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BACKGROUND Type 2 diabetes (T2D) tremendously affects patient health and healthcare globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioural, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change health behaviour and improve glucose regulation. Digital tools are effective in areas of self-mangement and have great potential to support patient self-management due to low costs, 24/7 availability and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and to use a structured approach to guide the development team in planning, coordinating and executing the development process. OBJECTIVE Taking this into account, we aimed to develop an integrated, eHealth-supported, educational care pathway for people with T2D. METHODS The educational care pathway was developed using the first three phases of the CeHRes Roadmap; the contextual inquiry, the value specification and the design phase. Following this roadmap we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with healthcare professionals and a patient panel, to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box and consisted of personalized education, online educational material, self-measurements of glucose, blood pressure, activity and sleep, and a smartphone application to bring it all together. RESULTS The scoping review highlights the importance of self-management education, and the potential of telemonitoring and mobile apps for blood glucose regulation in T2D patients. Focus groups with healthcare professionals revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualisation and that insulin use should be incorporated into the app. Both patients and healthcare professionals stressed the importance of direct automated feedback in the Diabetes Box. CONCLUSIONS After developing the Diabetes Box prototype using the CeHReS Roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible, and that direct automated feedback and education on stress and sleep are essential. To assess feasibility, acceptability and usefulness in more detail, a pilot study is planned.

BACKGROUND The medication package leaflet is the most used and trusted source of information in the home situation but is often incomprehensible for individuals, especially for those with limited health literacy. The platform “Watchyourmeds” comprises a web-based library with over 10,000 animated videos that explain the most essential information from the package leaflet in an unambiguous and simple manner to increase the accessibility and understandability of package leaflets. OBJECTIVE This study aimed to investigate Watchyourmeds in the Netherlands from a user perspective during the first year of implementation by investigating (1) usage data, (2) self-reported user experiences, and (3) the preliminary and potential impact on medication knowledge. METHODS This was a retrospective observational study. The first aim was investigated by examining objective user data from 1815 pharmacies from the first year of implementation of Watchyourmeds. User experiences (second aim) were investigated by examining individuals’ completed self-report questionnaires (n=4926) that they received after completing a video. The preliminary and potential impact on medication knowledge (third aim) was investigated by examining users’ self-report questionnaire data (n=67) that assessed their medication knowledge about their prescribed medication. RESULTS Nearly 1.8 million videos have been distributed to users by over 1400 pharmacies, with monthly numbers increasing to 280,000 in the last month of the implementation year. Most users (4444/4805, 92.5%) indicated to have fully understood the information presented in the videos. Female users reported more often to have fully understood the information than male users (χ24=11.5, P=.02). Most users (3662/4805, 76.2%) said that they did not think any information was missing in the video. Users with a lower educational level stated more often (1104/1290, 85.6%) than those with a middle (984/1230, 80%) or higher (964/1229, 78.4%) educational level that they did not seem to be missing any information in the videos (χ212=70.6, Pχ23=25.0, Pχ23=38.1, P CONCLUSIONS The results of this study suggest that a web-based library with animated videos is a valuable and acceptable addition to stand-alone package leaflets to increase the understanding and accessibility of medication information.

Due to the COVID-19 pandemic, a sudden shift was warranted from face-to-face to digital interviewing. This shift is in line with the existing trend of digitalization. However, limited literature is available on how to conduct focus group interviews online successfully. This research note provides practical guidelines, tips, and considerations for setting up and conducting online synchronous focus groups for eight relevant factors: preparation, the number of participants, the duration, a break, the usability of the online platform, the interaction between participants and researchers, support and roles of the research team, and privacy considerations. These guidelines were formulated based on the available literature and our own positive hands-on experiences. We consider online focus groups to be an excellent option when taking into account the considerations related to the eight factors.

BACKGROUND Economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternative to usual care, but evidence is mixed. OBJECTIVE The aim was to review the literature on cost-effectiveness of eHealth interventions for mental disorders compared to usual care and to provide an estimate of the monetary benefits of such interventions compared to usual care. METHODS A systematic review and meta-analysis of (1) randomized controlled trials that (2) included participants with symptoms of mental disorders, (3) investigated a telephone or internet-based intervention, (4) included a control condition in the form of treatment as usual, psychological placebo, waiting list control or bibliotherapy, (5) reported outcomes on both quality of life and costs and (6) were published in English, was conducted. Electronic databases PubMed (including Medline), Embase, Emcare, PsycINFO, Web of Science and The Cochrane Library were searched. Data on risk of bias, quality of the economic evaluation, quality-of-life adjusted life years (QALYs) and costs were extracted from included studies and the incremental net benefit (INB) was calculated and pooled. RESULTS The search yielded 6226 abstracts and 37 studies with 14,946 participants were included. Quality of economic evaluations of included studies was rated to be moderate and risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions to be slightly more effective than usual care in terms of QALY gain, Hedges’ g=.052 (95% CI .010; .094, P=.016), and equally expensive, Hedges’ g=.002 (95% CI -.080; 0.84, P=.96). The pooled INB was $255, (95% CI $91; $419, P=.002), favoring eHealth interventions over usual care. Perspective of the economic evaluation and targeted mental disorder moderated results. CONCLUSIONS Findings indicate that cost-effectiveness of e-mental health interventions compared to a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the area of mental health to pool cost-effectiveness outcomes in an aggregate-data meta-analysis. CLINICALTRIAL Prospero registration https://www.crd.york.ac.uk/PROSPERO/; registration number: CRD42019141659.

