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Introduction: There is a growing body of literature concerning endometriosis patients' perspectives on the healthcare system and endometriosis care in New Zealand. However, there is little research available on the perspectives of general practitioners (GPs) internationally, and none currently in New Zealand. The purpose of this study is to address New Zealand GPs' understanding of and approach to endometriosis diagnosis, referrals, management and guidelines. Methods and Materials: An online, anonymous survey was shared with 869 GP clinics and completed by 185 New Zealand‐based GPs regarding their awareness and application of the inaugural 2020 'Diagnosis and Management of Endometriosis in New Zealand' guidelines, their perception of their endometriosis knowledge, the diagnostic value they assign to symptoms, the treatments they recommend and the reasons they refer patients to specialist gynaecologists. Differences between groups were conducted using Chi‐squared tests, and text answers were assessed thematically using inductive, semantic coding. Results: All 185 GPs had gynaecology consults, and 73% had gynaecology consults every week. Despite 65% being aware of the 2020 guidelines, only 35% overall had read them. Only 52% of GPs considered themselves to know enough about endometriosis for their routine practice. The most common treatment to be considered first line was intrauterine contraceptive devices (IUDs; 96%), whereas the most common alternative treatment recommended was exercise (69%). The most common reason for referral to specialist care was the failure of all attempted treatments (84%). Conclusions: Many of the study's results align with current New Zealand and international endometriosis guidelines, particularly the prioritisation of progestin‐only therapies, the reduced emphasis on surgical treatment as the first line and the low rates of alternative treatment recommendations. This study also highlights the need to improve awareness of inappropriate GP recommendations, including long‐term treatment with prescription‐only pain relief such as codeine and pregnancy for symptomatic relief. Patient or Public Contribution: Two of the authors involved in the design and conduct of the study, data interpretation and manuscript preparation have sought care for endometriosis. Trial Registration: NA [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction There is a growing body of literature concerning endometriosis patients' perspectives on the healthcare system and endometriosis care in New Zealand. However, there is little research available on the perspectives of general practitioners (GPs) internationally, and none currently in New Zealand. The purpose of this study is to address New Zealand GPs' understanding of and approach to endometriosis diagnosis, referrals, management and guidelines. Methods and Materials An online, anonymous survey was shared with 869 GP clinics and completed by 185 New Zealand‐based GPs regarding their awareness and application of the inaugural 2020 ‘Diagnosis and Management of Endometriosis in New Zealand’ guidelines, their perception of their endometriosis knowledge, the diagnostic value they assign to symptoms, the treatments they recommend and the reasons they refer patients to specialist gynaecologists. Differences between groups were conducted using Chi‐squared tests, and text answers were assessed thematically using inductive, semantic coding. Results All 185 GPs had gynaecology consults, and 73% had gynaecology consults every week. Despite 65% being aware of the 2020 guidelines, only 35% overall had read them. Only 52% of GPs considered themselves to know enough about endometriosis for their routine practice. The most common treatment to be considered first line was intrauterine contraceptive devices (IUDs; 96%), whereas the most common alternative treatment recommended was exercise (69%). The most common reason for referral to specialist care was the failure of all attempted treatments (84%). Conclusions Many of the study's results align with current New Zealand and international endometriosis guidelines, particularly the prioritisation of progestin‐only therapies, the reduced emphasis on surgical treatment as the first line and the low rates of alternative treatment recommendations. This study also highlights the need to improve awareness of inappropriate GP recommendations, including long‐term treatment with prescription‐only pain relief such as codeine and pregnancy for symptomatic relief. Patient or Public Contribution Two of the authors involved in the design and conduct of the study, data interpretation and manuscript preparation have sought care for endometriosis. Trial Registration NA

Abstract Background The number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined. Methods We implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3). Results The pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders’ input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy. Conclusion This case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably.

