Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages

ObjectiveTo assess whether a warning system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women to antiretroviral drug-based treatment regimens and their impressions and satisfaction with respect to incoming messages.DesignA randomized controlled trial was conducted from May 2009 to April 2010 with HIV-infected Brazilian women. All participants (n = 21) had a monthly multidisciplinary attendance; each participant was followed over a 4-month period, when adherence measures were obtained. Participants in the intervention group (n = 8) received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. The messages were sent every Saturday and Sunday and on alternate days during the working week. Participants in the control group (n = 13) did not receive messages.MeasurementsSelf-reported adherence, pill counting, microelectronic monitors (MEMS) and an interview about the impressions and satisfaction with respect to incoming messages.ResultsThe HIV Alert System (HIVAS) was developed over 7 months during 2008 and 2009. After the study period, self-reported adherence indicated that 11 participants (84.62%) remained compliant in the control group (adherence exceeding 95%), whereas all 8 participants in the intervention group (100.00%) remained compliant. In contrast, the counting pills method indicated that the number of compliant participants was 5 (38.46%) for the control group and 4 (50.00%) for the intervention group. Microelectronic monitoring indicated that 6 participants in the control group (46.15%) were adherent during the entire 4-month period compared to 6 participants in the intervention group (75.00%). According to the feedback of the 8 participants who completed the research in the intervention group, along with the feedback of 3 patients who received SMS for less than 4 months, that is, did not complete the study, 9 (81.81%) believed that the SMS messages aided them in treatment adherence, and 10 (90.90%) responded that they would like to continue receiving SMS messages.ConclusionSMS messaging can help Brazilian women living with HIV/AIDS to adhere to antiretroviral therapy for a period of at least 4 months. In general, the results are encouraging because the SMS messages stimulated more participants in the intervention group to be adherent to their treatment, and the patients were satisfied with the messages received, which were seen as reminders, incentives and signs of affection by the health clinic for a marginalized population.     

Evaluation of a computer-based bilingual breastfeeding educational program on breastfeeding knowledge,self-efficacy and intent to breastfeed among rural Hispanic women

ObjectiveTo evaluate the impact of an interactive, computer based, bi-lingual breastfeeding educational program on breastfeeding knowledge, self–efficacy and intent to breastfeed among rural Hispanic women living in Scottsbluff, Nebraska.MethodsA two-group, repeated measures quasi-experimental study was conducted to evaluate the impact of a breastfeeding intervention. Forty six rural Hispanic women between ages 18 and 38 years were enrolled at the Regional West Medical Center in Scottsbluff, Nebraska. Study participants were randomized into intervention and control groups, with the intervention group (n = 23) receiving bi-lingual (English and Spanish) breastfeeding education on a touch screen computer program, while the control group received printed educational material. Study participants were enrolled during their last six weeks of pregnancy, with follow up assessments conducted post-partum at days 3 and 7, weeks 2 and 6, and months 3 and 6. The study protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB protocol #430-12-EP) and City University of New York Institutional Review Board (IRB protocol # 642980-1).ResultsA significant improvement in the breastfeeding knowledge and intent to breastfeed scores was seen over a 6 month period among all the study participants (p < 0.05). There was a gradual increase in the breastfeeding self-efficacy scores till week 6 followed by a decrease in self-efficacy scores at month 3 (p = 0.46), and month 6 (P = 0.54). Breastfeeding knowledge scores differed significantly between the study participants in the control and intervention groups at week 6 (p = 0.03). There were no significant differences in the breastfeeding knowledge between the control and intervention groups at other time points. The control group showed gradual decline in their self-efficacy scores at month 3 and month 6 compared to the intervention group that showed a gradual increase in their self-efficacy scores at different time points during their follow up period. However, there were no significant differences in the self-efficacy scores between the intervention and control groups at different points. The control group showed significantly higher negative breastfeeding sentiment scores compared to the intervention group at days 3 (p = 0.02) and 7 (p = 0.03) indicating a lower intent to breastfeed.ConclusionHispanic women living in rural settings showed improvement in breastfeeding knowledge, self-efficacy and intent to breastfeed using the computer based bi-lingual educational program. Results show week 6 and month 3 to be the critical time points of intervention so that women continue to breastfeed.     