BACKGROUND Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. OBJECTIVE The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). METHODS The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. RESULTS A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. CONCLUSIONS eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual. CLINICALTRIAL

BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. While medication can control and improve disease symptoms, incorrect use of medication is a common problem. The eHealth intervention SARA (Service Apothecary Respiratory Advice) aims to improve participants’ correct use of inhalation medication by providing information and as-needed tailored follow-up support by a pharmacist. OBJECTIVE The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. METHODS In this nonrandomized pre-post study, medication dispensing data from 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed short-course oral corticosteroids. Medication adherence between new and chronic users was assessed by calculating the proportion of days covered from dispensed inhalation maintenance medication. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed 1 year before and 1 year after implementation of SARA and were compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (ie, 1 year after SARA minus 1 year before SARA) and was subsequently compared between the study groups with independent-samples t tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression. RESULTS The study population comprised 9452 participants, of whom 2400 (25.39%) were SARA participants. The mean age of the population was 60.8 (15.0) years, and approximately two-thirds (n=5677, 60.06%) were female. The results showed an increase in mean exacerbation rates over time for both study groups (SARA: 0.05; control: 0.15). However, this increase in exacerbation rates was significantly lower for SARA participants (t9450=3.10, 95% CI 0.04-0.16; P=.002; Cohen d=0.06). Chronic users of inhalation medication in both study groups showed an increase in mean medication adherence over time (SARA: 6.73; control: 4.48); however, this increase was significantly higher for SARA participants (t5886=–2.74, 95% CI –3.86 to –0.84; P=.01; Cohen d=–0.07). Among new users of inhalation medication, results showed no significant difference in medication adherence between SARA and control participants in the year after implementation of SARA (t1434=–1.85, 95% CI –5.60 to 0.16; P=.06; Cohen d=–0.10). Among ICS users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654=0.29, 95% CI –0.40 to 0.54; P=.76; Cohen d=0). CONCLUSIONS This study provides preliminary evidence that the SARA eHealth intervention might have the potential to decrease exacerbation rates and improve medication adherence among patients with asthma and COPD.

Background Monitoring of symptoms and behavior may enable prediction of emerging COVID-19 hotspots. The COVID Radar smartphone app, active in the Netherlands, allows users to self-report symptoms, social distancing behaviors, and COVID-19 status daily. The objective of this study is to describe the validation of the COVID Radar. Methods COVID Radar users are asked to complete a daily questionnaire consisting of 20 questions assessing their symptoms, social distancing behavior, and COVID-19 status. We describe the internal and external validation of symptoms, behavior, and both user-reported COVID-19 status and state-reported COVID-19 case numbers. Results Since April 2nd, 2020, over 6 million observations from over 250,000 users have been collected using the COVID Radar app. Almost 2,000 users reported having tested positive for SARS-CoV-2. Amongst users testing positive for SARS-CoV-2, the proportion of observations reporting symptoms was higher than that of the cohort as a whole in the week prior to a positive SARS-CoV-2 test. Likewise, users who tested positive for SARS-CoV-2 showed above average risk social-distancing behavior. Per-capita user-reported SARS-CoV-2 positive tests closely matched government-reported per-capita case counts in provinces with high user engagement. Discussion The COVID Radar app allows voluntarily self-reporting of COVID-19 related symptoms and social distancing behaviors. Symptoms and risk behavior increase prior to a positive SARS-CoV-2 test, and user-reported case counts match closely with nationally-reported case counts in regions with high user engagement. These results suggest the COVID Radar may be a valid instrument for future surveillance and potential predictive analytics to identify emerging hotspots.

BACKGROUND Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. OBJECTIVE This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. METHODS A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed. RESULTS In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. CONCLUSIONS The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.

