scholarly journals Telepsychiatry and Telepsychology: Possibilities and Limitations of Remote Work

Psychiatry ◽  
2021 ◽  
Vol 19 (3) ◽  
pp. 68-79
Author(s):  
T. A. Solokhina ◽  
M. V. Kuzminova ◽  
V. G. Mitikhin
Keyword(s):  
Conventional Medicine ◽  
Large Body ◽  
Evidence Base ◽  
Psychological Services ◽  
Remote Work ◽  
Equitable Access ◽  
Traditional Treatment ◽  
Training And Research ◽  
Patient Groups ◽  
Methodological Problems

Purpose: analysis of domestic and foreign literature on the possibilities, features, benefi ts and limitations of telepsychiatry/ telepsychology. Material and method: the keywords “telepsychiatry, telepsychology, remote psychiatric care, impact of pandemic on mental health, information technology in psychiatry” were used to select publications available in MEDLINE/PubMed, Scopus, Web of science, eLibrary, Google. Results: literature research has shown that telepsychiatry is a service-enhancing modality that promotes equitable access and high levels of patient satisfaction. The coronavirus pandemic has led to an inevitable increase in the use of this method in the provision of psychiatric as well as psychological services. Telepsychiatry has both clinical and non-clinical applications, e.g. in administration, training and research. A large body of evidence shows that telepsychiatric diagnostic assessments are reliable and that the clinical outcomes of telepsychiatric interventions are comparable to those of traditional treatment among various patient groups, irrespective of age, diagnosis and other variables. However, the evidence base for telepsychiatry/telepsychology is still relatively limited in many aspects of effectiveness, and is often complicated by methodological problems, including technological diffi culties, negative opinions and pessimistic perceptions among psychiatrists, and several legal, ethical and administrative barriers. These impede wide implementation of telepsychiatry and its integration into everyday medicine. Conclusion: further advances in remote technology and research will solve many of the problems of telepsychiatry, and its development is likely to consist in the application of telepsychiatry as an adjunct to conventional medicine, and in the development of hybrid models, incorporating both conventional and telepsychiatric forms of psychiatric and psychological care.

scholarly journals Improving the External Validity of Clinical Trials: The Case of Multiple Chronic Conditions

2013 ◽  
Vol 3 (2) ◽  
pp. 30-35 ◽  
Author(s):  
Fortin Martin ◽  
Smith M. Susan
Keyword(s):  
Clinical Trials ◽  
External Validity ◽  
Chronic Conditions ◽  
Evidence Base ◽  
Specific Reference ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Department Of Health ◽  
Patient Groups ◽  
Intervention Trials

The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions (MCCs) incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity). The evidence base supporting the management of patients with MCCs will be built through intervention trials specifically designed to address multimorbidity and identification of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specific reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs) are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed.

scholarly journals Future Directions for Dementia Risk Reduction and Prevention Research: An International Research Network on Dementia Prevention Consensus

2020 ◽  
Vol 78 (1) ◽  
pp. 3-12
Author(s):  
Kaarin J. Anstey ◽  
Ruth Peters ◽  
Lidan Zheng ◽  
Deborah E. Barnes ◽  
Carol Brayne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Reduction ◽  
International Research ◽  
Large Body ◽  
Geographical Location ◽  
Evidence Base ◽  
Research Network ◽  
Future Research ◽  
Dementia Risk ◽  
Dementia Prevention

In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities.

Rehabilitation From Addiction and Chronic Illnesses: A Comparative Analysis of the Narratives of Hungarian Patients

2020 ◽  
Vol 34 (1) ◽  
pp. 65-80
Author(s):  
Asztrik Kovács ◽  
Virág Mezőfi ◽  
V. Anna Gyarmathy ◽  
József Rácz
Keyword(s):  
Chronic Illness ◽  
Recovery Process ◽  
Active Role ◽  
Healthcare Services ◽  
Chronic Illnesses ◽  
Psychological Services ◽  
Structured Interviews ◽  
Rehabilitation Process ◽  
Psychological Phenomena ◽  
Patient Groups

