Vital Health Stat 3. 2022 May;(47):1-93.
ABSTRACT
This report presents the most current national results from the National Study of Long-Term Care Providers (NSLTCP), conducted by the National Center for Health Statistics (NCHS) to describe providers and services users in seven major sectors of paid, regulated postacute and long-term care services in the United States.
PMID:35604771
JMIR Mhealth Uhealth. 2022 May 23;10(5):e23887. doi: 10.2196/23887.
ABSTRACT
BACKGROUND: On-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation.
OBJECTIVE: The aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients’ changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility.
METHODS: From June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting. A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission.
RESULTS: Of the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72%) were female and 31 (28%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities (β=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities (β=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities (β=-.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time (β=-.13; SE 0.06; P=.04) was associated with toileting activities.
CONCLUSIONS: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients’ progress or decline.
PMID:35604762 | DOI:10.2196/23887
JMIR Public Health Surveill. 2022 May 23;8(5):e37820. doi: 10.2196/37820.
ABSTRACT
BACKGROUND: Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated.
OBJECTIVE: We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies.
METHODS: A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data.
RESULTS: Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews.
CONCLUSIONS: The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/35332.
PMID:35604757 | DOI:10.2196/37820
J Consult Clin Psychol. 2022 May;90(5):446-458. doi: 10.1037/ccp0000727.
ABSTRACT
OBJECTIVE: Modeling cross-lagged effects in psychotherapy mechanisms of change studies is complex and requires careful attention to model selection and interpretation. However, there is a lack of field-specific guidelines. We aimed to (a) describe the estimation and interpretation of cross lagged effects using multilevel models (MLM) and random-intercept cross lagged panel model (RI-CLPM); (b) compare these models’ performance and risk of bias using simulations and an applied research example to formulate recommendations for practice.
METHOD: Part 1 is a tutorial focused on introducing/describing dynamic effects in the form of autoregression and bidirectionality. In Part 2, we compare the estimation of cross-lagged effects in RI-CLPM, which takes dynamic effects into account, with three commonly used MLMs that cannot accommodate dynamics. In Part 3, we describe a Monte Carlo simulation study testing model performance of RI-CLPM and MLM under realistic conditions for psychotherapy mechanisms of change studies.
RESULTS: Our findings suggested that all three MLMs resulted in severely biased estimates of cross-lagged effects when dynamic effects were present in the data, with some experimental conditions generating statistically significant estimates in the wrong direction. MLMs performed comparably well only in conditions which are conceptually unrealistic for psychotherapy mechanisms of change research (i.e., no inertia in variables and no bidirectional effects).
DISCUSSION: Based on conceptual fit and our simulation results, we strongly recommend using fully dynamic structural equation modeling models, such as the RI-CLPM, rather than static, unidirectional regression models (e.g., MLM) to study cross-lagged effects in mechanisms of change research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID:35604748 | DOI:10.1037/ccp0000727
J Consult Clin Psychol. 2022 May;90(5):381-391. doi: 10.1037/ccp0000734.
ABSTRACT
OBJECTIVE: This study assessed the efficacy of the marriage checkup, as adapted to integrated primary care settings and active-duty military couples, for improving relationship health and depressive symptoms.
METHOD: Married couples (N = 244, Mage = 32.4, 67.6% Caucasian) in which at least one member was active-duty Air Force were recruited from bases across the U.S. via online advertisement, emails sent from medical clinics to enrolled beneficiaries, social media posts, and flyers, and randomly assigned to active treatment or waitlist control. Treatment and control couples were linked in pairs sequentially and pairs completed nine sets of questionnaires at baseline, 1-, and 6-month posttreatment. Outcome measures included the Couples Satisfaction Index, Intimate Safety Questionnaire, Responsive Attention Scale, Partner Compassion Scale, Communication Skills Test, and the Center for Epidemiologic Studies Depression Scale.
RESULTS: A three-level multilevel model indicated, after adjustment for multiple comparisons, treatment couples experienced statistically significant small-to-moderate improvements compared to the control group (Cohen’s d from 0.21 to 0.55) at 1 month that were sustained at 6 months for relationship satisfaction, responsive attention, compassion toward their partners, communication skills, intimate safety, and depressive symptoms.
CONCLUSIONS: A longitudinal randomized control trial of the MC supports the hypothesis that the MC significantly improves relationship satisfaction, intimacy, communication, partner compassion, responsive attention, and depressive symptoms. Implications for theory, treatment, and dissemination are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID:35604745 | DOI:10.1037/ccp0000734
J Consult Clin Psychol. 2022 May;90(5):367-380. doi: 10.1037/ccp0000725.
ABSTRACT
OBJECTIVE: Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting.
METHOD: Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other.
RESULTS: Medication had large, salutary, statistically significant effects on children’s academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period.