Background Pre- and postoperative anxiety is a common phenomenon associated with negative postoperative outcomes. Symptoms of posttraumatic stress disorder, such as fear, nightmares, and sleep deprivation, are prevalent in approximately 30% to 50% of patients following discharge from intensive care units after cardiac surgery. Preliminary evidence suggests a promising role of virtual reality (VR) in preventing stress-related reactions using stress inoculation training. Such training enables cognitive preparation of individuals for stressful situations, thereby becoming more tolerant and resistant to stress, subsequently reducing the risk of potential negative psychological consequences. This study investigated a preoperative VR app—Pre-View—aimed at better informing and preparing patients for cardiac catheterization. Objective This study aims to assess the feasibility, usability, and acceptability of Pre-View in patients undergoing cardiac catheterization. Methods Eligible participants were adults scheduled for elective cardiac catheterization. Pre-View comprised an interactive virtual representation of the whole care process related to cardiac catheterization, from entering the hospital for admission to postprocedural stay and discharge. These processes were represented through 360° videos and interactive photos. Self-report questionnaires were completed at baseline (ie, before catheterization and after undergoing the VR experience) and after cardiac catheterization. Outcome measures included user experience and satisfaction, VR presence and immersive tendencies, and user friendliness. The perceived effectiveness was assessed exploratively. Results A total of 8 individuals, with a mean age of 67 (SD 7.5) years, participated in this study. Half of them underwent the VR experience at the hospital and the other half at home. Participants reported high levels of presence in the virtual environment (Presence Questionnaire score: mean 129.1, SD 13.4). The usability of Pre-View was well evaluated (System Usability Scale score: mean 89.1, SD 12.0), and patient satisfaction was high (Client Satisfaction Questionnaire score: mean 27.1, SD 3.2). Usability and satisfaction scores were higher for participants who underwent Pre-View at home versus those who underwent Pre-View at the hospital, although the latter group was significantly older; 72.8 versus 61.3, respectively. All participants reported Pre-View to be effective in terms of feeling better informed about the care process of cardiac catheterization. Most participants (7/8, 88%) reported Pre-View to be effective in terms of feeling better prepared for cardiac catheterization, acknowledging the potential of Pre-View in reducing negative psychological consequences after catheterization. Conclusions The results provide initial support for the feasibility and acceptability of a preoperative VR app, creating a virtual environment that supports patient education and preparation for upcoming cardiac catheterization. More studies are needed to further investigate the effects of VR as a tool to better prepare patients for medical procedures, its effectiveness in reducing negative patient outcomes (eg, anxiety, stress, and postoperative recovery outcomes), and the generalizability of effects across different settings and patient populations.

University student years are a particularly influential period, during which time students may adopt negative behaviours that set the precedent for health outcomes in later years. This study utilised a newly digitised health survey implemented during health screening at a university in Singapore to capture student health data. The aim of this study was to analyze the health status of this Asian university student population. A total of 535 students were included in the cohort, and a cross-sectional analysis of student health was completed. Areas of concern were highlighted in student&rsquo, s body weight, visual acuity, and binge drinking. A large proportion of students were underweight (body mass index (BMI) &lt, 18.5)&mdash, 18.9% of females and 10.6% of males&mdash, and 7% of males were obese (BMI &gt, 30). Although the overall prevalence of alcohol use was low in this study population, 9% of females and 8% of males who consumed alcohol had hazardous drinking habits. Around 16% of these students (male and female combined) typically drank 3&ndash, 4 alcoholic drinks each occasion. The prevalence of mental health conditions reported was very low (&lt, 1%). This study evaluated the results from a digitised health survey implemented into student health screening to capture a comprehensive health history. The results reveal potential student health concerns and offer the opportunity to provide more targeted student health campaigns to address these.

Patient health information is increasingly collected through multiple modalities, including electronic health records, wearables, and connected devices. Computer-assisted history taking could provide an additional channel to collect highly relevant, comprehensive, and accurate patient information while reducing the burden on clinicians and face-to-face consultation time. Considering restrictions to consultation time and the associated negative health outcomes, patient-provided health data outside of consultation can prove invaluable in health care delivery. Over the years, research has highlighted the numerous benefits of computer-assisted history taking; however, the limitations have proved an obstacle to adoption. In this viewpoint, we review these limitations under 4 main categories (accessibility, affordability, accuracy, and acceptability) and discuss how advances in technology, computing power, and ubiquity of personal devices offer solutions to overcoming these.

