Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial

Background Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul, Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. Methods Refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results There were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT. Trial registration ClinicalTrials.gov Identifier NCT03567083; date: 25/06/2018.

ANALISIS LAYANAN TI PADA DOMAIN SERVICE OPERATION DENGAN MENGGUNAKAN FRAMEWORK ITIL V3

Operasional bisnis PT. PLN (Persero) ULP sudah memanfaatkan TI dalam meberikan pelayanannya yang berupa sistem informasi berbasis website, layanan yang diberikannya seperti pelayanan online pemasangan listrik baru, penambahan daya listrik dan penyambungan sementara. Namun dalam penerapan operasional layanan TI yang berjalan belum sepenuhnya mengarah pada satu pengelolaan yang mengacu pada pedoman manajemen TI. Untuk memaksimalkan kinerja layanan TI, implementasi dari manajemen insiden dan masalah dengan kerangka kerja Information Technology Infrastructure Library (ITIL) merupakan salah satu solusi yang dibutuhkan untuk meningkatkan kualitas layanan TI di PT. PLN (Persero) ULP Lubuklinggau. Domian pada framerwork ITIL V3 yang digunakan dalam penelitian ini adalah domain service operation. Hasil yang didapatkan menunjukkan bahwa tingkat kematangan dari proses event management, incident management, dan problem management berada pada level 3 atau Defined serta request fulfillment berada pada level 2 atau Repeatable. Dengan nilai 3,06 untuk event management, nilai 3,12 untuk incident management, nilai 2,54 untuk request fulfillment, nilai 3,24 untuk problem management.

Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design

IntroductionEvidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda.Methods and analysisWe will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews.Ethics and disseminationThis evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.

The Challenges of Implementing the ITIL Problem Management Process in IT Support Organisations

<p>Information Technology Infrastructure Library (ITIL) is a framework and an integrated set of process orientated best practices for providing IT infrastructure support, managing and delivering IT services. As organisations in the digital age rely on Information Technology for their daily operations as well as future growth and success, the ITIL framework is widely adopted. The Problem Management process is one of the Service Operation processes defined by the ITIL framework. Whilst the adoption of the ITIL framework is often for the benefit of both the organisations that provide IT support and services and the organisations which consume them, the challenges of implementing this framework and its processes is often left to the IT support organisations. This paper focuses on the ITIL Problem Management process; it reviews the principles and objectives of this IT Service Management process from an IT Governance stand point, and its implementation in the context of organisational IT services and operations. This paper collects and presents the views and insights from IT professionals who routinely worked with ITIL processes. As empirical research, this paper seeks to identify and prioritize the challenges associated with implementing the ITIL Problem Management process by the IT support organisations; it also seeks to understand the ways and methods to overcome these challenges. This paper identifies 23 unique challenges in 6 categories including “the understanding”, “the buy-in”, “the investment”, “the interrelation”, the “execution” and “the organisational factors” which are associated with implementing the ITIL Problem Management process. The ranking of these challenges is also finalized. This paper further offers suggestions for IT support organisations to overcome these challenges. It suggests that IT support organisations may first address and overcome the challenges associated with the understanding and the buy-in of the ITIL Problem Management process, and use an overall top-down approach and effective organisational communication as they try to implement the ITIL Problem Management process.</p>

The Challenges of Implementing the ITIL Problem Management Process in IT Support Organisations

<p>Information Technology Infrastructure Library (ITIL) is a framework and an integrated set of process orientated best practices for providing IT infrastructure support, managing and delivering IT services. As organisations in the digital age rely on Information Technology for their daily operations as well as future growth and success, the ITIL framework is widely adopted. The Problem Management process is one of the Service Operation processes defined by the ITIL framework. Whilst the adoption of the ITIL framework is often for the benefit of both the organisations that provide IT support and services and the organisations which consume them, the challenges of implementing this framework and its processes is often left to the IT support organisations. This paper focuses on the ITIL Problem Management process; it reviews the principles and objectives of this IT Service Management process from an IT Governance stand point, and its implementation in the context of organisational IT services and operations. This paper collects and presents the views and insights from IT professionals who routinely worked with ITIL processes. As empirical research, this paper seeks to identify and prioritize the challenges associated with implementing the ITIL Problem Management process by the IT support organisations; it also seeks to understand the ways and methods to overcome these challenges. This paper identifies 23 unique challenges in 6 categories including “the understanding”, “the buy-in”, “the investment”, “the interrelation”, the “execution” and “the organisational factors” which are associated with implementing the ITIL Problem Management process. The ranking of these challenges is also finalized. This paper further offers suggestions for IT support organisations to overcome these challenges. It suggests that IT support organisations may first address and overcome the challenges associated with the understanding and the buy-in of the ITIL Problem Management process, and use an overall top-down approach and effective organisational communication as they try to implement the ITIL Problem Management process.</p>

Multi-Framework Implementation of the Problem Management Process

Many different information technology frameworks have been proposed to assist organizations implementing information technology. However, these frameworks are complex, difficult to implement, and overlap with one another making their simultaneous implementation even more difficult to accomplish by organizations. This study proposes to develop an overlapless maturity model that helps organizations deal with the aforementioned problems. The model was applied and evaluated by experts at five organizations. This approach was recognized as useful, complete, and helpful in a multi-framework implementation by problem management (PM) experts. This research provides contributions for academics since it distinguishes itself from the existing studies in the body of knowledge and is a baseline for further investigation.