Background: The number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined. Methods: We implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3). Results: The pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders' input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy. Conclusion: This case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably. [ABSTRACT FROM AUTHOR]

Background: Establishing the value of differing treatments for depression and anxiety is crucial in a climate of delimited spending and increased demand. Drawing from a well‐founded, diverse evidence base is salient to constructive evaluation and any subsequent recommendations being fit for purpose. Design: This study employed a practice‐based quantitative design to explore therapeutic gains in adult counselling clients attending person‐centred therapy (n = 301), delivered in a charitable, community‐based UK service. Measures: Outcome measures PHQ‐9 and GAD‐7 were used from three time points: initial assessment (IA), first ongoing session and last or 6th ongoing appointment (whichever occurred first; T1, T2 and T3). Analysis: Repeated measures ANOVA, CSI, RI and RCSI calculations were used to consider significant change in clients. Findings: Reductions in PHQ‐9 and GAD‐7 outcome measures were observed over time (between T2 & T3 and T1 & T3) and were all statistically significant (p = <0.001). By T3: CSI was achieved by 48.1% of clients on PHQ‐9 and 50.8% of clients on GAD‐7, RI was achieved by 47.8% of clients on PHQ‐9 and 60.5% of clients on GAD‐7, and RCSI was achieved by 32.6% of clients on PHQ‐9 and 41.2% of clients on GAD‐7. Conclusions: The treatment observed resulted in effective outcomes equivalent to other therapies reviewed in the literature for clients' symptoms of anxiety and depression as measured by GAD‐7 and PHQ‐9. [ABSTRACT FROM AUTHOR]

Integrating telemedicine into cancer care remains a major challenge. There are little clinical evidence for teleconsultation efficacy and safety in daily oncology practice. This study as a pioneering experience, aimed to analyze patient and physician opinions regarding the implementation of telemedicine consultations, and to identify major limitations of telehealth spread in an oncology institute. During COVID-19 lockdown, patients and physicians who took part to at least one video-based teleconsultation between March and May 2020, were enrolled in this observational study. All eligible patients received an anonymous online questionnaire. On the other hand, all physicians eligible to participate were asked through email to complete a questionnaire. In this study, 31 physicians and 304 patients consented to participate in this study by answering the questionnaire and were included. Regarding telemedicine satisfaction, 65.8% of patients were satisfied. The lack of clinical examination was the major limitation reported by 77% of patients. Patients belonging to a high socio-professional category were statistically more dissatisfied with the relationship with their doctor (OR = 2.31 and 95% CI [1.12; 4.74]). This study showed promising results of incorporating video-based teleconsultations into cancer patient management. Randomized clinical trials are needed in order to accelerate the digital implementation in clinical practice. [ABSTRACT FROM AUTHOR]

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Treatment satisfaction has been found to have good therapeu- tic results in psychotherapy, and the 18-item version of the client satisfaction questionnaire (CSQ-18) is one of the most widely used measures to evaluate it. This study sought to carry out a pilot analysis of the psychometric’s properties and factorial structure, as well as validate the CSQ-18’s applicability to the Portuguese population within the context of routine clinical practice. It also sought to explore the association that treatment satisfaction has with general symptoms, therapeutic alliance, and expectations at an early stage of psychotherapy. The sample comprised 98 clients who were undergoing psychotherapy in a routine practice context. All these clients completed self-reported measures for symptom assessment and therapeutic relationship, namely the clinical out- come routine evaluation-outcome measure, working alliance in- ventory, and credibility/expectancy questionnaire, in addition to the CSQ-18. The semi-confirmatory factorial analysis demon- strated that the CSQ-18 has good psychometric properties and re- vealed an association between treatment satisfaction and therapeutic alliance. The results corroborate the findings of other versions of the measure and present a good adjustment model for the semi-confirmatory factorial analysis.