To evaluate the development and implementation of clinical practice guidelines for the management of depression globally.We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries.We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence.Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost-effectiveness and impact on health outcomes.Évaluer le développement et la mise en œuvre des directives de pratique clinique pour la gestion de la dépression dans le monde.Nous avons effectué une revue systématique des directives existantes en matière de gestion de la dépression chez les adultes souffrant de troubles dépressifs majeurs ou de troubles bipolaires. Pour chaque directive identifiée, nous avons vérifié le degré de conformité vis-à-vis des mesures de qualité du développement des directives (transparence des processus d'élaboration des directives et de leur financement, composition multidisciplinaire du groupe d'auteurs, revue systématique des études d'efficacité comparative) ainsi que de la mise en œuvre (indicateurs de qualité). Nous avons confronté les directives des pays à faible et moyen revenu avec celles des pays à haut revenu.Nous avons identifié 82 directives de pratique clinique nationales et 13 directives de pratique clinique internationales dans 83 pays et en 27 langues. Les processus d'élaboration des directives et les sources de financement étaient explicitement indiquées dans une moindre proportion chez les pays à faible et moyen revenu (8/29; 28%) par rapport aux pays à haut revenu (35/58; 60%). Le nombre de directives rédigées par un groupe d'auteurs multidisciplinaire était moins élevé dans les pays à faible et moyen revenu (2/29; 7%) que dans les pays à haut revenu (22/58; 38%). Une revue systématique de l'efficacité comparative a été menée pour 31% (9/29) des directives dans les pays à faible et moyen revenu, contre 71% (41/58) des directives dans les pays à haut revenu. Seulement 10% (3/29) des directives émises par les pays à faible et moyen revenu et 19% (11/58) de celles émises par les pays à haut revenu comprenaient un programme d'évaluation des indicateurs de qualité ou de l'adhérence aux recommandations.La mise en œuvre des directives est mal planifiée, mal analysée et mal mesurée. Réduire les disparités de développement et de mise en œuvre des directives dans les pays à faible et moyen revenu est une priorité. À l'avenir, ces directives devraient prévoir des stratégies d'exécution des recommandations, mais aussi d'évaluation de la faisabilité, de la rentabilité et de l'impact sur l'état de santé.Evaluar la elaboración e implementación de las directrices de práctica clínica para el tratamiento de la depresión a nivel mundial.Se realizó una revisión sistemática de las directrices existentes para el tratamiento de la depresión en adultos con trastorno depresivo mayor o bipolar. Por cada directriz identificada, se evaluó el cumplimiento de las medidas de calidad de elaboración de directrices (como la transparencia en los procesos de elaboración de directrices y su financiamiento, la composición del grupo multidisciplinario de autores, la revisión sistemática del estudio de eficacia comparativo) y la implementación (como los indicadores de calidad). En este contexto, se compararon las directrices de los países de ingresos bajos y medios con las de los países de ingresos altos.Se identificaron las directrices de práctica clínica a nivel nacional (82) y a nivel internacional (13) de 83 países en 27 idiomas. Los procesos de elaboración de directrices y las fuentes de financiamiento se especificaron de manera explícita en un porcentaje menor de directrices de los países de ingresos bajos y medios (8/29; 28 %) en relación con las de los países de ingresos altos (35/58; 60 %). Un grupo de desarrollo multidisciplinario elaboró menos directrices (2/29; 7 %) para los países de ingresos bajos y medios, en relación con las de los países de ingresos altos (22/58; 38 %). Además, se realizó una revisión sistemática sobre la efectividad comparativa en el 31 % (9/29) de las directrices de los países de ingresos bajos y medios, frente al 71 % (41/58) de las directrices de los países de ingresos altos. Solo el 10 % (3/29) de las directrices de los países de ingresos bajos y medios y el 19 % (11/58) de las directrices de los países de ingresos altos describieron planes para evaluar los indicadores de calidad o el cumplimiento de las recomendaciones.La implementación de las directrices no se planifica, notifica ni evalúa de manera adecuada a nivel mundial. Es prioritario reducir las desigualdades en la elaboración y la implementación de las directrices en los países de ingresos bajos y medios. Las directrices que se elaboren en el futuro deberán presentar estrategias para implementar las recomendaciones y evaluar la viabilidad, la rentabilidad y el impacto en los resultados sanitarios.تقييم عملية وضع المبادئ التوجيهية للممارسة السريرية للتعامل مع الاكتئاب وتنفيذها على مستوى العالم.لقد أجرينا مراجعة منهجية للمبادئ التوجيهية الحالية الخاصة بالتعامل مع الاكتئاب لدى البالغين المصابين بحالات الاضطراب الاكتئابي أو الاضطراب ثنائي القطب. وفيما يتعلق بكل مبدأ توجيهي محدد، قمنا بتقييم الامتثال لمقاييس جودة وضع المبدأ التوجيهي (كالشفافية في عمليات وضع المبدأ التوجيهي والتمويل، وتكوين مجموعة من المؤلفين متعددي التخصصات، وكذلك المراجعة المنهجية لأبحاث الفعالية النسبية)، وتنفيذها (مثل مؤشرات الجودة). كما قمنا بمقارنة المبادئ التوجيهية الموجودة في البلدان منخفضة الدخل ومتوسطة الدخل، مع مثيلاتها الموجودة في البلدان مرتفعة الدخل.لقد حددنا 82 مبدأً توجيهيًا وطنيًا، و13 مبدأً توجيهيًا دوليًا من المبادئ التوجيهية الخاصة بالممارسات السريرية، من 83 بلدًا بـ 27 لغة. ولقد تم تحديد عمليات وضع المبدأ التوجيهي، ومصادر التمويل بشكل واضح في نسبة أصغر من المبادئ التوجيهية، الواردة من البلدان منخفضة الدخل ومتوسطة الدخل (8/29؛ 28%)، مقارنة بالبلدان مرتفعة الدخل (35/58؛ 60%). وتم وضع عدد أقل من المبادئ التوجيهية (2/29؛ 7%) الواردة من البلدان منخفضة الدخل ومتوسطة الدخل، بواسطة إحدى مجموعات التطوير متعددة التخصصات، مقارنة بالبلدان مرتفعة الدخل (22/58؛ 38%). وقد تم إجراء مراجعة منهجية للفعالية النسبية في 31% (9/29) من المبادئ التوجيهية للبلدان منخفضة الدخل ومتوسطة الدخل، مقابل 71% (41/58) من المبادئ التوجيهية للبلدان ذات الدخل المرتفع. ولم يتم وصف خطط لتقييم مؤشرات الجودة أو الالتزام بالتوصيات إلا في 10% من المبادئ التوجيهية فقط (3/29) الواردة من البلدان منخفضة الدخل ومتوسطة الدخل، و19% فقط (11/58) من المبادئ التوجيهية للبلدان عالية الدخل.لم يتم التخطيط لعملية تنفيذ المبدأ التوجيهي، والإبلاغ عنها وتقييمها، بشكل مناسب على الصعيد العالمي. إذ يعد تضييق الفوارق في عملية وضع المبادئ التوجيهية وتنفيذها في البلدان منخفضة الدخل ومتوسطة الدخل، إحدى الأولويات. ويجب أن تقدم المبادئ التوجيهية المستقبلية إستراتيجيات لتنفيذ التوصيات، وقياس الجدوى، وفعالية التكلفة، والتأثير على النتائج الصحية.评估全球抑郁症治疗临床实践指南的制定和实施情况。.我们系统评价了现有的成人重度抑郁或双相情感障碍的抑郁治疗指南。针对每份符合纳入标准的指南，我们评估其是否达到指南制定的质量标准（如制定过程和资金的透明度、多学科编著成员、比较疗效研究的系统评价），实施（如质量指标）是否合规。我们对比了中低收入国家和高收入国家的治疗指南。.我们最终确定了 82 份国家级和 13 份国际级的临床实践指南，涉及 83 个国家 27 种语言。与高收入国家相比，中低收入国家指南中明确说明其制定过程和资金来源的比例略低，29 份中仅 8 份给予明确说明，占比 28%，而高收入国家则达 60%，58 份中有 35 份。中低收入国家由多学科编撰成员编著的指南（29 份中仅有 2 份，占比 7%）相较于高收入国家也较少（58 份中有 22 份，占比 38%）。中低收入国家的指南中，有 31% (9/29) 对比较疗效展开系统审查，而高收入国家则达 71% (41/58)。中低收入国家仅有 10% (3/29) 的指南论述了评估质量指标的计划或随附了相关建议，而高收入国家则达 19% (11/58)。.全球范围内，指南的实施均缺乏充分的计划、报道和衡量。缩小中低收入国家在指南制定和实施方面的差距是当务之急。未来制定指南时，应提出实施策略建议，并衡量其可行性、成本效益及对健康结果的影响。.Оценить разработку и внедрениепрактических клинических рекомендаций по лечению депрессии во всем мире.Авторы выполнили систематический обзор существующих клинических рекомендаций по лечению депрессии у взрослых с клинической депрессией или биполярным расстройством. Всем идентифицированным клиническим рекомендациям была дана оценка по соответствию критериям качества разработки клинических рекомендаций (таким как прозрачность процессов разработки клинических рекомендаций и финансирования, мультидисциплинарный состав группы авторов, систематический обзор сравнительных исследований эффективности) и реализации (например, показатели качества). Авторы сравнили клинические рекомендации из стран с низким и средним уровнем доходов и из стран с высоким уровнем доходов.Было выявлено 82 национальных и 13 международных клинических рекомендации из 83 стран на 27 языках. Процессы разработки клинических рекомендаций и источники финансирования были четко указаны в меньшем количестве клинических рекомендаций из стран с низким и средним уровнем доходов (8/29; 28%) по сравнению со странами с высоким уровнем доходов (35/58; 60%). Меньшее количество клинических рекомендаций (2/29; 7%) из стран с низким и средним уровнем доходов по сравнению со странами с высоким уровнем доходов (22/58; 38%) было разработано мультидисциплинарной группой авторов. Систематический обзор сравнительной эффективности был выполнен в 31% (9/29) клинических рекомендаций из стран с низким и средним уровнем доходов по сравнению с 71% (41/58) клинических рекомендаций из стран с высоким уровнем доходов. Только в 10% (3/29) клинических рекомендаций из стран с низким и средним уровнем доходов и в 19% (11/58) клинических рекомендаций из стран с высоким уровнем доходов описаны планы по оценке показателей качества или приверженности соблюдению рекомендаций.В глобальном масштабе при внедрении клинических рекомендаций вопросы планирования, отчетности и измерения показателей внедрения решаются неадекватно. Приоритетной задачей является приближение стандартов разработки и внедрения клинических рекомендаций в странах с низким и средним уровнем доходов к таковым в странах с высоким уровнем доходов. В будущих клинических рекомендациях должны быть представлены стратегии по внедрению рекомендаций и оценке их осуществимости, экономической эффективности и воздействию на результаты в отношении здоровья.