Translation of the National Institutes of Health Diabetes Prevention Program in African American churches

ObjectiveTo translate the Diabetes Prevention Program (DPP) for delivery in African American churches.MethodsTwo churches participated in a 6-week church-based DPP and 3 churches participated in a 16-week church-based DPP, with follow-up at 6 and 12 months. The primary outcomes were changes in fasting glucose and weight.ResultsThere were a total of 37 participants; 17 participated in the 6-session program and 20 participated in the 16-ses-sion program. Overall, the fasting glucose decreased from 108.1 to 101.7 mg/dL post intervention (p =.037), and this reduction persisted at the 12-month follow-up without any planned maintenance following the intervention. Weight decreased 1.7 kg post intervention with 0.9 kg regained at 12 months. Body mass index (BMI) decreased from 33.2 to 32.6 kg/m² post intervention with a final mean BMI of 32.9 kg/m² at the 12-month check (P <.05). Both the 6- and 16-session programs demonstrated similar reductions in glucose and weight; however, the material costs of implementing the modified 6-session DPP were $934.27 compared to $1075.09 for the modified 16-session DPP.ConclusionTranslation of DPP can be achieved in at-risk African Americans if research teams build successful community-based relationships with members of African American churches. The 6-session modified DPP was associated with decreased fasting glucose and weight similar to the 16-session program, with lowered material costs for implementation. Further trials are needed to test the costs and effectiveness of church-based DPPs across different at-risk populations.     

Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts

BackgroundThis study aimed to assess the impact of telephone counseling on quality of life in patients with coronary artery bypass graft.MethodsA quasi-experimental study was conducted with 71 discharged patients after coronary artery bypass graft surgery at Ekbatan Edcuational hospital in Hamadan, Iran, in 2014. The patients were randomly allocated into intervention (n = 36) and control group (n = 35). The intervention group received education and counseling about therapeutic plan via telephone after discharge. Patients in the control group received only routines. All patients completed the quality of life questionnaire before and after the intervention period of five weeks.ResultsThere was no significant difference between intervention and control group about quality of life before intervention (p = 0.696). However, there was significant and positive deference between the two groups in favor of the telephone counseling after the intervention (P = 0.01) and control group (P = 0.04). Quality of life in the intervention group was significantly better compared to control group (P = 0.01).ConclusionsTelephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients’ quality of life.Practice implicationsTelephone counseling is feasible to implement and well accepted for patient counseling for many diseases.     

Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care

ObjectiveTo evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.MethodsA multi-center, quasi-experimental controlled study of patients with low back pain (n = 535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients’ illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.ResultsWe found a significant small between-group intervention effect on patients‘ illness knowledge in medium- to long term (6 months: η² = 0.015; 12 months: η² = 0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η² = 0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.ConclusionsThe standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.Practice implicationsFurther dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.     

Motivating and assisting physical exercise in independently living older adults: A pilot study

BackgroundWith age reaction time, coordination and cognition tend to deteriorate, which may lead to gait impairments, falls and injuries. To reduce this problem in elderly and to improve health, well-being and independence, regular balance and strength exercises are recommended. However, elderly face strong barriers to exercise.ObjectiveWe developed Active Lifestyle, an IT-based system for active and healthy aging aiming at improving elderly's balance and strength. Active Lifestyle is a proactive training application, running on a tablet, which assists, monitors and motivates elderly to follow personalized training plans autonomously at home, while integrating them socially. The objective is to run a pilot study to investigate: (i) the feasibility of assisting the autonomous, physical training of independently living elderly with the Active Lifestyle system, (ii) the adherence of the participants to the training plans, and (iii) the effectiveness of the motivation instruments built into the system.MethodsAfter three introductory meetings, 13 elderly adults followed personalized two-weeks strength and balance training plans using the Active Lifestyle app autonomously at home. Questionnaires were used to assess the technological familiarity of the participants, the feasibility aspects of the physical intervention, and the effectiveness of the motivation instruments. Adherence to the exercise plan was evaluated using the performance data collected by the app during the study.ResultsA total of 13 participants were enrolled, of whom 11 (85%) completed the study (mean age 77 ± 7 years); predominantly females (55%), vocational educated (64%), and their past profession requiring moderate physical activity (64%). The Active Lifestyle app facilitated autonomous physical training at home (median = 7 on a 7-point Likert scale), and participants expressed a high intention to use the app also after the end of the study (median = 7). Adherence with the training plans was 73% (89% on the balance exercises and 60% on the strength exercises). The outcome from our questionnaires showed that without the app the participants did not feel motivated to perform exercises; with the support of the app they felt more motivated (median = 6). Participants were especially motivated by being part of a virtual exercise group and by the capability to automatically monitor their performance (median = 6 for both).ConclusionsThis study shows that the Active Lifestyle app prototype has valuable potential to support physical exercise practice at home and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to the knowledge base into mobile-based applications for elderly, in that it shows that elderly users can learn to work with mobile-based systems. The Active Lifestyle app proved viable to support and motivate independently living elderly to autonomously perform balance and strength exercises.     

