Traditional-versus Online videoconferencing with smartphone application support Cognitive Behavioral Therapy for Depression: A retrospective cohort study (Preprint)

2021 ◽  
Author(s):  
Annemiek van Dijke ◽  
Gisela R.M. Emmory-Lijde ◽  
Mathijs Deen
Keyword(s):  
Cohort Study ◽  
Depressive Symptoms ◽  
Major Depression ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Behavioral Therapy ◽  
Smartphone Application ◽  
Post Treatment ◽  
Reliable Change ◽  
Significant Change

BACKGROUND Background: The prevalence of major depression is very high and it is considered one of the most hindering disorders, associated with a strong social- and financial impact. Despite the effectiveness of traditional cognitive behavioral therapy (CBT), response, improvement, remission and recovery rates are low and relapse percentages are considerably high. This study is the first to investigate the effectiveness of online videoconferencing CBT with smartphone app support in patients with major depression. With this ‘modern’ way of online CBT, we aim to enhance the effectiveness of CBT OBJECTIVE Objective: The objective is to assess the results of online videoconferencing CBT with app-support compared to TAU in patients with depression. To enhance therapy outcome and patient satisfaction for the treatment of depression. METHODS Methods: A retrospective cohort study was conducted in an outpatient treatment center (PsyQ-Parnassia, the Netherlands). Routine Outcome Monitoring (ROM) data was collected from September 2018 to March 2020, at pre- and post-treatment. Seven hundred and seventy patients were included; 40 for psyQ-online and 730 for psyQ-TAU. The primary outcome measure is the symptoms of depression measured with the Quick Inventory of Depressive Symptomatology (QIDS-SR-16; Trivedi et al., 2004). To assess ‘significant change’ in depressive symptoms we compared pre-and post-treatment scores for PsyQ-online group compared with the PsyQ-TAU group. Clinical significant change or remission was defined as ‘going from above the clinical cut-off score at pre-treatment to below the cut-off score’ which equals ‘normalcy’ or ‘no depression’ (in this case below 6) at post-treatment. ‘Reliable change’ was defined as ‘whether people changed sufficiently that the change is unlikely to be due to simple measurement unreliability’. Reliable changes were grouped in four categories: (1) Recovered = reliable and clinical significant change in QIDS-SR-16, (2) Improved = reliable change, without clinical significant change, (3) No change = no reliable change and no clinical significant change, and (4) Deteriorated = negative reliable change in the QIDS-SR-16 (Jakobsen et al., 2017). To investigate patients satisfaction for online psychotherapy when compared to the patients in the PsyQ-TAU group, we used KLANT scores (Huijbrechts et al., 2009). RESULTS Results: The psyQ-online patients showed significantly higher improvement, remission and recovery percentages compared to the psyQ-TAU patients. Online patients were more satisfied with their therapy compared to TAU patients. CONCLUSIONS Conclusion: ‘Significant reduction’ in depressive symptoms and high percentages of ‘improvement’, ‘remission’ and ‘recovery’, can be obtained when performing online cbt with smartphone-application-support for depression. This even enhances CBT-outcome in highly satisfied patients. CLINICALTRIAL n/a

Abstract P215: Treatment With Il-17 Inhibitors Is Not Associated With A Change In Blood Pressure In Human Subjects: A Retrospective Cohort Study

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Peihsuan Tsai ◽  
Daniel Gilroy ◽  
Thu H Le ◽  
Erika R Drury
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Vascular Dysfunction ◽  
Human Subjects ◽  
Time Windows ◽  
Aggregated Data ◽  
Significant Change