Introduction: This qualitative study explored healthcare professionals' current understanding of, and clinical practices related to, Online Child Sexual Abuse (OCSA). Methods: Data were collected across two UK sites (Manchester and Edinburgh). Interviews and one focus group were held with 25 practitioners working in services offering clinical support to young people who have experienced OCSA. Thematic analysis of the data identified three overarching themes and 10 subthemes related to the research questions: (1) the breadth of the problem; (2) working with OCSA; and (3) the emotionally charged nature of OCSA. Results: While practitioners recognized OCSA as problematic, they differed in how they conceptualized it. There was a heightened awareness of the role that sexual images played inOCSA and concerns about first-person-produced imagery by Children and Young People (CYP). Practitioners described a generational gap related to their technology use and that of the young people they worked with. Practitioners also described a paucity of referral pathways and concerns that there was no training available to them. Organizational barriers meant that questions about technology use were not routinely included in assessments and often there was reliance on young people making disclosures. Discussion: Novel findings from this study were the psychological impacts that such cases had on practitioners, which may indicate a need for organizational support for staff as well as further training needs. Existing frameworks that help conceptualize and assess the role of technology as part of the ecology of the child may have great utility for practitioners. [ABSTRACT FROM AUTHOR]

Mindfulness-based interventions (MBIs) proliferate in today's health care landscape. Most prominent MBIs teach mindfulness technique through protocols structured in time-limited treatment packages, though the arc of mindfulness practice as "a lifetime's engagement" is much longer than the typical MBI length of eight weeks. Although studies have shown that MBIs can be efficacious in addressing a wide range of health concerns, sustaining routine meditation practice long-term can be difficult, and treatment gains can fade if routine practice is not maintained. This article discusses long-term weekly mindfulness groups, a unique mindfulness treatment modality that emphasizes ongoing training and support for developing and sustaining routine mindfulness practice, that have been in continuous operation for more than 10 years at a large Veterans Affairs hospital. The protocol utilized for these mindfulness groups is described in this article. Fundamentals of mindfulness and common challenges, such as issues of avoidance, grasping, and dissociation, are articulated as guidelines for the therapist's facilitation of the group process and individual members' practice routines. [ABSTRACT FROM AUTHOR]

This research was conducted because Self-Efficacy and Student Learning Outcomes are still weak. The direct learning model with routine practice is thought to be a factor influencing the Self-Efficacy and Student Learning Outcomes of students in higher education. This study aims to determine how the direct learning model with regular practice affects student self-efficacy and swimming learning outcomes. This type of research is a quantitative correlation with the research population is 90 students who take swimming courses in Higher Education. The research sample was selected by purposive random sampling. The instrument used is a questionnaire, because it is an effective data collection method to test the variables to be measured and the answers expected by the respondents. The questionnaire uses a Likert scale by providing an opportunity to answer each item. Hypothesis testing was carried out with the SPSS 26.0 program using correlational analysis. The results showed that the use of a direct learning model with regular practice will increase students' self-efficacy, as well as improve learning outcomes in swimming lessons.

IntroductionThis qualitative study explored healthcare professionals' current understanding of, and clinical practices related to, Online Child Sexual Abuse (OCSA).MethodsData were collected across two UK sites (Manchester and Edinburgh). Interviews and one focus group were held with 25 practitioners working in services offering clinical support to young people who have experienced OCSA. Thematic analysis of the data identified three overarching themes and 10 subthemes related to the research questions: (1) the breadth of the problem; (2) working with OCSA; and (3) the emotionally charged nature of OCSA.ResultsWhile practitioners recognized OCSA as problematic, they differed in how they conceptualized it. There was a heightened awareness of the role that sexual images played in OCSA and concerns about first-person-produced imagery by Children and Young People (CYP). Practitioners described a generational gap related to their technology use and that of the young people they worked with. Practitioners also described a paucity of referral pathways and concerns that there was no training available to them. Organizational barriers meant that questions about technology use were not routinely included in assessments and often there was reliance on young people making disclosures.DiscussionNovel findings from this study were the psychological impacts that such cases had on practitioners, which may indicate a need for organizational support for staff as well as further training needs. Existing frameworks that help conceptualize and assess the role of technology as part of the ecology of the child may have great utility for practitioners.