Objective To investigate the cost-utility of the internet-based intervention “Featback” provided with different levels of therapist support, in comparison to a waiting list. Method This economic evaluation was conducted from a societal perspective and was part of a randomized controlled trial in which participants (N = 354) with self-reported ED symptoms were randomized to: (1) 8 weeks of Featback, consisting of psychoeducation and a fully automated monitoring- and feedback system, (2) Featback with low-intensity (weekly) therapist support, (3) Featback with high-intensity (three times a week) therapist support, and (4) a waiting list. Participants were assessed at baseline, postintervention, and 3-month follow-up. Cost-utility acceptability curves were constructed. Results No significant differences between the study conditions were found regarding quality-adjusted life-years (P = 0.55) and societal costs (P = 0.45), although the mean costs per participant were lowest in the Featback condition with low-intensity therapist support (€1951), followed by Featback with high-intensity therapist support (€2032), Featback without therapist support (€2102), and the waiting list (€2582). Featback seemed to be cost-effective as compared to the waiting list. No clear preference was found for Featback with or without therapist support. Discussion A fully automated Internet-based intervention for ED symptoms with no, low-, or high-intensity therapist support represented good value for money when compared to a waiting list. This finding may have important implications for clinical practice, as both the unguided- and guided intervention could allow for more efficient care and widespread dissemination, potentially increasing the accessibility and availability of mental health care services for individuals with ED symptoms. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1068–1076)

