The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of ...these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.
•Being physically present with a client does not appear essential to generating therapeutic outcomes.•There are few meaningful differences in intervention or assessment outcomes across remote and in-person deliveries.•Medical settings may produce more favorable outcomes through the use of videoconferencing than other settings.•More rigorous research designs that focus on a wider range of client demographics and clinical concerns are lacking.
Background
Sickle cell disease (SCD) is one of the most common inherited diseases worldwide. It is associated with lifelong morbidity and a reduced life expectancy. Hydroxyurea (hydroxycarbamide), an ...oral chemotherapeutic drug, ameliorates some of the clinical problems of SCD, in particular that of pain, by raising fetal haemoglobin. This is an update of a previously published Cochrane Review.
Objectives
To assess the effects of hydroxyurea therapy in people with SCD (all genotypes), of any age, regardless of setting.
Search methods
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Register, comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and books of conference proceedings. We also searched online trial registries.
Date of the most recent search: 16 January 2017.
Selection criteria
Randomised and quasi‐randomised controlled trials, of one month or longer, comparing hydroxyurea with placebo, standard therapy or other interventions for people with SCD.
Data collection and analysis
Authors independently assessed studies for inclusion, carried out data extraction and assessed the risk of bias.
Main results
Seventeen studies were identified in the searches; eight randomised controlled trials were included, recruiting 899 adults and children with SCD (haemoglobin SS (HbSS), haemoglobin SC (HbSC) or haemoglobin Sβºthalassaemia (HbSβºthal) genotypes). Studies lasted from six to 30 months.
Four studies (577 adults and children with HbSS or HbSβºthal) compared hydroxyurea to placebo; three recruited individuals with only severe disease and one recruited individuals with all disease severities. There were statistically significant improvements in terms of pain alteration (using measures such as pain crisis frequency, duration, intensity, hospital admissions and opoid use), measures of fetal haemoglobin and neutrophil counts and fewer occurrences of acute chest syndrome and blood transfusions in the hydroxyurea groups. There were no consistent statistically significant differences in terms of quality of life and adverse events (including serious or life‐threatening events). Seven deaths occurred during the studies, but the rates by treatment group were not statistically significantly different.
Two studies (254 children with HbSS or HbSβºthal also with risk of primary or secondary stroke) compared hydroxyurea and phlebotomy to transfusion and chelation; there were statistically significant improvements in terms of measures of fetal haemoglobin and neutrophil counts, but more occurrences of acute chest syndrome and infections in the hydroxyurea and phlebotomy group. There were no consistent statistically significant differences in terms of pain alteration and adverse events (including serious or life‐threatening events). Two deaths occurred during the studies (one in a the hydroxyurea treatment arm and one in the control arm), but the rates by treatment group were not statistically significantly different. In the primary prevention study, no strokes occurred in either treatment group but in the secondary prevention study, seven strokes occurred in the hydroxyurea and phlebotomy group (none in the transfusion and chelation group) and the study was terminated early.
The quality of the evidence for the above two comparisons was judged as moderate to low as the studies contributing to these comparisons were mostly large and well designed (and at low risk of bias); however evidence was limited and imprecise for some outcomes such as quality of life, deaths during the studies and adverse events and results are applicable only to individuals with HbSS and HbSβºthal genotypes.
Of the remaining two studies, one (22 children with HbSS or HbSβºthal also at risk of stoke) compared hydroxyurea to observation; there were statistically significant improvements in terms of measures of fetal haemoglobin and neutrophil counts but no statistically significant differences in terms of adverse events (including serious or life‐threatening events).
The final study (44 adults and children with HbSC) compared treatment regimens with and without hydroxyurea – there was statistically significant improvement in terms of measures of fetal haemoglobin, but no statistically significant differences in terms of adverse events (including serious or life‐threatening events). No participants died in either of these studies and other outcomes relevant to the review were not reported.
The quality of the evidence for the above two comparisons was judged to be very low due to the limited number of participants, the lack of statistical power (as both studies were terminated early with approximately only 20% of their target sample size recruited) and the lack of applicability to all age groups and genotypes.
Authors' conclusions
There is evidence to suggest that hydroxyurea is effective in decreasing the frequency of pain episodes and other acute complications in adults and children with sickle cell anaemia of HbSS or HbSβºthal genotypes and in preventing life‐threatening neurological events in those with sickle cell anaemia at risk of primary stroke by maintaining transcranial doppler velocities. However, there is still insufficient evidence on the long‐term benefits of hydroxyurea, particularly in preventing chronic complications of SCD, recommending a standard dose or dose escalation to maximum tolerated dose. There is also insufficient evidence about the long‐term risks of hydroxyurea, including its effects on fertility and reproduction. Evidence is also limited on the effects of hydroxyurea on individuals with HbSC genotype. Future studies should be designed to address such uncertainties.