Background: Recent evidence suggests IL-17 contributes to the pathogenesis of autoimmune, inflammatory, and cardiovascular diseases. It has been demonstrated in vivo that IL-17 is critical for the maintenance of angiotensin II-induced hypertension (HTN) and vascular dysfunction. We aim to determine if IL-17 inhibitors (IL-17I) have direct effects on blood pressure (BP) in human subjects. Method: We conducted a single-center retrospective cohort study of patients who had been treated with an IL-17I (ixekuzumab or secukinumab) for psoriasis (P) or psoriatic arthritis (PA). Aggregated data in a 3 month window at 3-months prior to initiation of the IL-17I (baseline) and at 3, 6, and 12 months after initiation were analyzed using paired t-test. Wilcoxon non-parametric test was used if normality test failed. Pre-existing HTN was defined by ICD-coding. Unique antihypertensive medication was defined as number of unique class of BP prescription filled within a specified 3-month windows. Results: We identified 307 patients who had been treated with IL-17I. We included 103 patients who had BP data in all above specified time windows. The mean age was 47 ± 13 years, 39 (38%) were men, 68 (66%) had HTN, and 23 (22%) had diabetes. Among all patients, mean baseline BP was 129/76 mmHg. There was no significant change in systolic or diastolic BP (SBP or DBP, respectively) at 3 months (129/76 mmHg) or 6 months (130/76 mmHg). There was a trend of increased BP at 12 months (131/77 mm Hg), reaching significance only for DBP (p = 0.048). When stratified by pre-existing HTN, there was no significant change in SBP or DBP at any time point. The number of unique prescribed BP medication was 0.45 at baseline, and significantly increased to 0.68 (p= 0.027), 0.87 (p=0.006), and 0.83(p=0.004) at 3-,6-, and 12-month respectively, suggesting patients required more antihypertensive therapy while on IL-17I. Conclusion: IL-17I use for P or PA was not associated with a significant change in BP over 1 year of treatment. This could be confounded by an increase in the number of unique BP medications prescribed which implies a rise in BP. This could be due to IL-17I therapy or other factors such as age. A prospective study is needed to better evaluate the effects of IL-17 inhibition on BP.

scholarly journals Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kelly Fleetwood ◽  
Sarah H. Wild ◽  
Daniel J. Smith ◽  
Stewart W. Mercer ◽  
Kirsty Licence ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bipolar Disorder ◽  
Mental Illness ◽  
Cohort Study ◽  
Major Depression ◽  
Severe Mental Illness ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Sociodemographic Factors ◽  
Coronary Revascularisation

Abstract Background Severe mental illness (SMI), comprising schizophrenia, bipolar disorder and major depression, is associated with higher myocardial infarction (MI) mortality but lower coronary revascularisation rates. Previous studies have largely focused on schizophrenia, with limited information on bipolar disorder and major depression, long-term mortality or the effects of either sociodemographic factors or year of MI. We investigated the associations between SMI and MI prognosis and how these differed by age at MI, sex and year of MI. Methods We conducted a national retrospective cohort study, including adults with a hospitalised MI in Scotland between 1991 and 2014. We ascertained previous history of schizophrenia, bipolar disorder and major depression from psychiatric and general hospital admission records. We used logistic regression to obtain odds ratios adjusted for sociodemographic factors for 30-day, 1-year and 5-year mortality, comparing people with each SMI to a comparison group without a prior hospital record for any mental health condition. We used Cox regression to analyse coronary revascularisation within 30 days, risk of further MI and further vascular events (MI or stroke). We investigated associations for interaction with age at MI, sex and year of MI. Results Among 235,310 people with MI, 923 (0.4%) had schizophrenia, 642 (0.3%) had bipolar disorder and 6239 (2.7%) had major depression. SMI was associated with higher 30-day, 1-year and 5-year mortality and risk of further MI and stroke. Thirty-day mortality was higher for schizophrenia (OR 1.95, 95% CI 1.64–2.30), bipolar disorder (OR 1.53, 95% CI 1.26–1.86) and major depression (OR 1.31, 95% CI 1.23–1.40). Odds ratios for 1-year and 5-year mortality were larger for all three conditions. Revascularisation rates were lower in schizophrenia (HR 0.57, 95% CI 0.48–0.67), bipolar disorder (HR 0.69, 95% CI 0.56–0.85) and major depression (HR 0.78, 95% CI 0.73–0.83). Mortality and revascularisation disparities persisted from 1991 to 2014, with absolute mortality disparities more apparent for MIs that occurred around 70 years of age, the overall mean age of MI. Women with major depression had a greater reduction in revascularisation than men with major depression. Conclusions There are sustained SMI disparities in MI intervention and prognosis. There is an urgent need to understand and tackle the reasons for these disparities.

scholarly journals Artificial colloids versus human albumin for the treatment of ovarian hyperstimulation syndrome: A retrospective cohort study

2019 ◽  
Author(s):  
Tetsuji Minami ◽  
Hayato Yamana ◽  
Daisuke Shigemi ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Ovarian Hyperstimulation Syndrome ◽  
Human Albumin ◽  
Post Treatment ◽  
Colloid Solution ◽  
Ovarian Hyperstimulation ◽  
Treatment Complications