Background Identifying predictors of psychological outcome for patients with eating disorders may improve the effectiveness of treatment. Patients with different pre-treatment characteristics and symptoms may benefit from different therapies. This study aimed to identify potential predictors of treatment outcome in a large naturalistic cohort of patients with an eating disorder. Method The study sample included patients (N = 1153) with all types of eating disorders who were receiving residential, day, or outpatient treatment. Remission was defined by means of four different indicators based on the Eating Disorder Examination-Questionnaire global score: 1. achieving reliable change; 2. showing a 50% reduction in baseline symptom severity; 3. reaching the clinical significance cut-off point; and 4. a combination of indicators 2 and 3. Potential predictor variables were investigated in univariate and multivariate Cox regression models. Results Different predictors were found for the four outcome criteria. Patients with high levels of interpersonal distrust at baseline were less likely to have achieved reliable change in eating disorder psychopathology. Higher self-esteem and less body dissatisfaction at baseline was independently associated with a symptom reduction of more than 50% and/or reaching the clinical significance cut-off point. Contrary to our expectations, no differences in outcome were found between the eating disorder subtypes. Discussion Clinically, it is important to reduce the risk of poor outcome and to achieve a rapid response in treatment using an intervention designed for this purpose, such as shared decision making or an intervention directed at self-esteem or body image, which may act as a catalyst for change. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016)

Executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior. They play a role in mediating self-control, self-regulation and decision-making. It has been suggested that the inability to control eating behavior in binge eating disorder (BED) may indicate deficits in executive functioning. This may be worsened by depressive symptoms. The aim of the present study was to compare executive functioning of patients with BED and no-to-mild depressive symptoms (n = 25), patients with BED and moderate-to-severe depressive symptoms (n = 66), and healthy controls (Body Mass Index n = 56), matched on age, educational level and gender. The participants were assessed by means of neuropsychological tests and questionnaires. The neuropsychological tests did not show significant differences in executive functioning between the groups. However, eating disorder psychopathology and depressive symptoms are associated with self-reported difficulties in executive functioning in daily life. A self-report questionnaire which evaluates the functional, real-world impact of executive dysfunction expressed in everyday activities seems to be more useful in this population than neuropsychological tests. This study highlights the importance of taking depressive symptoms into account when studying executive functioning in patients with (binge) eating disorders.