Exploring the roles of gender performance through the experience of digital gaming provides an arena for discussing the power of fear and anxiety as cultural tools for counterhegemonic forces. The ...power and function of gender performativity in its varied and multiplicitous forms is a newer branch of game studies research. In this article, fear and anxiety are explored as a game procedure and cultural tool used by the character Alice Angel in Kindly Beast's Bendy and the Ink Machine. By enacting Barbara Creed's uncanny gaze and the monstrous-feminine, Alice Angel calls attention and visibility to the function of the abject as a form of visibility for the oppressed. The monstrous-feminine as a theoretical concept for horror media texts provides a framework to explore the posing, behaviors, and actions of game characters and their relationships to the player and culture at large.
In a randomized trial, children with uveitis associated with juvenile idiopathic arthritis who were taking a stable dose of methotrexate were significantly less likely to have treatment failure but ...more likely to have adverse events with adalimumab than with placebo.
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk for inflammation of the uvea (uveitis). Uveitis develops in approximately 12 to 38% of patients with JIA within 7 years after the onset of arthritis.
1
,
2
Despite current screening and therapeutic options, visual impairment in both eyes may develop in up to 15% of children with JIA-associated uveitis, and they may be certified as legally blind.
3
,
4
Experimental models of autoimmune uveitis have shown that tumor necrosis factor α (TNF-α) plays a pivotal role in the pathogenesis,
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findings that have been borne . . .
He Looks Like My Father White Jones, Ashley
Health promotion practice,
05/2023, Letnik:
24, Številka:
3
Journal Article
Recenzirano
Social media has kept us connected in many ways but for Black adults, it can be a harrowing reminder of the treatment of Black bodies. This poem was crafted from focus group data on a study of the ...effects of vicarious racism on the mental health of Black adults in the wake of George Floyd’s death in 2020. This poem uses elements of found poetry and incorporates texts from the narrative (re)telling of Black adults’ emotional impact of seeing racially and police-involved killings of Black men. Participants expressed feelings of anger, powerlessness, and sadness and how watching these videos has led to avoidance behavior for the sake of coping. In this poem titled “He Looks like My Father,” the participant shares a memory of the last video that they watched on social media in 2014 and why they continue to avoid this type of content. It’s traumatizing. It is important to fully reflect on these stories as Black Americans struggle with staying informed and preserving their mental health while being inundated by a continuous feedback loop of Black death. The elements of this poem incorporate repetition and the bolded words are verbatim text from the participant transcript. I acknowledge that my positionality being a Black American woman, with a Black father, and having shared the embodied experience of witnessing Black death via social media influenced the meaning of this poem. As we continue to see a focus on naming racism as a public health threat, this form of vicarious racism is salient and should be explored as health professionals dig deeper into understanding the many ways racism permeates the lives of Black, is a daily stressor, and is a social determinant of mental health equity. These are the narratives from muted lips to unveil your eyes. To view the original version of this poem, see the supplemental material section of this article online.
The joint influence of persons and situations on behavior has long been posited by personality and social psychological theory (Funder, 2006; Lewin, 1951). However, a lack of tools for real-time ...behavioral and situation assessment has left direct investigations of this sort immobilized. This study combines recent advances in situation assessment and experience sampling methodology to examine the simultaneous effects of personality traits and situation characteristics on real-time expressions of behavior and emotion in N = 210 participants. The results support an additive model such that both personality traits and situation characteristics independently predict real-time expressions of behavior and emotion. These results have implications for several prominent theoretical perspectives in personality, including both trait and cognitive theories.
As online education becomes a more popular and permanent option for obtaining an education after high school, it also raises questions as to the academic rigor of such classes and the academic ...integrity of the students taking the classes. The purpose of the current study is to explore the integrity issue and to investigate student performance on online examinations. Utilizing a sample of about 1,700 students who took online psychology classes of varying difficulty at Washington State University from the spring 2015 to spring 2016, we found that students performed 10-20% better but took about twice as long on non-proctored versus proctored exams. This confirmed our hypotheses and the effect held when we compared our in-house proctoring service used during this time against ProctorU used for one semester in the fall 2012. To ensure the most robust design possible, we also rotated the proctored exam in each class at least once and then compared performance on an exam when it was proctored versus when the same exam was non-proctored. Results showed better performance when the exam was non-proctored then when it was proctored. Finally, since instructors changed over the four semesters our study ran, we wanted to ensure that the results were due to student misconduct and not differences in teaching style. This potential confounding variable was eliminated. Implications of student misconduct for academic integrity in online classes is discussed and potential solutions presented, including a future direction for research.
