Development of a Wearable Biocueing Application (Sense-IT) among Forensic Psychiatric Outpatients with Aggressive Behavior: Design and Evaluation Study (Preprint)

2021 ◽  
Author(s):  
Annemieke ter Harmsel ◽  
Thimo van der Pol ◽  
Lise Swinkels ◽  
Anneke Goudriaan ◽  
Arne Popma ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Clinical Outcomes ◽  
Outpatient Care ◽  
New Technology ◽  
Real Life ◽  
Evaluation Study ◽  
Treatment Programs ◽  
Post Intervention ◽  
Forensic Psychiatric ◽  
It Application

BACKGROUND The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and the predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. OBJECTIVE The aim of this study was to explore whether a new technology-based biocueing intervention, the Sense-IT application, could be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT application, providing the user with real-time physiological feedback and behavioral support, was developed to strengthen emotional awareness and facilitate real life practice. In this study, a new version of the Sense-IT, suitable for forensic outpatients with aggressive behavior, was developed and evaluated. METHODS First, a design study was conducted to assess the attitude of forensic professionals and patients towards biocueing, and to collect requirements for a biocueing application in this specific population. Based on this information, a new version of the Sense-IT application was developed. In an evaluation study, 10 forensic outpatients used the application during two weeks. Acceptability, usability and clinical outcomes (aggression, anger and recognition of bodily signals related to anger) were measured pre- and post-intervention, using both quantitative and qualitative measures. RESULTS The design study revealed a cautiously positive attitude towards the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability of the new version of the Sense-IT. Exploratory analysis revealed a significant decrease in trait aggression post-intervention; no significant changes were found on other anger related clinical outcomes. To further increase acceptability and usability, a stable functioning application with self-adjustable settings, the use of smartwatches with a longer battery life and the use of patient’s own smartphone devices were recommended. CONCLUSIONS This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude towards new technology, allowing exploration of the potential benefits of the Sense-IT case-by-case, and training of therapists in using the application, are expected to facilitate integration in therapy. CLINICALTRIAL The evaluation study was registered in the Netherlands Trial Register (NL8206).

The Hitman Study

2010 ◽  
Vol 15 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Christopher J. Ferguson ◽  
Stephanie M. Rueda
Keyword(s):  
Experimental Study ◽  
Young Adults ◽  
Aggressive Behavior ◽  
Video Game ◽  
Real Life ◽  
Mood Management ◽  
Video Game Play ◽  
Video Game Playing ◽  
Violent Video Game ◽  
The Social

This article explores commonly discussed theories of violent video game effects: the social learning, mood management, and catharsis hypotheses. An experimental study was carried out to examine violent video game effects. In this study, 103 young adults were given a frustration task and then randomized to play no game, a nonviolent game, a violent game with good versus evil theme (i.e., playing as a good character taking on evil), or a violent game in which they played as a “bad guy.” Results indicated that randomized video game play had no effect on aggressive behavior; real-life violent video game-playing history, however, was predictive of decreased hostile feelings and decreased depression following the frustration task. Results do not support a link between violent video games and aggressive behavior, but do suggest that violent games reduce depression and hostile feelings in players through mood management.

scholarly journals 110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Katie A McCrink ◽  
Kailynn DeRonde ◽  
Adriana Jimenez ◽  
Gemma Rosello ◽  
Yoichiro Natori ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Patient Survival ◽  
Intervention Group ◽  
Culture Collection ◽  
Drug Resistant ◽  
Intervention Period ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

scholarly journals Apixaban concentration variability and relation to clinical outcomes in real-life patients with atrial fibrillation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alenka Mavri ◽  
Nina Vene ◽  
Mojca Božič-Mijovski ◽  
Marko Miklič ◽  
Lisbeth Söderblom ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Thromboembolic Event ◽  
Real Life ◽  
Individual Variability ◽  
Blood Samples ◽  
Chromatography Tandem Mass Spectrometry ◽  
Significant Difference ◽  
Liquid Chromatography Tandem Mass ◽  
Peak Blood