Abstract Background Patients with mild to moderate depressive symptoms can have limited access to regular treatment; to ensure appropriate care, low-threshold treatment is needed. Effective online interventions could increase the supply of low-threshold treatment. Further research is needed to evaluate the effectiveness of online interventions. This study aims to evaluate the online-based self-help programme “Selfapy” on a sample of depressive subjects and compares the impact of the programme’s unaccompanied version with its therapeutic accompanied version. Methods A sample of 400 subjects that have a mild to severe depressive episode (Becks Depression Inventory - II and Hamilton Depression Scale) will be used. Subjects are randomly assigned to immediate access to an unaccompanied course (no support from psychologist via weekly phone calls), immediate access to an accompanied course (support from a psychologist via weekly phone calls) or a waiting list control group (access to the intervention after 24 weeks). The intervention will last for a period of 12 weeks. Depressive symptoms as a primary parameter, as well as various secondary parameters, such as life satisfaction, therapeutic relationships, social activation, self-esteem, attitudes towards Internet interventions and drop-out rates, are recorded at four different points in time: at baseline (T1), 6 weeks after the start of the intervention (T2), 12 weeks after the start of the intervention (T3) and 3 months after completion of the treatment follow-up (T4). Conclusion This randomized and controlled, blinded study will make use of a “dismantled” approach to adequately compare the accompanied and unaccompanied versions of the intervention. Positive and meaningful results are expected that could influence the acceptance and implementation of online interventions. Trial registration German Clinical Trials Register DRKS00017191. Registered on 14 June 2019

Background: Digital health apps are efficacious treatment options for mild-to-moderate depressive disorders. However, the extent to which psychological guidance increases the efficacy of these apps is controversial. Objective: We evaluated the efficacy of a web-based intervention, called Selfapy, for unipolar depression. We also investigated differences between psychotherapist-guided and unguided versions. Methods: Selfapy is a cognitive behavioral therapy-based intervention for depressive disorders. Participants with mild-to-severe depressive disorders were assigned randomly to participate in either guided (weekly 25-minute duration telephone calls) intervention, unguided version, or waiting list (control group) for 12 weeks. We assessed depressive symptoms at the start of the study, midway through the intervention (6 weeks), at the end of the intervention (12 weeks), and at follow-up (6 months). The main outcome was difference in the Beck Depression Inventory score between the start of the study and the end of the intervention. Secondary outcomes were the Quick Inventory of Depressive Symptomatology--Self Report, the Hamilton Rating Depression Scale, and the Beck Anxiety Inventory. Results: Of 401 participants, 301 participants (75.1%) completed the intervention. Changes in the Beck Depression Inventory from baseline differed significantly between groups at the postintervention (F2,398=37.20, P<.001). The reductions in scores for both guided and unguided intervention groups were greater than that for the control group, with large between-group effect sizes (guided vs control: d=1.63, 95% CI 1.37 to 1.93; unguided vs control: d=1.47, 95% CI 1.22 to 1.73) at postintervention. No significant differences were found between guided and unguided intervention groups (P=.18). At follow-up (6 months), treatment effects on the primary outcome were maintained for both intervention groups (guided: F1,194=0.62, P>.999; unguided: F1,176=0.13, P>.999). Conclusions: Both guided and unguided versions of the intervention were highly effective in reducing depressive symptoms. Follow-up data suggest that these effects could be maintained. The guided version was not superior to the unguided version. [ABSTRACT FROM AUTHOR]

Antipsychotic monotherapy (APM) is considered best-acceptable treatment option regardless of antipsychotic class and formulation types for treating schizophrenia. However, antipsychotic polypharmacy (APP) has been also widely utilized in routine clinical practice. Despite APP has some clinical benefits it has also numerous pitfalls in relation with increased total number and doses of APs leading to adverse events as well as decrease of treatment adherence and persistence resulting in poor clinical outcomes. Recent introduction of long-acting injectable antipsychotics (LAIs) to the market has offered a chance for better medication adherence/persistence and also provided a simplification of treatment regime leading to more stabilized treatment for schizophrenia patients. When we cannot stay away from APP in the treatment of schizophrenia, clinicians need to find more proper APP regimens and thereby utilization of APP in efficient way should be a practical strategy to benefit schizophrenia patient in a real world treatment setting. With this regard, LAIs can be one of available APP regimen for treatment of schizophrenia in routine practice since their clinical utility and pharmacokinetic stability over oral APs have been well-elaborated today. However, when we have to commence LAIs as a part of APP with oral APs or other LAIs, every effort should be made before doing so whether or not validated and available treatment options or other clinical factors were not done or evaluated yet. Any treatment guidelines do not support APP regardless of the formulation of APP regimen or address two or more LAIs for treatment of schizophrenia till today. [ABSTRACT FROM AUTHOR]