Dornase alfa for cystic fibrosis Jones, Ashley P; Wallis, Colin
Cochrane database of systematic reviews,
2010-Mar-17
3
Journal Article
Recenzirano
Dornase alfa is currently used to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis.
To determine whether the use of dornase alfa in cystic fibrosis is ...associated with improved mortality and morbidity compared to placebo or other mucolytics and to identify any adverse events associated with its use.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstracts from conferences.Date of the most recent search of the Group's Cystic Fibrosis Register: 17 July 2009.
All randomised and quasi-randomised controlled trials where dornase alfa was compared to placebo, standard therapy or another mucolytic.
Authors independently assessed trials for inclusion criteria; the lead author and a colleague carried out analysis of methodological quality and data extraction.
The searches identified 43 trials, of which 15 met our inclusion criteria, including a total of 2469 participants. Three additional studies examined the healthcare cost from one of the clinical trials. Twelve studies compared dornase alfa to placebo or no dornase alfa treatment; one compared daily dornase alfa with hypertonic saline and alternate day dornase alfa; and two compared daily dornase alfa to hypertonic saline. Study duration varied from six days to two years. The number of deaths was not significant between treatment groups. Spirometric lung function improved in the treated groups, with significant differences at one month, three months, six months and two years, there was a non-significant difference at three years. There was no excess of adverse effects except voice alteration and rash, which were reported more frequently in one trial in the treated groups. Insufficient data were available to analyse differences in antibiotic treatment, inpatient stay and quality of life.
There is evidence to show that therapy with dornase alfa over a one-month period is associated with an improvement in lung function in CF; results from a trial lasting six months also showed the same effect. Therapy over a two-year period (based on one trial) significantly improved FEV(1) in children and there was a non-significant reduction in the risk of infective exacerbations. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials.
Across disciplines, there has been increased attention to understanding and addressing compounded oppression and marginalization associated with intersecting identities. We argue that involvement ...with the criminal justice system can, in itself, represent an identity (self-ascribed or not) that interplays with other demographic and systemic variables, making it more difficult for these clients to disconnect from the system. We offer our perspective on integrating conversations and tools focused on intersectionality into assessment and interventions that address criminogenic risks, recommendations for adopting a mixed-methods approach to researching intersectionality in correctional settings that better accounts for individual variability, as well as suggestions for advocacy, policy reform, and graduate-level training. With its emphasis on diversity and multiculturalism, health service psychology and related professions are uniquely poised to help correctional agencies move in a more inclusive direction that will likely improve client well-being and prosocial reengagement as well as reduce continued systemic oppression.
Oxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing humidified O2 to standard O2 in ...children is feasible, and specifically to obtain data on recruitment, tolerability and outcome measure stability.
Heated humidified, cold humidified and standard O2 treatments were compared for children (2-16 years) with acute severe asthma in a multi-centre, open, parallel, pilot randomised controlled trial (RCT). Multiple outcomes were assessed.
Of 258 children screened, 66 were randomised (heated humidified O2 n = 25; cold humidified O2 n = 21; standard O2 n = 20). Median (IQR) length of stay (hours) in hospital was 37.9 (29.1), 52 (35.4) and 49.1 (29.7) for standard, heated humidified and cold humidified respectively and time (hours) on O2 was 15.9 (9.4), 13.6 (14.9) and 13.1 (14.9) for the three groups respectively. The mean (standard deviation) time (hours) taken to step down nebulised to inhaled treatment was 5.6 (14.3), 35.1 (28.2) and 32.7 (20.1). Asthma Severity Score decreased in all three groups similarly, although missing data prevented complete analysis. Humidified O2 was least well tolerated with eight participants discontinuing their randomised treatment early. An important barrier to recruitment was research nurse availability.
Although, the results of this pilot study should not be extrapolated beyond the study sample and inferential conclusions should not be drawn from the results, this is the first RCT to compare humidified and standard O2 therapy in acute severe asthmatics of any age. These findings and accompanying screening data show that a large RCT of O2 therapy is feasible. However, challenges associated with randomisation and data collection should be addressed in any future trial design.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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