This study investigated moderators of intervention response in a fully automated Internet-based monitoring and feedback intervention (‘Featback’) with different levels of therapist support for individuals with eating disorder (ED) symptoms. This study was part of a randomized controlled trial comparing four conditions: 1) Featback, 2) Featback with low-intensity (weekly) therapist support, 3) Featback with high-intensity (three times a week) therapist support, and 4) a waiting list. A total of 273 participants completed baseline and post-intervention assessments. The outcome measure was ED psychopathology. Model-based recursive partitioning was applied. Baseline levels of ED psychopathology were found to moderate intervention response. Specifically, in terms of improvement in symptoms of anorexia nervosa, participants with higher baseline levels of anorectic psychopathology showed better outcomes in the waiting list condition and the Featback conditions with low- and high-intensity therapist support in comparison with Featback without therapist support. In terms of improvement in symptoms of bulimia nervosa, participants with mild to moderate bulimic symptoms had better outcomes in the Featback conditions compared with the waiting list. Thus, the fully automated Internet-based intervention with and without therapist support may be particularly suitable in improving mild to moderate bulimic psychopathology, whereas the intervention without therapist support may be less effective in improving severe anorectic psychopathology. Further investigating differential intervention responses is important, as this could help to optimize the delivery and dissemination of E-health interventions and therapist support, which in turn could help moving toward personalized (E-)care.

Introduction Many individuals with eating disorder problems seek information and support online. There are however numerous websites that promote eating disordered behaviors. The website and e-community ‘Proud2Bme’ was developed as a healthy alternative for pro-eating disorder websites, providing a safe, positive, and pro-recovery focused environment. It offers a wide array of information and personal stories, as well as platforms for interaction such as a forum and chat. The first aim of this study was to investigate whether, and to what extent, empowering processes and outcomes are experienced by participants on Proud2Bme. The second aim was to examine correlates of empowering processes and outcomes. Methods Participants ( n = 311) were recruited via an online survey on Proud2Bme. Correlations were examined and T -tests and ANOVAs were conducted. Results Exchanging information, finding recognition, and sharing experiences were the empowering processes most often reported by participants. The most pronounced empowering outcome was feeling better informed. To a smaller degree, increased help-seeking behavior, increased optimism and control over the future, and increased confidence in treatment and the relationship with the therapist were reported. Lower levels of general empowerment, younger age, and more interactive usage patterns of the website were positively associated with the experience of empowering processes and outcomes. Discussion Offering a platform where individuals can share their experiences and find recognition might be one of the most important ingredients for successful e-health initiatives aimed at improving patient empowerment. Moreover, in the field of eating disorders specifically, such initiatives offer a healthy alternative to the harmful and negative effects of pro-eating disorder websites.

Objective To review the literature regarding internet-based treatment of eating disorders (ED). Method Relevant studies were identified by searching electronic databases (including Medline, Embase, PsycInfo, and Web of Science). Eligible studies evaluated an internet-based treatment for ED, or an ED treatment that included at least one internet-based component. Results Twenty-one studies were included. Methodological quality varied. Internet-based treatments were superior to waiting lists in reducing ED psychopathology, frequency of binge eating and purging, and in improving (ED-related) quality of life. Internet-based treatment was more effective for individuals with less comorbid psychopathology, binge eating as opposed to restrictive problems, and individuals with binge eating disorder as opposed to bulimia nervosa. Higher levels of compliance were related to more improvements in ED symptoms. Study dropout ranged from 5.3 to 76.8%. Inclusion of face-to-face assessments and therapist support seemed to enhance study compliance. Overall, the internet can be considered an acceptable vehicle for delivering ED treatment. Discussion Future research should determine the utility of internet-based treatment by comparing them to face-to-face treatment. Research should furthermore focus on unraveling predictors and mediators of treatment outcome, compliance, and dropout, respectively. Studies with good methodological quality are needed with reports according to CONSORT guidelines. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:539–552)

Identifying predictors of psychological outcome for patients with eating disorders may improve the effectiveness of treatment. Patients with different pre-treatment characteristics and symptoms may benefit from different therapies. This study aimed to identify potential predictors of treatment outcome in a large naturalistic cohort of patients with an eating disorder.The study sample included patients (N = 1153) with all types of eating disorders who were receiving residential, day, or outpatient treatment. Remission was defined by means of four different indicators based on the Eating Disorder Examination-Questionnaire global score: 1. achieving reliable change; 2. showing a 50% reduction in baseline symptom severity; 3. reaching the clinical significance cut-off point; and 4. a combination of indicators 2 and 3. Potential predictor variables were investigated in univariate and multivariate Cox regression models.Different predictors were found for the four outcome criteria. Patients with high levels of interpersonal distrust at baseline were less likely to have achieved reliable change in eating disorder psychopathology. Higher self-esteem and less body dissatisfaction at baseline was independently associated with a symptom reduction of more than 50% and/or reaching the clinical significance cut-off point. Contrary to our expectations, no differences in outcome were found between the eating disorder subtypes.Clinically, it is important to reduce the risk of poor outcome and to achieve a rapid response in treatment using an intervention designed for this purpose, such as shared decision making or an intervention directed at self-esteem or body image, which may act as a catalyst for change. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:863-873).