The article studies “ontological” security concept. In a general sense the term depicts expectations of a state about its stable and predictable relations with counterparts. With the term gaining theoretical sway in constructivism since the 21st century, we argue, that it still lacks instrumental definition with fixed assumptions and variables. The analysis of ontological security is conducted in twofold manner. First, we overview the broad range of interpretations, demonstrate the absence of an instrumental definition of the concept and suggest some parameters of such a definition. Secondly, we study the ways how a state can gain ontological security. Three options of achieving ontological security are being presented: adaptation (assuming the role of ‘another’ from the external environment); change of rules (imposing its own role on the subject with whom the interaction occurs); and the breach of relations. At all these stages, the state tries either to adopt the norms and practices by which it interacts with the environment, or to redefine its position in ongoing relations with counterparties. We conclude by presenting a sought definition of the term and by arguing that the concept enhances the constructivist contribution to the IR theory since it allows to define the logic of states’ behavior in international arena. Thus, states seek to be socialized into an intersubjective reality and to define norms, practices and status through forging common and communicative knowledge with ‘other’. Otherwise, the state’s behavior could be irrational. Theory emphasizes the need to avoid situations of the ontological security dilemma: the state projects its own, mostly protective reality, which, however, does not provide it with ontological security from the counterparty and could potentially push for further escalation of crisis interactions.Authors declare the absence of conflict of interests.

This study aimed to validate and explore the psychometric properties of the credibility/expectancy questionnaire (CEQ) for the Portuguese population in the context of routine practice. The sample includes 87 clients from a university psychotherapy clinic. All clients completed self-report measures to assess credibility and expectation (CEQ), as well as measures of general mental health, depressive symptoms and therapeutic alliance in session 1 and session 2. The exploratory analysis revealed the existence of two factors in CEQ for the Portuguese population, factor 1 credibility and factor 2 expectation. The measure demonstrated good internal consistency, test-retest reliability and good adjustment in the confirmatory analysis. In terms of convergent validity, no significant correlation was found between credibility and expectation and the therapeutic alliance. The results corroborate the CEQ psychometric qualities for the Portuguese population, also showing its applicability in a context of routine practice.

Background: Falls are a major health problem in older persons but are still under-diagnosed and challenging to prevent. Current guidelines do not target high-risk populations, especially people living with dementia. In France, people with neurocognitive disorders are mainly referred to memory clinics (MCs).Objective: We aimed to survey the routine practice of physicians working in MCs regarding fall risk assessment.Methods: We conducted a cross-sectional survey in France from January to May 2019 among physicians working in MCs, through an anonymous online questionnaire: twenty-seven questions about the physician's background and their practice of fall risk assessment, especially use of clinical and paraclinical tools. We compared the results according to the age and the specialty of the physician.Results: We obtained 171 responses with a majority of women (60%) and geriatricians (78%). All age classes and all French regions were represented. Most of respondents (98.8%) stated that they address gait and/or falls in outpatient clinic and 95.9%in day hospitals. When asked about how they assess fall risk, fall history (83%) and gait examination (68.4%) were the most widely used, while orthostatic hypotension (24%) and clinical standardized tests (25.7%) were less common. Among standardized tests, One-leg Balance, Timed Up and Go Test, and gait speed measurements were the most used. Geriatricians had more complete fall risk assessment than neurologists (e.g., 56%versus 13%for use of standardized tests, p < 0.0001).Conclusion: Almost all physicians addressed the question of fall in MC, but practices are widely heterogeneous. Further investigations are needed to standardize fall risk assessment in MCs. [ABSTRACT FROM AUTHOR]