Evaluation of a 3D serious game for advanced life support retraining

ObjectiveAdvanced life support (ALS) knowledge and skills decrease in as little as three months, but only a few ALS providers actually attend retraining courses. We assess the effectiveness of a 3D serious game as a new tool for frequent ALS retraining.MethodsWe developed a 3D serious game for scenario-based ALS retraining. The serious game, called EMSAVE, was designed to promote self-correction while playing. We organized a retraining course in which 40 ALS providers played two cardiac arrest scenarios with EMSAVE and took a test with 38 multiple-choice questions before and after playing. We administered the same test again 3 months later to evaluate retention. Participants also rated EMSAVE and the overall retraining experience.ResultsAfter using EMSAVE, the number of correct answers per participant increased by 4.8 (95%CI +3.4, +6.2, p < 0.001) and all but one participant improved. After 3 months, despite an expected decrease in ALS knowledge and skills (?1.9 correct answers, 95%CI ?0.6, ?3.3, p < 0.01), there was a significant retention benefit (+2.9 correct answers per participant, 95%CI +1.5, +4.2, p < 0.001). Moreover, all but one participant regarded EMSAVE as a valuable tool to refresh ALS knowledge and skills, and 85% of participants were also willing to devote 1 h/month to retrain with the serious game.ConclusionsA 3D serious game for scenario-based retraining proved effective to retrain in ALS and supported retention of acquired knowledge and skills at 3 months. EMSAVE also positively engaged and motivated participants.     

Impact of a goal setting and decision support telephone coaching intervention on diet,psychosocial, and decision outcomes among people with type 2 diabetes

ObjectiveEvaluate a 16-week decision support and goal-setting intervention to compare diet quality, decision, and diabetes-related outcomes to a control group.MethodsAdults with type 2 diabetes (n = 54) were randomly assigned to an intervention or control group. Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls. Participants reported previous goal attempts and set diet- and/or physical activity-related goals during coaching calls. Control group participants received information about local health care resources on the same contact schedule.ResultsThere was a significant difference between groups for diabetes empowerment (p = 0.045). A significant increase in diet quality, diabetes self-efficacy, and diabetes empowerment, and a significant decrease in diabetes distress and depressive symptoms (all p ≤ 0.05) occurred in the intervention group. Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end (both p ≤ 0.05).ConclusionsSetting specific diet-related goals may promote dietary change, and telephone coaching can improve psychosocial outcomes related to diabetes self-management.Practice implicationsInformed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals’ lifestyle. Decision coaching may empower patients to improve self-management practices and reduce distress.     

Impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: A quasi-experimental study in Iran

Background and aimsCoronary artery bypass graft is a major surgery and has complications that require professional and long term follow-up and nursing care that if do not properly handled, could reduce the quality of life and increase post-operative complications. On the other hand Tele-nursing is a cost-effective way to educate and follow-up of patients. This study aimed to assess the impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft.Materials and methodsA quasi-experimental study was carried out at Ekbatan Therapeutic and Educational Center of Hamadan University of Medical Sciences at Hamadan, Iran, in 2013. In this study, 71 patients who had undergone coronary artery bypass graft surgery and had inclusion criteria were randomly divided into two experimental group (n = 36), and control group (n = 35). They completed questionnaire before discharging from Therapeutic and Educational Center. In the experimental group on days 2, 4, 7, second week (day 11), third week (day 18) and fourth week (day 25) after discharge, follow-up interventions and nursing education with Tele-nursing was done, but in the in the control groups, patients received only routine interventions. After completion of the intervention period, both groups completed the questionnaire and the results were compared.ResultsAdherence of treatment plan in both groups did not have significant difference before intervention (P = 0.696), but had a significant difference with regard to baseline after intervention in aromatherapy group (P <  0.01) and with control group after intervention (P < 0.01). Adherence to treatment plan in the aromatherapy group was better in compared to control group (P < 0.01).ConclusionTele-nursing is a convenient way, cost effective training and follow-up care for patients after coronary artery bypass surgery, which can improve patients’ adherence to treatment plan in developing countries such as Iran.     

Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year

ObjectivesTo modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching.MethodsThis was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n = 215) received the usual lecture-based education program, and the intervention group (n = 209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values.ResultsStatistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3–2.6) IG: +1.6 (95%-CI 0.8–2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P = 0.06, η2 = 0.01).ConclusionThe modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge.Practical implicationsStructured and behavioral patient education fosters patient’s disease management ability. Possible ways of improving asthma control need to be explored.     

Changes in voluntary quadriceps activation predict changes in quadriceps strength after therapeutic exercise in patients with knee osteoarthritis

IntroductionRecent rehabilitation paradigms have suggested that improving voluntary muscle activation may optimize strength outcomes related to resistance training. The aim of this study was to determine if changes in voluntary quadriceps activation could predict changes in quadriceps strength following a 4 week therapeutic exercise regimen.MethodThirty-six participants with tibiofemoral osteoarthritis volunteered for this study, while 30 participants (14 males, 16 females, 58 ± 11.8 years, 172.2 ± 9.2 cm, 87.1 ± 18.5 kg) finished the 4 week supervised therapeutic exercise protocol and were used in the final analysis. Demographics, quadriceps strength and voluntary quadriceps activation using the burst superimposition technique were evaluated prior to the intervention. Following the therapeutic exercise program, quadriceps strength and voluntary activation were assessed. Simple correlations were performed to determine covariates in a multiple regression equation to evaluate if changes in voluntary quadriceps activation could predict changes in quadriceps strength.ResultsThere was a significant moderate simple correlation between participant height and change in MVIC (r = ? 0.44, P = 0.01). Both height and changes in voluntary quadriceps activation significantly predicted changes in MVIC (R² = 0.66, P < 0.001). After controlling for patient height, a change in voluntary quadriceps activation produced a significant improvement in the prediction of a change in MVIC (ΔR² = 0.47, P < 0.001).DiscussionChanges in voluntary quadriceps activation predicted 47% of variance in the change in quadriceps strength. These results suggest that interventions aimed at manipulating quadriceps activation may be helpful for improving quadriceps strength in patients with tibiofemoral osteoarthritis.Level of evidence2b.     

SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored

BackgroundPoor adherence to oral antidiabetics has a negative influence on glycaemic control in type 2 diabetes patients. Real Time Medication Monitoring (RTMM) combines real time monitoring of patients’ medication use with SMS reminders sent only if patients forget their medication, aiming to improve adherence. This study aimed to investigate the effect of these SMS reminders on adherence to oral antidiabetics in patients using RTMM and investigate patients’ experiences with RTMM.MethodsData were collected in a RCT involving 104 type 2 diabetes patients with suboptimal adherence to oral antidiabetics. Fifty-six patients were randomised to receive SMS reminders if they forgot their medication, 48 patients received no reminders. Primary outcome measure was adherence to oral antidiabetics registered with RTMM, measured as: (1) days without dosing; (2) missed doses; (3) doses taken within predefined standardized time windows. Patients’ experiences were assessed with written questionnaires.ResultsOver the six-month study period, patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders: 50% vs. 39% within a 1-h window (p = 0.003) up to 81% vs. 70% within a 4-h window (p = 0.007). Reminded patients tended to miss doses less frequently than patients not reminded (15% vs. 19%, p = 0.065). Days without dosing were not significantly different between the groups. The majority of patients reported positive experiences with RTMM and SMS reminders.ConclusionRTMM with SMS reminders improves adherence of type 2 diabetes patients, especially the precision with which patients follow their prescribed regimen, and is well accepted by patients.Trial registrationNetherlands Trial Register NTR1882.     