AbstractIn some clinical situations, measurements of anticoagulant effect of apixaban may be needed. We investigated the inter- and intra-individual apixaban variability in patients with atrial fibrillation and correlated these results with clinical outcome. We included 62 patients receiving either 5 mg (A5, n = 32) or 2.5 mg (A2.5, n = 30) apixaban twice-daily. We collected three trough and three peak blood samples 6–8 weeks apart. Apixaban concentration was measured by liquid chromatography-tandem mass-spectrometry (LC–MS/MS) and by anti-Xa. Patients on A2.5 were older, had lower creatinine clearance, higher CHA2DS2VASc (4.7 ± 1.0 vs. 3.4 ± 1.7) and lower trough (85 ± 39 vs. 117 ± 53 ng/mL) and peak (170 ± 56 vs. 256 ± 91 ng/mL) apixaban concentrations than patients on A5 (all p < 0.01). In patients on A5, LC–MS/MS showed a significant difference between through levels and between peak levels (p < 0.01). During apixaban treatment, 21 patients suffered bleeding (2 major). There was no association between bleeding and apixaban concentrations or variability. Four patients who suffered thromboembolic event had lower peak apixaban concentrations than patients without it (159 ± 13 vs. 238 ± 88 ng/mL, p = 0.05). We concluded, that there was a significant intra- and inter-individual variability in apixaban trough and peak concentrations. Neither variability nor apixaban concentrations were associated with clinical outcomes.

scholarly journals Nutritional Intervention with Dried Bonito Broth for the Amelioration of Aggressive Behaviors in Children with Prenatal Exposure to Dioxins in Vietnam: A Pilot Study

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1455
Author(s):  
Muneko Nishijo ◽  
Tai The Pham ◽  
Ngoc Thao Pham ◽  
Hai Thai Thu Duong ◽  
Ngoc Nghi Tran ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Prenatal Exposure ◽  
Intervention Group ◽  
Experimental Period ◽  
Nutritional Intervention ◽  
Autism Spectrum ◽  
Aggressive Behaviors ◽  
Post Intervention ◽  
Dioxin Exposure ◽  
Covert Aggression

Dioxins have been suggested to induce inflammation in the intestine and brain and to induce neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), partly due to deficits in parvalbumin-positive neurons in the brain that are sensitive to inflammatory stress. Previously, we reported ADHD traits with increased aggressiveness in children with prenatal exposure to dioxins in Vietnam, whereas dried bonito broth (DBB) has been reported to suppress inflammation and inhibit aggressive behavior in animal and human studies. In the present study, we investigated the association between dioxin exposure and the prevalence of children with highly aggressive behaviors (Study 1), as well as the effects of DBB on the prevalence of children with highly aggressive behaviors (Study 2). Methods: In Study 1, we investigated the effects of dioxin exposure on the prevalence of children with high aggression scores, which were assessed using the Children’s Scale of Hostility and Aggression: Reactive/Proactive (C-SHARP) in dioxin-contaminated areas. The data were analyzed using a logistic regression model after adjusting for confounding factors. In Study 2, we performed nutritional intervention by administering DBB for 60 days to ameliorate the aggressiveness of children with high scores on the C-SHARP aggression scale. The effects of DBB were assessed by comparing the prevalence of children with high C-SHARP scores between the pre- and post-intervention examinations. Results: In Study 1, only the prevalence of children with high covert aggression was significantly increased with an increase in dioxin exposure. In Study 2, in the full ingestion (>80% of goal ingestion volume) group, the prevalence of children with high covert aggression associated with dioxin exposure was significantly lower in the post-ingestion examination compared with in the pre-ingestion examination. However, in other ingestion (<20% and 20–79%) groups and a reference (no intervention) group, no difference in the prevalence of children with high covert aggression was found between the examinations before and after the same experimental period. Conclusions: The findings suggest that DBB ingestion may ameliorate children’s aggressive behavior, which is associated with perinatal dioxin exposure.

scholarly journals Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service

2014 ◽  
Vol 42 (6) ◽  
pp. 747-759 ◽  
Author(s):  
Stella W. Y. Chan ◽  
Malcolm Adams
Keyword(s):  
Clinical Outcomes ◽  
High Intensity ◽  
Recovery Rate ◽  
Service Use ◽  
Evaluation Study ◽  
Drop Out ◽  
Stepped Care ◽  
Depression And Anxiety ◽  
Low Intensity ◽  
Drop Out Rate

Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.