Background: The optimal colloid solution for the treatment of ovarian hyperstimulation syndrome (OHSS) remains to be established. Objective: We aimed to compare artificial colloids (AC) with human albumin (HA) for the treatment of OHSS. Materials and Methods: In this retrospective cohort study, data for OHSS participants were collected from a national inpatient database in Japan. The participants received intravenous fluid management with AC (n = 156) or HA (n = 127). We compared the two groups in terms of the length of stay, development of post-treatment complications, and termination surgery. Results: In multivariable linear regression analyses for log-transformed length of stay with reference to the OHSS participants receiving AC, the regression coefficient (95% confidence interval) in participants receiving HA was 0.03 (-0.04-0.09, p = 0.42). Thromboembolism occurred in two participants in the HA group and three participants in the AC group. Two participants in the HA group suffered renal failure during hospitalization. No participants underwent termination surgery in the two groups. Conclusions: The present results showed comparable efficacy between AC and HA for the treatment of OHSS. There were no significant differences in post-treatment complications between the two groups. Key words: Ovarian hyperstimulation syndrome, Treatment, Colloid, Length of stay.

scholarly journals Web-based Cognitive Behavioral Therapy Blended with Face-to-Face Sessions for Major Depression: a Randomized Clinical Trial (Preprint)

2018 ◽  
Author(s):  
Shigetsugu Nakao ◽  
Atsuo Nakagawa ◽  
Yoshiyo Oguchi ◽  
Dai Mitsuda ◽  
Noriko Kato ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Major Depression ◽  
Behavioral Therapy ◽  
Post Treatment ◽  
Waiting List ◽  
Web Based ◽  
Face To Face ◽  
Antidepressant Medications ◽  
Hamd Score

BACKGROUND Meta-analyses of a large number of randomized controlled trials have shown that cognitive behavioral therapy (CBT) has comparable efficacy to antidepressant medication, but therapist availability and cost-effectiveness is a problem. OBJECTIVE This study aimed to evaluate the effectiveness of a web-based CBT blended with face-to-face sessions that reduce therapist time in patients with major depression who were unresponsive to antidepressant medications. METHODS A 12-week, assessor-masked, parallel-group, waiting-list controlled, randomized trial was conducted in three medical institutions located in Tokyo. Outpatients aged 20–65 years with a primary diagnosis of major depression (taking one or more antidepressant medications at an adequate dose for ≥ 6 weeks, 17-item GRID-Hamilton Depression Rating Scale [GRID-HAMD] score ≥ 14) were randomly assigned (1:1) to blend CBT or waiting-list groups using a computer allocation system, stratified by the study site with the minimization method, to balance age and baseline GRID-HAMD score. The CBT intervention was given in a combined format, consisting of a web-based program and twelve 45-minute face-to-face sessions. Thus, across 12 weeks, a participant could receive up to 540 minutes of contact with a therapist, which was approximately two-thirds of the therapist contact time provided in the conventional CBT protocol, which typically provides sixteen 50-minute sessions. The primary outcome was the alleviation of depressive symptoms, as measured by a change in the total GRID-HAMD score from baseline (at randomization) to post-treatment (at 12 weeks). Additionally, in an exploratory analysis, we investigated whether the expected positive effects of the intervention were sustained during follow-up, 3 months after the post-treatment assessment. Analyses were performed on an intention-to-treat basis, and the primary outcome was analyzed using a mixed-effects model for repeated measures. RESULTS A total of 40 participants were randomized to either blend CBT (n=20) or waiting-list (n=20) groups. All patients completed the 12-week treatment protocol, and all were included in the intention-to-treat analyses. Participants in the blend CBT group had significantly alleviated depressive symptoms at week 12, as shown by greater least squares mean changes in GRID-HAMD score, than those in the waiting-list group (−8.9 points vs. −3.0 points; mean between-group difference = −5.95; 95% CI, −9.53 to −2.37; p =0.0002). The follow-up effects within the blend CBT group, as measured by GRID-HAMD score, was sustained at 3-months follow-up (week 24) after treatment (week 12) (post-treatment: 9.4 ± 5.2 vs. follow-up: 7.2 ± 5.7, p= 0.009). CONCLUSIONS Although our findings need to be confirmed in larger and longer-term studies with active controls, the present findings suggest that a combined form of CBT is effective in reducing depressive symptoms in patients with major depression who were unresponsive to antidepressant medications. CLINICALTRIAL Japanese Clinical Trials Registry UMIN Clinical Trials Registry Identifier: UMIN000009242.

Tu1788 CLINICAL CHARACTERISTICS AND TREATMENT DIFFERENCES BETWEEN YOUNGER AND OLDER ONSET MICROSCOPIC COLITIS: A MULTICENTER RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 158 (6) ◽  
pp. S-1161
Author(s):  
Amrit K. Kamboj ◽  
Amandeep Gujral ◽  
Elida Voth ◽  
Daniel Penrice ◽  
Jessica McGoldrick ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Microscopic Colitis
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