This study aimed to review the emerging findings regarding E-health interventions for eating disorders and to critically discuss emerging issues as well as challenges for future research. Internet-based cognitive behavioral therapy and guided self-help have demonstrated promising results in terms of reducing eating disorder psychopathology. Emerging findings also suggest that E-health interventions reach an underserved population and improve access to care. The use of smartphone applications is becoming increasingly popular and has much potential although their clinical utility and effectiveness is presently unknown and requires investigation. Important challenges include the diagnostic process in E-health interventions, the optimization of E-health within existing health care models, and the investigation and implementation of blended care. More high-quality research is needed to bring the field forward and to determine the place for E-health in our health care service delivery systems.

To review the literature regarding internet-based treatment of eating disorders (ED).Relevant studies were identified by searching electronic databases (including Medline, Embase, PsycInfo, and Web of Science). Eligible studies evaluated an internet-based treatment for ED, or an ED treatment that included at least one internet-based component.Twenty-one studies were included. Methodological quality varied. Internet-based treatments were superior to waiting lists in reducing ED psychopathology, frequency of binge eating and purging, and in improving (ED-related) quality of life. Internet-based treatment was more effective for individuals with less comorbid psychopathology, binge eating as opposed to restrictive problems, and individuals with binge eating disorder as opposed to bulimia nervosa. Higher levels of compliance were related to more improvements in ED symptoms. Study dropout ranged from 5.3 to 76.8%. Inclusion of face-to-face assessments and therapist support seemed to enhance study compliance. Overall, the internet can be considered an acceptable vehicle for delivering ED treatment.Future research should determine the utility of internet-based treatment by comparing them to face-to-face treatment. Research should furthermore focus on unraveling predictors and mediators of treatment outcome, compliance, and dropout, respectively. Studies with good methodological quality are needed with reports according to CONSORT guidelines.

The first aim of this study was to provide norms for the Eating Disorder Examination Questionnaire (EDE-Q) in a diverse and large clinical sample of individuals with an eating disorder (ED), and a general population sample without an ED. Norms for individuals with obesity without an ED were also provided, as a more relevant comparison group for individuals with binge eating disorder. The second aim was to investigate the discriminative validity of the EDE-Q. A sample of females with an ED (N=935), women from the general population without an ED (N=235), and obese females without an ED (N=321) completed the EDE-Q. Explorative factor analyses did not support the theorized four subscales of the EDE-Q. Norms for EDE-Q global scores were provided for each of the three samples. Within the ED sample, norms were provided separately for patients with different ED diagnoses. Receiver operating characteristic analyses showed the EDE-Q global score to be highly accurate in discriminating individuals with an ED from those without, and moderately accurate in discriminating individuals with binge eating disorder from those with obesity. The presented norms contribute to a more accurate interpretation of EDE-Q scores, providing an index of the severity level of ED psychopathology. Furthermore, these norms can be used to assess clinical significant change during treatment. In addition, this study demonstrates that the EDE-Q, when using its global score, is a valid instrument to assess levels of ED psychopathology.

Background: Several Internet-based interventions for eating disorders have shown their effectiveness. Still, there is a need to refine such interventions given that most existing programs seem to be limited by their static ‘one-size-fits-all’ approach. ‘Featback’, an Internet-based intervention for symptoms of eating disorders provides a more individualized approach. It consists of several components (psychoeducation, a fully automated monitoring and feedback system, and support from a coach), which can be matched to participants’ needs and preferences. Until now, it is unclear whether online self-help interventions for eating disorders with support are more effective than those without. The aims of the current study are i) to examine the relative effectiveness of (the different components of) Featback; ii) to examine predictors, moderators and mediators of intervention responses; iii) to report on practical experiences with Featback; and iv) to examine the cost-effectiveness of Featback. Methods/design: Individuals aged 16 years or older, with mild to severe eating disorder symptoms will be randomized to one of the four study conditions. In condition one, participants receive the basic version of Featback, consisting of psychoeducation and a fully automated monitoring and feedback system. In conditions two and three, participants receive the basic version of Featback supplemented with the possibility of infrequent (weekly) or frequent (three times a week) e-mail, chat, or Skype support from a coach, respectively. The fourth condition is a waiting list control condition. Participants are assessed at baseline, post-intervention (8 weeks), and at 3- and 6-month follow-up (the latter except for participants in the waiting list control condition). Primary outcome measures are disordered eating behaviors and attitudes. Secondary outcome measures are (eating disorder-related) quality of life, self-stigma of seeking help, self-esteem, mastery and support, symptoms of depression and anxiety, repetitive negative thinking, motivation to change, user satisfaction, compliance, and help-seeking attitudes and behaviors. Discussion: This study aims to provide more insight into the (cost-) effectiveness of Internet-based interventions for eating disorders, particularly those with and without professional support, as well as different levels of support. Trial registration: NTR3646