A Feasibility Study to Develop and Test a Cognitive Behavioral Stress Management Mobile Health Application for HIV-Related Fatigue

ContextExacerbated by life stressors, fatigue is the most common symptom for people living with HIV.ObjectiveTo adapt, develop, and assess the feasibility of a Cognitive Behavioral Stress Management Mobile Health (CBSM mHealth) application (app) for HIV-related fatigue.MethodsThis study had two phases: app development with key informants (N = 5) and a randomized controlled trial (N = 30). Patients randomized to the intervention group completed 10 weekly CBSM modules; those in the control group received a generic healthy lifestyle app. Measures included HIV-related fatigue, depression, anxiety, stressful life events, CD4 count, HIV viral load, credibility and acceptability of the intervention, and barriers to treatment participation.ResultsWe were able to recruit participants for this study, and they were able to complete the required measures. They found the intervention to be credible and acceptable and reported few barriers to treatment participation. The direction of change in the primary outcome, a decrease in fatigue, is in the expected direction and provides evidence of the promise of the intervention, which still needs to be tested in an adequately powered trial. For completers (randomized to the intervention group and completed at least 80% of the modules), there were significant changes (95% CI; lower scores indicate improvement) in fatigue intensity (from 64.2 to 59.7) and overall fatigue-related functioning (from 6.6 to 4.2).ConclusionWe have proof of concept as to the feasibility, acceptability, and initial signals of efficacy for an mHealth intervention to help people with HIV-related fatigue better cope with stress and reduce their fatigue.     

基于信息技术的自我管理干预对2型糖尿病患者效果的Meta分析

目的系统评价基于信息技术的自我管理干预对2型糖尿病(T2DM)患者的效果。方法计算机检索PubMed、The Cochrane Library、EMbase、万方数据库(WangFang Data)、中国生物医学数据库(CBM)、中国维普全文数据库(VIP)和中国知网全文数据库(CNKI)。搜集基于信息技术的自我管理干预对2型糖尿病患者效果的随机对照试验(RCT),检索时限均从建库至2018年5月。由2名研究人员独立筛选文献、提取资料并对纳入研究进行偏倚风险评估,使用RevMan 5.3软件进行数据分析。结果纳入文献23篇,共3902例患者。Meta分析结果显示,基于信息技术的自我管理干预可使T2DM患者糖化血红蛋白(HbA1c)下降0.39%[95%CI(-0.51,-0.27),P<0.00001],但对患者生活质量和自我效能的影响未见改善。结论使用信息技术对患者进行自我管理干预,可改善2型糖尿病患者的血糖控制,但对生活质量和自我效能的影响尚需更多研究验证。     

基于超声靶向微泡破坏技术的纳米给药系统的研究进展

纳米给药系统是治疗多种疾病,尤其是肿瘤的一种极具应用潜力的方法。然而,目前其药物输送效率仍难以满足靶向治疗的需要。超声靶向微泡破坏(UTMD)技术作为一种安全的物理靶向方法,可以增强组织渗透性和细胞膜通透性,进而提高纳米给药系统的药物递送效率。本文就UTMD介导的纳米给药系统的研究进行综述。     

Detection of Mycoplasma pneumoniae using a highly sensitive rapid diagnostic method with silver amplification technology

To prevent an increase in the frequency of antimicrobial resistance (AMR), the specific and rapid diagnosis of causative pathogens is important, as the results can be used to initiate appropriate antibiotics treatment. Recently, the highly sensitive rapid immunochromatographic assay of silver amplification technology was developed for the detection of Mycoplasma pneumoniae. We investigated the sensitivity and specificity of the silver amplification immunochromatographic assay in adolescent and adult patients. A total of 767 patients with respiratory tract infection (RTI) and 605 with pneumonia were assessed by the silver amplification assay and real-time polymerase chain reaction (PCR). M. pneumoniae was identified by PCR in 95 patients with RTI and in 30 patients with community-acquired pneumonia (CAP), but it was not identified in patients with nursing- and healthcare-associated pneumonia. Eighteen of the 95 RTI patients and 7 of the 30 CAP patients with PCR-positive M. pneumoniae were found to be infected with macrolide-resistant M. pneumoniae. When PCR was used as the control test, the sensitivity, specificity, and overall agreement with the silver amplification assay were 90.5%, 99.0%, and 97.9%, respectively, in RTI patients and 90.0%, 99.1%, and 98.7%, respectively, in pneumonia patients. Our results show that the silver amplification assay has excellent sensitivity and specificity compared with PCR despite being a rapid diagnostic method. The silver amplification assay may be helpful for initiating appropriate antibiotic treatment and preventing AMR.     

基于孤立性护理行为规避的环节协作护理模式在下肢深静脉血栓介入溶栓治疗中的应用

目的观察基于孤立性护理行为规避的环节协作护理模式在下肢深静脉血栓介入溶栓治疗中的应用效果。方法将2018年1月~9月于我院接受下肢深静脉血栓介入溶栓治疗患者40例设为对照组。将2018年10~2019年6月于我院收治的同类患者40例设为试验组。对照组接受常规护理服务。试验组接受基于孤立性护理行为规避的环节协作护理模式。并对两组干预后的各观察指标进行比较。结果试验组干预后特质与状态焦虑评分、手术相关并发症发生率、术后下床活动时间及总住院时间显著低于对照组(P<0.05)。结论采用基于孤立性护理行为规避的环节协作护理模式对下肢深静脉血栓介入溶栓治疗者施加干预,有助于缓解患者焦虑情绪,提高治疗安全性与康复进程的发展。     

Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research

Patton SR, Williams LB, Eder SJ, Crawford MJ, Dolan L, Powers SW. Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research. Objective: This study presents data on the use of continuous glucose monitoring (CGM) in young children with type 1 diabetes mellitus (T1DM). CGM provides moment‐to‐moment tracking of glucose concentrations and measures of intra‐ and interday variability, which are particularly salient measures in young children with T1DM. Methods: Thirty‐one children (mean age = 5.0 yr ) with T1DM wore the Medtronic Minimed CGM for a mean of 66.8 h. The CGM was inserted in diabetes clinics, and parents were provided brief training. Results: Few difficulties were experienced and families cited the acceptability of CGM. Participants' CGM data are compared with self‐monitoring blood glucose (SMBG) data as well as data from older children with T1DM to illustrate differences in methodology and variability present in this population. CGM data are used to calculate glucose variability, which is found to be related to diabetes variables such as history of hypoglycemic seizures. Conclusions: CGM is an acceptable research tool for obtaining glucose data in young children with T1DM and has been used previously in older children and adults. CGM may be particularly useful in young children who often experience more glucose variability. Data obtained via CGM are richer and more detailed than traditional SMBG data and allow for analyses to link blood glucose with behavior.     

A Large‐Scale Dissemination and Implementation Model for Evidence‐Based Treatment and Continuing Care

[Clin Psychol Sci Prac 18: 67–83, 2011] Multiple evidence‐based treatments for adolescents with substance use disorders are available; however, the diffusion of these treatments in practice remains minimal. A dissemination and implementation model incorporating research‐based training components for simultaneous implementation across 33 dispersed sites and over 200 clinical staff is described. Key elements for the diffusion of the Adolescent Community Reinforcement Approach and Assertive Continuing Care were as follows: (a) 3 years of funding to support local implementation; (b) comprehensive training, including a 3.5‐day workshop, biweekly coaching calls, and ongoing performance feedback facilitated by a web tool; (c) a clinician certification process; (d) a supervisor certification process to promote long‐term sustainability; and (e) random fidelity reviews after certification. Process data are summarized for 167 clinicians and 64 supervisors.