Effects of whole-body vibration exercise on muscular strength and power,functional mobility and self-reported knee function in middle-aged and older Japanese women with knee pain

BackgroundWhole-body vibration training using vertical-vibration machines is called “acceleration training” (AT). The purpose of this study was to elucidate the effect of AT on lower-limb muscular strength and power, functional mobility and self-reported knee function in middle-aged and older Japanese women with knee pain.MethodsThirty-eight middle-aged and older Japanese women (aged 50–73 years) with knee pain were divided into two groups: (1) the AT group (n = 29) engaged in AT three times per week for eight weeks, and (2) the control group (C group, n = 9). The AT program consisted of flexibility training, strength training of mainly the quadriceps and surrounding muscles and cool-down exercises. The C group was encouraged to perform the same or similar exercises at home without vibratory stimulus. We evaluated knee strength and power, functional mobility (timed up and go: TUG) and self-reported knee function (Japanese Knee Osteoarthritis Measure: JKOM).ResultsNo one in the AT group dropped out during the program. All JKOM categories except degree of pain improved significantly post intervention indicating improved knee function, and TUG was significantly shorter in these participants. All knee strength and power parameters except isometric knee extension peak torque improved significantly. The degree of change in JKOM total score and TUG was significantly different between the two groups.ConclusionVibratory stimulus during an eight week AT programme can promote participation and safely improve functional mobility and self-reported knee function better than exercise without vibratory stimulus in middle-aged and older Japanese women with knee pain.Level of evidence: level 2.     

Patient adoption of an internet based diabetes medication tool to improve adherence: A pilot study

ObjectiveTo investigate the effect of a video intervention, Managing Your Diabetes Medicines, on patient self-efficacy, problems with using medication, and medication adherence in a rural, mostly African American population.MethodsPatients selected their problem areas in medication use and watched one of nine 2-min videos with a research assistant at a clinic or pharmacy and were given an access code to watch all the videos at their convenience. Outcomes were measured at baseline and 3-month follow-up.ResultsFifty-one patients were enrolled; 84% were African American and 80% were female (mean age: 54 years). Seventy-three percent watched at least one module after the initial visit. Improved self-efficacy was associated with a decrease in concerns about medications (r = −0.64). Low literate patients experienced greater improvement in self-efficacy than more literate patients (t = 2.54, p = 0.02). Patients’ mean number of problems declined from 6.14 to 5.03. The number of patients with high or medium adherence rose from 33% at baseline to 43% at 3-month follow-up.ConclusionsA practical, customized video intervention may help improve patient self-efficacy, reduce problems with medication use, and improve medication adherence in diabetes patients.Practice implicationsProviders should consider implementing technology-based interventions in the clinic to address common problems that patients have with self-management.     

Predictors of adherence to follow-up recommendations after an abnormal Pap smear among underserved inner-city women

ObjectivesThis study aimed to identify cognitive-affective predictors of adherence to initial diagnostic colposcopy and 6-month follow-up recommendations among underserved women.MethodsA secondary data analysis was completed of a randomized clinical trial assessing tailored telephone counseling for colposcopy adherence after an abnormal screening Pap smear among 210 underserved inner-city women.ResultsAdherence to initial diagnostic colposcopy was significantly associated with greater self-efficacy (OR = 1.504, 95% CI 1.021–2.216). Women with lower monitoring attentional style had significantly greater adherence to 6-month follow-up recommendations compared to women with higher monitoring scores (OR = 0.785, 95% CI 0.659–0.935).ConclusionIncreasing cervical cancer-related self-efficacy and tailoring cervical cancer risk communication to monitoring attentional style may help improve adherence to follow-up recommendations after an abnormal Pap smear test result.Practice implicationsFuture research is needed to develop and implement psychosocial approaches to improving adherence to diagnostic colposcopy and follow-up recommendations adherence among underserved women.     

The effectiveness of clinical pharmacist’s intervention in improving asthma care in children and adolescents: Randomized controlled study in Jordan

ObjectiveTo evaluate the effectiveness of clinical pharmacist’s intervention on achieving better asthma control, quality of life and other clinical parameters.MethodsA prospective randomized controlled study in north Jordan was conducted. Pediatric patients with asthma (aged 7–18 years old) were included and randomly allocated into two groups, intervention and control. Both groups were interviewed at the first visit and followed up twice by phone (at 3 and 6 months). Education was provided to patients and their caregivers in the intervention group only.ResultsOf 206 eligible patients recruited and randomized to our study, 178 patients completed the study (48.3% intervention versus 51.7% control). There were no significant differences in all baseline data between both groups. We identified significant differences in the improvement of asthma control (p < 0.001) and consequently pediatric and caregiver quality of life (p < 0.001) between both groups at the end of study. Significant differences were also detected in other clinical parameters (p < 0.05).ConclusionImplementation of clinical pharmacy service can positively influence asthma control, pediatric and caregiver’s quality of life, and other clinical parameters.Practice implicationsTo maintain a good asthma status, education of pediatric patients and their caregivers should be part of routine assessment during clinic visit.     