Background: Patients with mild to moderate depressive symptoms can have limited access to regular treatment; to ensure appropriate care, low-threshold treatment is needed. Effective online interventions could increase the supply of low-threshold treatment. Further research is needed to evaluate the effectiveness of online interventions. This study aims to evaluate the online-based self-help programme "Selfapy" on a sample of depressive subjects and compares the impact of the programme's unaccompanied version with its therapeutic accompanied version.Methods: A sample of 400 subjects that have a mild to severe depressive episode (Becks Depression Inventory - II and Hamilton Depression Scale) will be used. Subjects are randomly assigned to immediate access to an unaccompanied course (no support from psychologist via weekly phone calls), immediate access to an accompanied course (support from a psychologist via weekly phone calls) or a waiting list control group (access to the intervention after 24 weeks). The intervention will last for a period of 12 weeks. Depressive symptoms as a primary parameter, as well as various secondary parameters, such as life satisfaction, therapeutic relationships, social activation, self-esteem, attitudes towards Internet interventions and drop-out rates, are recorded at four different points in time: at baseline (T1), 6 weeks after the start of the intervention (T2), 12 weeks after the start of the intervention (T3) and 3 months after completion of the treatment follow-up (T4).Conclusion: This randomized and controlled, blinded study will make use of a "dismantled" approach to adequately compare the accompanied and unaccompanied versions of the intervention. Positive and meaningful results are expected that could influence the acceptance and implementation of online interventions.Trial Registration: German Clinical Trials Register DRKS00017191. Registered on 14 June 2019. [ABSTRACT FROM AUTHOR]

This study aimed to validate and explore the psychometric properties of the credibility/expectancy questionnaire (CEQ) for the Portuguese population in the context of routine practice. The sample includes 87 clients from a university psychotherapy clinic. All clients completed self-report measures to assess credibility and expectation (CEQ), as well as measures of general mental health, depressive symptoms and therapeutic alliance in session 1 and session 2. The exploratory analysis revealed the existence of two factors in CEQ for the Portuguese population, factor 1 credibility and factor 2 expectation. The measure demonstrated good internal consistency, test-retest reliability and good adjustment in the confirmatory analysis. In terms of convergent validity, no significant correlation was found between credibility and expectation and the therapeutic alliance. The results corroborate the CEQ psychometric qualities for the Portuguese population, also showing its applicability in a context of routine practice. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence on how to implement new interventions into complex healthcare environments is often poorly reported and indexed, reducing its potential to inform initiatives to improve healthcare services. Using the implementation of a digital intervention within routine National Health Service (NHS) practice, we provide an example of how to develop a theoretically based implementation plan and how to report it transparently. In doing so we also highlight some of the challenges to implementation in routine healthcare. Methods The implemented intervention was HeLP-Diabetes, a digital self-management programme for people with Type 2 Diabetes, which was effective in improving diabetes control. The target setting for the implementation was an inner city London Clinical Commissioning Group in the NHS comprised of 34 general practices. HeLP-Diabetes was designed to be offered to patients as part of routine diabetes care across England. Evidence synthesis, engagement of local stakeholders, a theory of implementation (Normalization Process Theory), feedback, qualitative interviews and usage data were used to develop an implementation plan. Results A new implementation plan was developed to implement HeLP-Diabetes within routine practice. Individual component strategies were selected and developed informed by Normalization Process Theory. These strategies included: engagement of local opinion leaders, provision of educational materials, educational visits, educational meetings, audit and feedback and reminders. Additional strategies were introduced iteratively to address barriers that arose during the implementation. Barriers largely related to difficulties in allocating resources to implement the intervention within routine care. Conclusion This paper provides a worked example of implementing a digital health intervention. The learning from this work can inform others undertaking the work of planning and executing implementation activities in routine healthcare. Of particular importance is: the selection of appropriate theory to guide the implementation process and selection of strategies; ensuring that enough attention is paid to planning implementation; and a flexible approach that allows response to emerging barriers.