CONCLUSIONS: Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID:35604744 | DOI:10.1037/ccp0000725
Clin J Oncol Nurs. 2022 Jun 1;26(3):300-307. doi: 10.1188/22.CJON.300-307.
ABSTRACT
BACKGROUND: There is insufficient evidence of the effects of intermittent flushing with normal saline versus heparin to prevent occlusion or increased alteplase use in pediatric patients with central venous catheters.
OBJECTIVES: The primary objective was to evaluate the effectiveness of a new standard flushing practice in the management of central venous access devices in pediatric patients with cancer. A secondary objective was to assess the cost of heparin flushing supplies to patients and financial impact.
METHODS: New flushing guidelines included tunneled lines flushed with saline in the push-pause method twice daily in the inpatient setting. The outpatient setting required saline lock while receiving care and heparin lock on discharge. Alteplase usage was monitored for five months in all pediatric patients with cancer who had tunneled central lines.
FINDINGS: There was no statistically significant difference in alteplase usage rate pre- to postimplementation. A formal flushing guideline was recommended using saline and lower heparin concentrations for tunneled catheters.
PMID:35604736 | DOI:10.1188/22.CJON.300-307
Clin J Oncol Nurs. 2022 Jun 1;26(3):261-267. doi: 10.1188/22.CJON.261-267.
ABSTRACT
BACKGROUND: Opioid misuse risk may be similar in individuals with chronic cancer and noncancer pain. However, risk screening is not uniformly used for patients with cancer, so its prevalence is unknown.
OBJECTIVES: The primary aim of this study was to estimate the level of risk for opioid misuse among patients with cancer. Secondary aims were to compare opioid misuse risk across cancer types and specialties and to explore psychosocial factors that may contribute to opioid misuse risk.
METHODS: Clinicians were trained to administer the Opioid Risk Tool during ambulatory visits. Data were retrieved from electronic health records and analyzed using descriptive statistics.
FINDINGS: Five percent of patients seen in the cancer center during the data collection period were screened for opioid misuse risk. Of the 226 patients screened, 163 were at low risk, 34 were at moderate risk, and 29 were at high risk for future opioid misuse. The most frequent cancer diagnoses for patients at moderate or high risk were lung (n = 15), breast (n = 16), gastrointestinal (n = 10), and genitourinary (n = 8). Of the 63 patients at moderate or high risk, 50 had a family history of substance misuse, 45 had a personal history of substance misuse, and 29 had a history of psychological disease.
PMID:35604731 | DOI:10.1188/22.CJON.261-267
Br J Radiol. 2022 May 23:20220140. doi: 10.1259/bjr.20220140. Online ahead of print.
NO ABSTRACT
PMID:35604720 | DOI:10.1259/bjr.20220140
Exp Clin Psychopharmacol. 2022 May 23. doi: 10.1037/pha0000566. Online ahead of print.
ABSTRACT
The status of remission in patients with major depressive disorder treated with selective serotonin reuptake inhibitors (SSRIs) is mostly evaluated with clinical rating scales. Morphological correlates of the remission status remain a rare event. Addressing this challenge, we investigated functional correlates of remission by assessment of serotonin and dopamine transporter availability (SERT and DAT) using single-photon emission computed tomography (SPECT). Our purpose was to identify changes in the SERT/DAT binding potential in accordance with the clinical improvement. Nineteen drug-naïve patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of major depression were included. [¹²³I]2β-carbomethoxy-3β-(4-iodophenyl)tropane(β-CIT) SPECT was obtained from each participant before (baseline) and after 6 weeks (follow-up) of standardized treatment with escitalopram. The [¹²³I]β-CIT-SPECT recordings were acquired 4 hr (SERT-weighted) and 20-24 hr p.i (DAT-weighted), and binding potentials (˜BPND: baseline, follow-up, and rate of change) were calculated for thalamus, midbrain, pons (SERT), and striatum (DAT). From all study participants, neuropsychiatric symptoms were assessed using Hamilton depression (HAM-D) and Beck Depression Inventory scores. At follow-up, patients were divided into responders and nonresponders (as well as remitters and nonremitters). Compared to nonremitted, remitted patients showed over the course of 6 weeks a significantly higher loss of SERT binding potential in the thalamus (p = .036) and in the midbrain (p = .019). Additionally, the correlation of HAM-D with SERT binding potential in the thalamus showed a trend toward significance (p = .057) with higher HAM-D scores (at baseline) leading to lower SERT binding potential. No significant associations were identified for the analysis of baseline prediction of therapy response with SERT and DAT. Our results suggest that patients who remit from their depressive symptoms under escitalopram are characterized by stronger decreases of SERT, indicating that escitalopram blocking of SERT leads to clinical improvement. Therefore, this study shows that measuring SERT availability with SPECT could be an efficient and applicable technique to illustrate a possible underlying pathophysiology of symptom remission in response to treatment. In addition, the present results could help to stimulate new treatment approaches based on SERT and DAT binding. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID:35604719 | DOI:10.1037/pha0000566
