace d'écoute peut produire pendant la pandémie COVID-19. Dans un mode virtuel, la recherche du Service d'orientation pédagogique en a continué et a soulevé des points qui nous sont chers pour réfléchir à la parentalité aujourd'hui. À la lumière de la psychanalyse, il est discuté deux notes différentes des services fournis: la première est précisément située sur la demande qui est emmenée à l'école, signalant un appel au savoir sur l'enfant à qui on suppose savoir à propos de chaque enfant. Le second concerne le discours des parents sur l'enfant - qui révèle quelque chose au-delà de ce qui est présenté.

Web-mediated counseling to counteract the emotional impact of COVID-19 for women with interstitial cystitis/bladder pain syndrome.

OBJECTIVE: Interstitial Cystitis (IC) is a chronic and rare disease, more frequent in women. Symptoms of continuous pain can produce psychological disorders, such as anxiety and depression. The spread of COVID-19 pandemic added to distress experienced by patients with IC emotions, such as fear, sadness, boredom, frustration and anger. MATERIALS AND METHODS: A research on very recent literature outlines the necessity for patients facing the complexity of IC during the COVID-19 outbreak to prevent the temporary crisis, to broaden perspectives, to deal with confusion, to support in struggling with unpleasant and unexpected events. CONCLUSIONS: People affected by IC have a psychological vulnerability that needs tailored support interventions, particularly in the COVID era. A multidisciplinary approach offers a personalized treatment through a web-mediated counseling intervention for patients and their caregivers: a space for continuous discussion and reflection can favour a relationship-based process of change aimed at an improvement in quality of life.

Evaluating the effects of guided coaching calls on engagement and outcomes for online acceptance and commitment therapy.

Previous research indicates mixed results for guided support with online interventions. The current secondary analysis evaluated the effects of phone coaching from a dismantling trial of online acceptance and commitment therapy (ACT) in a sample of 136 distressed college students randomized to one of three versions of an ACT website. Participants were randomized to receive email prompts alone (non-coaching condition) or email plus phone coaching (coaching condition). Results indicated no differences between the coaching and non-coaching conditions on program engagement, program satisfaction, mental health outcomes, and almost all psychological flexibility processes. However, participants in the coaching condition reported stronger pre- to posttreatment improvements in psychological inflexibility than the non-coaching condition. This effect was moderated by ACT component condition, with larger pre- to posttreatment effects from coaching on psychological inflexibility in the values/committed action condition and weaker improvements from coaching in the acceptance/defusion condition. Overall, results indicate online self-guided ACT interventions with email prompts are sufficient for addressing college student mental health and that phone coaching provided minimal additional benefit.

Automated E-Counseling for Chronic Heart Failure: CHF-CePPORT Trial.

BACKGROUND: International task force statements advocate telehealth programs to promote health-related quality of life for patients with chronic heart failure (CHF). To that end, we evaluated the efficacy and usability of an automated e-counseling program. METHODS: This Canadian multi-site double-blind randomized trial assessed whether usual care plus either internet-based e-counseling (motivational and cognitive-behavioral tools for CHF self-care) or e-based conventional CHF self-care education (e-UC) improved 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS). Secondary outcomes included program engagement (total logon weeks, logons, and logon hours), total CHF self-care behaviors, diet (fruit and vegetable servings), 6-minute walk test, and 4-day step count. The association between program engagement and health-related quality of life was assessed using KCCQ-OS tertiles. RESULTS: We enrolled 231 patients, median age =59.5 years, 22% female, and elevated median KCCQ-OS=83.0 (interquartile range, 68-93). KCCQ-OS increase ≥5 points was not more prevalent for e-counseling, n=29 (29.6%) versus e-UC, n=32 (34.0%), P=0.51. E-Counseling versus e-UC increased total logon weeks (P=0.02), logon hours (P=0.001), and logons (P<0.001). Only e-counseling showed a positive association between 12-month KCCQ-OS tertile and logon weeks (P=0.04) and logon hours (P=0.004). E-Counseling increased CHF self-care behavior and diet but not 6-minute walk test or 4-day step count. CONCLUSIONS: The primary KCCQ-OS end point was negative for this trial. Only e-counseling showed a positive association between program engagement and 12-month KCCQ-OS tertile, and it improved CHF self-care behavior and diet. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01864369.

EMDR in Telemental Health Counseling for Healthcare Workers Caring for COVID-19 Patients: A Pilot Study.