Real-world clinical outcomes study of sequential novel antihormonal therapy (NAH) or radium-223 (Ra-223) treatment of metastatic castration-resistant prostate cancer (mCRPC) that progressed after first-line NAH.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 48-48
Author(s):  
Oliver A. Sartor ◽  
Daniel J. George ◽  
Bertrand Tombal ◽  
Celestia S. Higano ◽  
Cora N. Sternberg ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Real Life ◽  
Patient Characteristics ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Highly Active ◽  
Radium 223 ◽  
Alpha Emitter ◽  
Antihormonal Therapy ◽  
The Usa

48 Background: We assessed real-life clinical outcomes in patients with mCRPC treated in the USA who received sequential first-line (1L)/second-line (2L) NAH (abiraterone/enzalutamide or enzalutamide/abiraterone) or switched to a different mechanism of action (alpha-emitter Ra-223) after progression on 1L NAH. Methods: This was a retrospective study (PHENIX, NCT03896984) of the Flatiron electronic health record database in patients with mCRPC that progressed on 1L NAH and started 2L monotherapy with Ra-223 (n=120) or NAH (n=226) between Jan 2013 and Dec 2018. Patient characteristics, overall survival (OS) from 2L start, and symptomatic skeletal events (SSEs) were analyzed descriptively. Results: The two cohorts were generally similar at 2L start, including similar rates of bone-health agent (BHA) use, but the Ra-223 cohort had a higher incidence of bone-only metastases, shorter duration of 1L NAH, and higher rate of prior SSEs than the 2L NAH cohort (Table). Median treatment duration was 5.6 mo (median 4.5 doses) for Ra-223 and 4.7 mo for 2L NAH. Median OS from 2L start was 10.8 mo for Ra-223 and 11.2 mo for 2L NAH, with 49% and 39%, respectively, receiving subsequent therapy. Among those who received subsequent therapy, the proportion who received subsequent taxane was lower in the Ra-223 cohort (47%) than in the 2L NAH cohort (76%). SSEs were observed after 2L start in 32 patients (27%) on Ra-223 and 49 (22%) on 2L NAH. Conclusions: OS from start of 2L mCRPC treatment was similar for patients who received Ra-223 or alternative NAH in 2L. Slightly more patients received subsequent therapy in the Ra-223 cohort than in the 2L NAH cohort. Patients who received subsequent therapy were more likely to receive chemotherapy in the 2L NAH cohort, which is unsurprising as 2L NAH after 1L NAH is not highly active. Although the prior SSE rate before 2L start was higher in the Ra-223 cohort than in the 2L NAH cohort, and the two cohorts had similar rates of BHA use at 2L start, the rate of SSEs after 2L start was similar in both cohorts. Clinical trial information: NCT03896984. [Table: see text]

Routine Chest Radiography Following Tunneled Hemodialysis Catheter: Use and Clinical Outcomes

2021 ◽  
Author(s):  
Mouafak J. Homsi ◽  
Ibrahim M. Hashim ◽  
Caroline M. Hmedeh ◽  
Boutros Karam ◽  
Jamal J. Hoballah ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Superior Vena Cava ◽  
Guide Wire ◽  
Superior Vena ◽  
Vena Cava ◽  
Real Life ◽  
Venous Catheter ◽  
Brachiocephalic Vein ◽  
Hemodialysis Catheter ◽  
Independent Reviewer