A brief dyadic group based psychoeducation program improves relapse rates in recently remitted bipolar disorder: A pilot randomised controlled trial

BackgroundVarious adjunctive psychotherapies assist in decreasing relapse and improving outcomes for people with bipolar disorder (BD). Psychoeducation programs involving patient-only or caregiver-only groups have demonstrated some efficacy. We tested in recently remitted BD if a combined group based psychoeducation program involving patient–companion dyads decreased relapse.Method58 recently remitted BD out-patients were randomised to receive either treatment as usual (TAU, n = 31) or 12 × 90 minute psychoeducation sessions delivered weekly in a group program to the patient and companion (SIMSEP, n = 27). After 12 weeks SIMSEP patients reverted to TAU and all patients were followed until week 60 or relapse. The primary outcome measure was relapse requiring hospital or intensive community intervention.Results45 patients completed the study. 29 patients remained well at week 60 (SIMSEP n = 17, TAU n = 12), whilst 16 had relapsed (SIMSEP n = 3, TAU n = 13). The SIMSEP group were less likely to relapse (Fisher's exact test p = 0.013; OR = 0.16; 95% CI 0.04–0.70) and had an 11 week longer time to relapse compared to the TAU group (chi-square (1) = 8.48, p < 0.01). At study completion SIMSEP compared to TAU patients had lower Young Mania Rating Scale scores (Mann–Whitney U = 255, p < 0.01).LimitationsThe study was limited by a small sample size.ConclusionA brief group psychoeducation program with recently remitted BD patients and their companions resulted in a decreased relapse rate, longer time to relapse, decreased manic symptoms and improved medication adherence suggesting utility in the adjunctive psychotherapeutic treatment of BD.     

Needs analysis and development of a tailored mobile message program linked with electronic health records for weight reduction

ObjectiveWe developed and pilot-tested a personalized text messaging service program based on data from electronic health records (EHRs) and lifestyle questionnaires for weight control.MethodsIn the health promotion center of a hospital, 340 participants with a body mass index (BMI) greater than 25 were recruited and surveyed for the development of a text messaging program. After developing the interface linking the EHRs with personalized text messages for weight loss, we pilot-tested this program in 102 participants for its feasibility, acceptability and satisfaction.ResultsAccording to the needs analysis, the participants desired additional information about personalized nutrition and exercise. We selected many variables from the EHRs and questionnaires to create text messages with a more personalized program. After a 1-month trial of the text messaging program, the participants’ satisfaction score was 7.9 ± 1.5 and recommendation score was 7.5 ± 1.8.ConclusionsA personalized short message service (SMS) linked with EHRs was feasible, and the pilot test showed high satisfaction and recommendation scores. Further evaluation using a well-designed trial will be needed.     

The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials

ObjectiveTo determine the effects of patient navigation (PN) on healthcare utilization outcomes using meta-analysis and the quality of evidence.MethodsMedical and social science databases were searched for randomized controlled trials published in English between 1989 and May 2015. The review process was guided by PRISMA. Included studies were assessed for quality using the Downs and Black tool. Data were extracted to assess the effect of navigation on: health screening rates, diagnostic resolution, cancer care follow-up treatment adherence, and attendance of care events. Random-effects models were used to compute risk ratios and I² statistics determined the impact of heterogeneity.ResultsOf 3985 articles screened, 25 articles met inclusion criteria. Compared to usual care, patients who received PN were significantly more likely to access health screening (OR 2.48, 95% CI, 1.93–3.18, P < 0.00001) and attend a recommended care event (OR 2.55, 95% CI, 1.27–5.10, P < 0.01). PN was favoured to increase adherence to cancer care follow-up treatment and obtain diagnoses. Most studies involved trained lay navigators (n = 12) compared to health professionals (n = 9).ConclusionPN is effective to increase screening rates and complete care events.Practice implicationsPN is an effective intervention for use in healthcare.