BackgroundIn Hungary the psychological care provided during the rehabilitation of patients with chronic illnesses is insufficient. Patients with addiction, on the other hand, appear to make more use of psychological services. Narratives of patients recovering from addiction and patients with various chronic illnesses were examined in order to gain a better understanding of psychological phenomena during rehabilitation.MethodsSemi-structured interviews were carried out. Narrative and thematic analysis was used in order to determine the structure and characteristics of patients' narratives.ResultsThe narratives of patients recovering from addiction were found to be more structured and uniform; they identified with their illness and played an active role in their recovery. Patients with a chronic illness mainly recounted passive events and physical difficulties. Stigmatization was mentioned by both groups.Implications for practiceThe level of stigmatization experienced by patients with a chronic illness may be one of the reasons why they use healthcare services more frequently than patients with an addiction. The authors believe that teaching patients to provide good narratives about suffering from and recovering from chronic illnesses may aid them in the rehabilitation process. An adaptive mixture of different illnesses and addiction narratives might be beneficial in the recovery process of various patient groups.

scholarly journals History and Progress of Japanese Acupuncture

2010 ◽  
Vol 7 (3) ◽  
pp. 359-365 ◽  
Author(s):  
Akiko Kobayashi ◽  
Miwa Uefuji ◽  
Washiro Yasumo
Keyword(s):  
Knowledge Exchange ◽  
Evidence Base ◽  
Modern Medicine ◽  
Strong Impact ◽  
Ordinary People ◽  
Edo Period ◽  
Traditional Treatment ◽  
The Past ◽  
Foreign Countries ◽  
Firm Evidence

After Chiso brought acupuncture to Japan from Wu (China) in the sixth century, it has progressed in unique ways within the various historical milieus of the past 1500 years. Ishitsu-rei, the first medical law of Japan established in 701, explains the medical system of acupuncture in detail showing that acupuncture was being administered under the authorization of the national government. For the next 1200 years, acupuncture continued to be an important facet of public health in Japan. From the Azuchimomoyama through the Edo period, the knowledge exchange with China became active and people who studied in China developed new styles and techniques of acupuncture treatment and organized their own private schools orryu-hain Japan. In 1635, when the Edo government decided to close the country, Japan cut-off exchange with foreign countries for over 200 years. The national isolation caused some development that was unique to Japan. During that time, acupuncture filtered into people's everyday lives. Moxibustion, in particular, became popular as a treatment that ordinary people could practice by themselves. Also in this period of isolation, Western medicine was imported from Holland, the only country allowed to maintain trade with Japan. This novel modern medicine had a strong impact on Japanese medicine, which has its foundation of Chinese traditional medicine. At the same time, Japanese acupuncture was introduced into Europe via Holland. When Japan opened its borders in 1865 period, the new government was eager to accept Western culture to the extent of prohibiting the progress of Japanese acupuncture for a period of time. Even so, Japanese acupuncture has survived and flourished up to the present day due to the strong demand and the great efforts of the practitioners. Scientific studies are now in the process of establishing a firm evidence base for over a millennium of clinical use, respecting the classic ideas of the traditional treatment.

scholarly journals Crisis teams: systematic review of their effectiveness in practice

2013 ◽  
Vol 37 (7) ◽  
pp. 232-237 ◽  
Author(s):  
Rebecca A. Carpenter ◽  
Jara Falkenburg ◽  
Thomas P. White ◽  
Derek K. Tracy
Keyword(s):  
Systematic Review ◽  
Cost Effective ◽  
Evidence Base ◽  
Clinical Implications ◽  
Crisis Resolution ◽  
Longitudinal Outcomes ◽  
Patient Admissions ◽  
High Quality Evidence ◽  
Crisis Resolution Teams ◽  
Patient Groups

Aims and methodCrisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.ResultsCrisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.Clinical implicationsHigh-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.

scholarly journals Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study (Preprint)

2019 ◽  
Author(s):  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Large Body ◽  
Complex Interventions ◽  
Significant Others ◽  
Evidence Base ◽  
Development Phase ◽  
Frail Older People ◽  
Existential Loneliness ◽  
Intervention Protocol

BACKGROUND International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. OBJECTIVE This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. METHODS The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. RESULTS The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. CONCLUSIONS The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. INTERNATIONAL REGISTERED REPOR RR1-10.2196/13607

scholarly journals Indwelling pleural catheters for malignancy related pleural effusions

2020 ◽  
Author(s):  
Avinash Aujayeb
Keyword(s):  
Large Body ◽  
Evidence Base ◽  
Case Review ◽  
Statistical Methodology ◽  
Pleural Effusions ◽  
Male Population ◽  
Radiographic Findings ◽  
North East ◽  
The North ◽  
Large Case