Objective: To assess the relationship and agreement between mean total scores for the Speech Spatial Qualities of Hearing Scale (SSQ49) and the shorter SSQ12 to measure daily hearing function for a large group of auditory implant recipients.Methods: Prospective, longitudinal self-assessment by 1013 implant recipients using the SSQ49 at preimplant and at annual post-implant intervals (one, two and three-years) via an international registry. Mean total scores were calculated for the SSQ49 and the extracted SSQ12 responses. Pearson correlation and Bland-Altman agreement were examined between the SSQ49, SSQ12 and transformed SSQ12 versions. Longitudinal mixed-effects models were used to compare changes over time.Results: Very high correlation was shown between mean total scores for all versions while perfect agreement was not reached. Clinically acceptable agreement (<1.0 unit) between all versions was obtained with the transformed SSQ12 being least biased. All versions showed statistically significant improvement at one-year post-implant (>2.2 units; p < 0.001).Conclusions: All scale-versions showed comparable sensitivity to changes in self-reported hearing function over time. TheSSQ12 may be considered as a potential time-efficient self-assessment of hearing function for implant recipients in routine practice. Further research may involve independent repeated administration of each scale version. [ABSTRACT FROM AUTHOR]

Apixaban is the only NOA the administration of which is associated with a reduction in the incidence of both stroke and major bleeding. Therefore, apixaban is the drug of choice in patients with non-valvular AF, including elderly patients, patients with a high risk of bleeding complications, as well as in patients with impaired renal function. In clinical practice, the efficacy and safety of apixaban are not inferior to those obtained in the ARISTOTLE trial. Apixaban is safe when used during cardioversion and catheter ablation. The results of pre-clinical studies provide implications for further investigation into the possibility of administration of apixaban in patients with «valvular» AF.

Highlights: The experiences of detained youth may rest predominantly in their interactions with detention staff.This study examined rehabilitative practices infused within the daily activities of detention staff.We found evidence for three categories of rehabilitative practices embedded in staff activities.Our findings can be used to build staff members' capacity to bridge service gaps in detention. Research on the rehabilitation of juvenile justice‐involved youth is often focused on specific evidence‐based interventions. Less attention has been paid to everyday interactions that correctional staff members have with detained youth and, further, how these may align with trauma‐informed care principles and thus encourage a more supportive setting. Using an ethnographic case study approach, this study addressed this gap in knowledge by documenting the nature of rehabilitative practices as they naturally occurred in the context of short‐term detention staff members' daily routine and interactions with detained youth. This study found evidence for three primary forms of routine rehabilitative practices: (a) promotion of youths' emotional safety and well‐being, (b) provision of rights‐based information and explanations, and (c) encouraging youths' success in and beyond detention. These practices were observed across several key setting contexts: (a) staff‐led group activities, (b) routine contact between individual youth and staff (e.g., formal procedures, informal conversations), and (c) staff‐only spaces. Our findings highlight the need for ongoing research to effectively translate promising intervention approaches, such as trauma‐informed care, into juvenile detainment settings. [ABSTRACT FROM AUTHOR]

Aims: This study sought to evaluate family intervention (FI) for psychosis that had been offered in routine practice by a dedicated FI service. Method: A retrospective analysis of electronic clinical records was undertaken to examine those who had received FI and their use of acute services (accident and emergency, home treatment, inpatient) in the two years preceding and following FI, as a measure of outcome. The analysis included 29 patients whose families had participated in five or more sessions of FI. Results: The demographics of the sample were diverse. While there was no significant change in the number of admissions following FI, there was a modest reduction in time spent in acute care, particularly use of home treatment. Conclusions: Notable demographic differences between families suggest referral decision-making in routine care warrants further investigation. The study also offers tentative support for the translation of good FI outcomes into routine practice though implementation rates remain low. [ABSTRACT FROM AUTHOR]