Highlights Abstract Background: A postoperative chest x-ray (CXR) remains part of some hospital protocols following tunneled hemodialysis catheter placement despite the use of operative imaging-guided techniques. The aim is to assess the usefulness of this practice and its impact on clinical outcomes and resource use. Methods: A review of medical records and postoperative CXR was done for 78 adult patients who had tunneled hemodialysis catheters placed in the operating room under fluoroscopy guidance. Catheters were inserted by ultrasound-guided puncture (51.3%) or exchanged from an existing catheter over a guide wire (48.7%). The postoperative CXRs were also examined by an independent reviewer to assess the catheter tip position and the need for repositioning to mimic a real-life postoperative setting. Procedural, nursing, and billing records were also reviewed. Results: No patients had a pneumothorax or major complications. On postoperative CXRs, 29 (37.2%) patients had the catheter tips in the right atrium, 23 (29.5%) in the cavoatrial junction, 25 (23.1%) in the superior vena cava, and 1 (1.3%) in the brachiocephalic vein. The independent reviewer found the catheter tips in acceptable anatomical positions in 75 of 78 patients. Only 3 (3.9%) patients had catheter malfunctions during dialysis and exchanged their catheters (2 had high catheters in the superior vena cava and brachiocephalic vein, 1 had a kinked catheter). Postoperative CXRs also caused delays in patient discharge from postanesthesia care units and significant increases in medical expenses (around $199 per patient). Conclusion: Routine CXR after tunneled hemodialysis central venous catheter insertion is unnecessary and does not add to the procedure's safety or to the patient's outcome.

Cemiplimab in a very frail population of patients with advanced or metastatic cutaneous squamous cell carcinoma: A monocenter real-life experience from Italy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21524-e21524
Author(s):  
Michele Guida ◽  
Annarita Fanizzi ◽  
Davide Quaresmini ◽  
Annalisa Nardone ◽  
Andrea Armenio ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Antitumor Activity ◽  
Cell Carcinoma ◽  
Clinical Outcomes ◽  
Squamous Cell ◽  
Life Experience ◽  
Locally Advanced ◽  
Real Life ◽  
Cutaneous Squamous Cell Carcinoma ◽  
High Antitumor Activity

e21524 Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer. Although representing less than 5% of all CSCCs, advanced stages are difficult to treat. Cemiplimab, an antiPD-1 monoclonal antibody, is the first approved immunotherapy in the US and EU for patients with locally advanced (laCSCC) or metastatic (mCSCC) CSCC. Phase I-II studies showed high antitumor activity and good tolerability, but few data are still available regarding cemiplimab in real life experience in non-selected patients. Methods: We recruited 30 consecutive patients with laCSCC (25 pts) and mCSCC (5 pts) treated with cemiplimab from August 2019 to November 2020 at our Institution. Median age was 81 years (range 36-95); 24 males; median ECOG PS 1 (range 0-2). Five patients had an immunosuppressive condition including 3 patients with stable hematologic malignancies and two patients on immunosuppressive therapy for kidney transplantation and Crohn’s disease, respectively. The majority of patients had comorbidities (median 3). Cemiplimab was administered at the flat dose of 350 mg i.v. every 21 days until disease progression or unacceptable toxicity. In all patients we evaluated clinical outcomes, toxicity, and associations between clinical outcomes and peripheral blood parameters. Results: We reported 23 responses (ORR 76.7%) with CR in 5 patients (16.7%). One patient had SD for 5 months. The global DCR was 80%. The median duration of response and PFS was not reached at a median follow-up of 6 months. We observed a higher ORR in head and neck primary tumours (87% vs. 42.9% of others, p = 0.016) and in patients with haemoglobin level > 12 g/dL (87.5% vs. 64.3%). No significative difference in ORR was observed with respect to the median age (81.3% in >81 years vs. 71.4% in < 81 years). Among the 5 patients with immunosuppressive status, a response was obtained in 4 patients (80%), including 1 CR. Nine patients died, 7 for PD and 2 for causes unrelated to the disease. Twenty patients (67.7%) still have an ongoing response. The treatment was well tolerated by the majority of patients. The most common adverse events were fatigue in 7 patients (23.3%) and skin toxicity in 10 patients (33.3%) including pruritus in 6 patients, rash in 3 patients, bullous erythema in 1 patient. Only 3 (10%) patients experienced severe (grade 3/4) toxicity. Three responder patients interrupted treatment (2 for toxicity after 7 and 9 cycles, and one for pre-existing dementia) but maintaining their response. Conclusions: In our real-life experience cemiplimab showed high antitumor activity with acceptable safety profile similar to those in selected patients of trials. Moreover, its antitumor activity resulted not impaired in very elderly patients or in those with immunocompromized status.

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