Abstract ObjectivesThe incidence of malignancy related pleural effusions (MPE) is increasing. MPE carry significant morbidity and mortality. Indwelling pleural catheters (IPCs) have become the cornerstone in management and are supported by established international guidance. Large case reviews add to the evidence base regarding safety and efficacy. Methods168 patients had an IPC insertion between January 2012 and December 2018 in a large pleural centre in the North East of England. Data on outcomes and complications were obtained from the patients’ notes, electronic records, laboratory, and radiographic findings. Descriptive statistical methodology was applied. Results168 IPCs were inserted in a predominantly male population by experienced pleural practitioners. Overall complication rate is 13% and the incidence of any individual complications such as infection, metastatic seeding, drain displacement and loculations are much less than previously quoted in the literature. ConclusionThis case review adds to the large body of evidence that IPCs are safe and have minimal complications in the palliation of symptoms of malignant pleural effusion.

scholarly journals Treatment of acute psychotic agitation: gaps in the evidence base

2011 ◽  
Vol 17 (2) ◽  
pp. 101-103 ◽  
Author(s):  
Steve Brown
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Drug ◽  
Research Evidence ◽  
Evidence Base ◽  
Current Treatment ◽  
Treatment Recommendations ◽  
Pharmacological Interventions ◽  
Similar Patient ◽  
Patient Groups ◽  
Moderate Agitation

SummaryTreatment of psychotic agitation is an area that is very poorly evidenced, principally because research evidence from patients with moderate agitation may not generalise to the more severely agitated patients. There is a significant gap between current treatment recommendations and what is seen in clinical practice. There are also big differences in clinical practice between different units treating seemingly similar patient groups. This commentary considers possible reasons for these findings and also discusses non-pharmacological interventions, which probably contribute more to the management of psychotic agitation than does the choice of one antipsychotic drug over another.

scholarly journals Increasing and diversifying turnout in non-electoral participation - a field experiment

2020 ◽  
Author(s):  
Annabelle Sophie Wittels
Keyword(s):  
Field Experiment ◽  
Good Governance ◽  
Large Body ◽  
Large City ◽  
Evidence Base ◽  
Electoral Participation ◽  
Participation Rates ◽  
Rigorous Testing ◽  
Democratic Engagement ◽  
The Uk

Non-electoral participation initiatives are regarded as the gold standard for good governance - encouraging and sustaining democratic engagement. However, participation rates typically are low and disadvantaged groups under-represented. A large body of evidence shows that communication campaigns can increase participation in elections. However, the evidence base for non-electoral participation is scarce and in many aspects completely lacking. This study contributes to the literature by theorising and empirically testing whether such inequalities can be redressed. It uses a randomised field experiment with 29,008 households in a large city in the UK to test the effect of different direct mail messages on participation. It illustrates that rigorous testing of interventions is necessary to understand their impact across different democratic contexts: Contrary to what theory would predict for electoral contexts and paid-for work, all tested interventions significantly decrease participation in the governance initiative under study.

Identification of Gaps in Training, Research, and School-Based Practice: A Survey of School-Based Speech-Language Pathologists

2021 ◽  
pp. 1-19
Author(s):  
John Heilmann ◽  
Andrea Bertone
Keyword(s):  
Professional Development ◽  
School Environment ◽  
Evidence Base ◽  
Early Career ◽  
Speech Language Pathologists ◽  
Preservice Training ◽  
Perceived Needs ◽  
School Based ◽  
Training And Research ◽  
Training Research

Purpose Speech-language pathologists (SLPs) encounter many challenges in the school environment. We sought to identify school-based SLPs' needs in the areas of training and research to support school-based practice. Method We collected surveys from 145 school-based SLPs practicing in Wisconsin. Respondents were asked to describe aspects of preservice training that most and least prepared them for school-based practice. Respondents next described training needs for early-career SLPs and desired topics for general professional development. Respondents then described research topics that require further study to advance school-based practice. After completing this series of open-ended questions, the respondents completed a series of preferential-ranking questions about general needs for training and research. We employed mixed methods to analyze the data, using grounded theory for the qualitative analysis. Results During preservice training, respondents most valued the applied aspects of their training. Respondents noted that early-career SLPs require significant support, particularly with the professional responsibilities of school-based practice (e.g., individualized education programs, interprofessional practice, and scheduling). When describing general professional development and research needs, the respondents placed high value on practical topics that have clear implications for school-based practice. Conclusions Understanding the perceived needs of school-based SLPs can assist in designing training supports and ensuring that the developing evidence base is relevant to SLPs practicing in the schools. This exploration-stage study established a foundation for future testing of implementation initiatives to fill gaps in school-based practice.

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