Peningkatan Kinerja Organisasi TI Berdasarkan Metode DMAIC Dengan Pendekatan Frame Work ITIL V.3

Dalam upaya untuk memberikan layanan TI yang baik dan berkualitas guna mendukung jalannya bisnis proses perusahaan, kemungkinan pencapaian tujuan pemberian layanan TI yang baik dan berkualitas dapat tidak tercapai. Salah satu indikator pencapaian layanan TI tersebut maksimal adalah tercapainya indeks kepuasan pengguna internal terhadap penggunaan layanan TI tersebut. Buruknya indeks pencapaian kepuasan pengguna tersebut dapat disebabkan oleh banyak faktor, salah satunya adalah kinerja organisasi TI. Jenis Penelitan adalah kuantitatif kualitatif dengan desain penelitian adalah deskriptif. Tujuan penelitian adalah untuk mengetahui hal-hal yang mempengaruhi buruknya indeks pencapaian kepuasan pengguna layanan TI dan bagaimana mendapatkan improvement yang tepat, ditinjau dari sisi service operation di organisasi TI Supernova Group. Dilakukan dengan melaksanakan focus group discussion dengan manajemen organisasi TI Supernova Group dan hasil yang diperoleh dianalisa dengan metode DMAIC dengan menggunakan acuan baku ITSM, frame work ITIL v.3. Kesimpulan adalah buruknya indeks pencapaian kepuasan pengguna layanan TI Supernova Group adalah disebabkan tidak adanya beberapa hal berikut, tidak adanya OLA & UC untuk semua layanan, tidak adanya KEDB, tidak adanya problem management, tidak adanya configuration management, kurangnya informasi insiden yang diterima melalui telepon, kurangnya pelatihan serta tidak adanya panduan untuk menentukan prioritas insiden. Hasil improvement adalah adanya peningkatan resolusi penanganan insiden dari 7.686 jam menjadi 4.884 jam serta IT maturity dari incident & problem management process dan service desk function dari 0, 1.5, 1.5 menjadi 1.5, 1.5, 2.5.

Assessment Tools Preferred by the Undergraduate Clinical Medical Students: A Study in National Defense University of Malaysia

Background: Assessment in medical education is necessary to determine the students’ competency as well as other attributes. Objectives: The aim of this study was to determine the methods of assessment at the end of rotational posting examination and final professional examination at the end of the course, preferred by the undergraduate clinical medical students. Methods: This study was conducted on 89 medical students belonging to 4th and 5th year of the Faculty of Medicine, National Defense University of Malaysia (NDUM).Results: In this study 46 students were males (51.7%) and 43 (48.3%) females; the mean age was 23.5 years. Among the multiple-choice questions (MCQ), a combination that contained multiple true-false and single best answer, was preferred by 55.1% of the students. Among the essay type of written assessments “problem management patient (PMP)” questions were preferred most (46.1%) followed by modified essay questions (MEQ), short essay questions (SEQ), and key feature questions (KFQ). Among the assessments by long case, conventional long case, which had been practiced during the course, was preferred by 67.4% of the students at the end of the medical program rather than the modified or observed long case examinations. While assessment by short case, running commentary on what was being examined, was preferred by 47.2% of students, followed by no commentary (38.2%) and not sure by the rest. 56.2% of students would prefer procedure OSCEs on mannequins and the rest won’t. Picture quizzes were highly preferred (89.9%).Conclusion: At the end of the medical program the clinical medical students prefer those methods which have already been practiced by them during the academic course. For the best achievement, every tool of assessments used in the medical curriculum should be made clear to the students and the students should practice those before they proceed for final evaluation.

Effectiveness of Group Problem Management Plus, a brief psychological intervention for adults affected by humanitarian disasters in Nepal: A cluster randomized controlled trial

Background Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. Methods and findings We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, “heart–mind” problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment’s mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18–91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of −0.4 (95% CI: −0.5, −0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of −0.2 (95% CI: −0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have “heart–mind” problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. Conclusions In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. Trial registration ClinicalTrials.gov NCT03747055.