BACKGROUND: The COVID-19 pandemic is putting a strain on health systems around the world. Healthcare workers, on the front lines of the epidemic, are facing major and potentially traumatic stressful events, overwhelming their ability to cope and their resources. OBJECTIVE: The objective of this article will be to show how the use of the URG-EMDR protocol in a telemental health setting has proven to be feasible and effective in the treatment of a group of healthcare professionals working in nursing homes or hospital services that were highly mobilized during the acute phase of COVID-19. METHOD: 17 participants, registered nurses (N = 7) and licensed practical nurses (N = 10), were remotely treated using the URG-EMDR protocol in a single session. The assessment focused on anxiety and depressive symptoms (HAD scale) and the level of perceived disturbance (SUD). An additional evaluation of the satisfaction with the remote psychotherapy intervention was conducted. RESULTS: As the URG-EMDR protocol has already proven itself during emergency interventions, it is interesting to note that its remote use in the treatment of healthcare providers caring for COVID-19 patients allows for an improvement in the emotional state and a decrease in perceived disturbance, in a single session. This result is maintained 1 week after the intervention, despite the continued professional activities of the participants and the continuity of the event. Moreover, the remote therapy setting was judged satisfactory by the patients, even if it required adjustments and certain recommendations for practice. DISCUSSION: The remote use of the URG-EMDR protocol opens up innovative perspectives for early interventions and the prevention of the development of psychological disorders in the long term following a situation of acute stress.

The impact of phone counseling on urinary stone prevention.

OBJECTIVE: We compared the effect of standard office-based consultation (OC) and phone correspondences (PC) on dietary 24-h urinary parameters. METHODS: The medical record of all patients treated between January and April 2019 was reviewed. Only patients who had at least two consecutive 24-h urine collections were included. Linear and logistic regressions were used to investigate the difference between the changes in urinary parameters after OC and PC. RESULTS: Forty-three patients underwent 135 OC and 34 PC. Twenty-one received OC and PC, and 22 had only OC. Gender, age, the distance to stone clinic, the number of previous stone episodes, and baseline urinary parameters were similar between the groups. Patients who had both OC and PC had a longer follow-up time (51.7 vs 18.5 months, p < 0.0001) as well as more consults (Median 5.4 vs 2.5, p < 0.0001). Six (27%) patients who had only OC, and eight (38%) patients who had both OC and PC, experienced stone recurrence during the study period (p = 0.52). Following PC, there was a greater improvement in urine volume in comparison to OC (0.27 l/day vs -0.06 l/day, p = 0.034), but there was no difference in the absolute values after the consults between the groups. CONCLUSION: In established stone-clinic patients, PC was associated with a better adherence with follow-up. The 24-h urine results were similar between PC and OC. PC may be an effective alternative for urinary stone management.

Distance Assessment for Detecting Cognitive Impairment in Older Adults: A Systematic Review of Psychometric Evidence.

INTRODUCTION: Distance or remote cognitive assessments, administered via phone or computer platforms, have emerged as possible alternatives to traditional assessments performed during office visits. Distance refers to any nontraditional assessment feature, not only or necessarily location. We conducted a systematic review to examine the psychometric soundness of these approaches. METHOD: We searched PubMed, PsycINFO, AgeLine, and Academic Search Premier for articles published between January 2008 and June 2020. Studies were included if participants were over the age of 50, a structured assessment of cognitive function in older adults was evaluated, the assessment method was deemed distant, and validity and/or reliability data were reported. Assessment distance was defined as having any of the following features: use of an electronic test interface, nonroutine test location (e.g., home), test self-administered, and test unsupervised. Distance was categorized as low, intermediate, or high. RESULTS/DISCUSSION: Twenty-six studies met inclusion criteria. Sample sizes ranged from n = 8 to 8,627, and the mean age ranged from 57 to 83. Assessments included screens, brief or full batteries, and were performed via videoconferencing, phone, smartphone, or tablet/computer. Ten studies reported on low distance, 11 on intermediate distance, and 5 studies for high distance assessments. Invalid performance data were observed with older age and cognitive impairment. Convergent validity data were reported consistently and suggested a decline with increasing distance: r = 0.52-0.80 for low, 0.49-0.75 for intermediate, and 0.41-0.53 for high distance. Diagnostic validity estimates presented a similar pattern. Reliability data were reported too inconsistently to allow evaluation. CONCLUSION: The validity of cognitive assessments with older adults appears supported at lower but not higher distance. Less is known about the reliability of such assessments. Future research should delineate the person and procedure boundaries for valid and reliable test results.