Background: Depressive disorder is a major societal challenge. Despite the availability of clinically and cost-effective treatments including Internet interventions, the number of patients receiving treatment is limited. Evidence-based Internet interventions promise wide availability and high efficiency of treatments. However, these interventions often do not enter routine mental healthcare delivery at a large scale. The MasterMind project aims to provide insight into the factors that promote or hinder the uptake and implementation of evidence-based Internet interventions by mental healthcare practice. Internet-based Cognitive Behaviour Therapy (iCBT) and videoconferencing facilitating collaborative care (ccVC) will be implemented in routine mental healthcare. The services will be offered to 5230 depressed adults in 15 European regions. The current paper describes the evaluation protocol for this large-scale implementation project. Design: Current summative evaluation study follows a naturalistic one-group pretest–posttest design and assesses three distinct stakeholders: patients, mental healthcare professionals, and mental healthcare organisations. The Model for Assessment of Telemedicine applications (MAST) will be employed to structure the implementation and evaluation study. The primary focal points of interest are reach, clinical effect, acceptability, appropriateness, implementation costs, and sustainability of the interventions in practice. Mixed-methods are used to provide an understanding of what (quantitative) the implementation projects have achieved and their meaning to various stakeholders (qualitative). Discussion: The use of Internet interventions in routine practice is limited. MasterMind attempts to bridge the gap between routine practice and effectiveness research by evaluating the implementation of evidence-based Internet interventions for depressive disorders in routine mental healthcare settings in Europe.

Background: Evidence on how to implement new interventions into complex healthcare environments is often poorly reported and indexed, reducing its potential to inform initiatives to improve healthcare services. Using the implementation of a digital intervention within routine National Health Service (NHS) practice, we provide an example of how to develop a theoretically based implementation plan and how to report it transparently. In doing so we also highlight some of the challenges to implementation in routine healthcare.Methods: The implemented intervention was HeLP-Diabetes, a digital self-management programme for people with Type 2 Diabetes, which was effective in improving diabetes control. The target setting for the implementation was an inner city London Clinical Commissioning Group in the NHS comprised of 34 general practices. HeLP-Diabetes was designed to be offered to patients as part of routine diabetes care across England. Evidence synthesis, engagement of local stakeholders, a theory of implementation (Normalization Process Theory), feedback, qualitative interviews and usage data were used to develop an implementation plan.Results: A new implementation plan was developed to implement HeLP-Diabetes within routine practice. Individual component strategies were selected and developed informed by Normalization Process Theory. These strategies included: engagement of local opinion leaders, provision of educational materials, educational visits, educational meetings, audit and feedback and reminders. Additional strategies were introduced iteratively to address barriers that arose during the implementation. Barriers largely related to difficulties in allocating resources to implement the intervention within routine care.Conclusion: This paper provides a worked example of implementing a digital health intervention. The learning from this work can inform others undertaking the work of planning and executing implementation activities in routine healthcare. Of particular importance is: the selection of appropriate theory to guide the implementation process and selection of strategies; ensuring that enough attention is paid to planning implementation; and a flexible approach that allows response to emerging barriers. [ABSTRACT FROM AUTHOR]

Aim: To analyze the clinical profile and rates of stroke, major bleeding and intracranial hemorrhage of patients with atrial fibrillation (AF) treated with rivaroxaban in clinical practice.Methods: Retrospective study of AF patients anticoagulated with rivaroxaban in a Healthcare Area of Valencia, Spain. Patients started treatment with rivaroxaban from July 2012 to December 2015.Results: A total of 230 patients (mean age 76.9 ± 9.9 years; CHA2DS2-VASc 4.3 ± 1.7; HAS-BLED 1.7 ± 0.9) were included. Rates of stroke, major bleeding and intracranial bleeding were 0.4, 1.9 and 0.5 events per 100 patient-years, respectively.Conclusion: In this cohort of AF patients anticoagulated with rivaroxaban, despite patients being older and having a high thromboembolic risk, rates of stroke, major bleeding and intracranial bleeding were low. [ABSTRACT FROM AUTHOR]