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With the objective of increasing the magnitude of treatment effects in behavioral health, there is steadily growing interest in tailoring assessments and interventions to better match individual needs. This aligns with the central idea that behavior can be adequately understood by considering the unique characteristics of the individual and context. Thus, data collected at an individual level provides critical evidence that can be used to inform health care decisions, improve treatment, or refine theories. Yet, the majority of research in behavioral health is based on group-level analyses. Recent developments in the field of singlecase experimental design (SCED) has provided new opportunities to utilize individual data. The present article provides a stateof-the art overview regarding key aspects of SCED, including a historical background to why and how SCED emerged, declined, and recently reemerged as well as methodological aspects such as design issues, challenges related to reliability and validity of repeated observations, innovations in visual and statistical analyses of individual data, strategies to deal with missing values, methodology to examine effect size, and approaches to summarize data from a large number of SCEDs using multilevel models and meta-analyses of replication data. Finally, the article discusses key concerns and actions needed to move the field forward. Keywords Single case experimental design * Idiosyncratic assessment * Treatment outcome * Effectiveness research, Introduction Psychology is the science of the individual, yet the bulk of available research data is derived from groups. Indeed, randomized controlled trials (RCT) are considered the gold standard for [...]

Background Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness. Methods and findings We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled. Conclusions In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation., Author(s): Timothy B. Smith *, Connor Workman, Caleb Andrews, Bonnie Barton, Matthew Cook, Ryan Layton, Alexandra Morrey, Devin Petersen, Julianne Holt-Lunstad Introduction Decades ago, researchers found that psychosocial support interventions [...]

The study aimed to explore predictors of treatment effectiveness in a sample of 79 children with ASD who received cognitive behavioral therapy (CBT) for their anxiety disorders. Severity of anxiety disorders and anxiety symptoms were used to measure treatment effectiveness and was assessed pre-treatment, post-treatment, 3 months-, 1 and 2 years after CBT. Child characteristics and maternal anxiety did not predict treatment effect. Children with anxious fathers and children in 'un-involved' families had less anxiety symptoms at pre-treatment and displayed a less steep decline. Children from 'authoritarian' families showed higher pre-treatment anxiety levels but responded quite well to treatment. Findings stress the importance of parent (father) and family factors in the treatment of anxiety disorders in youth with ASD., Author(s): F. J. A. van Steensel [sup.1] , V. M. Zegers [sup.1] , S. M. Bögels [sup.1] Author Affiliations: (1) 0000000084992262grid.7177.6Child Development and Education, Research Priority Area YIELD, University of [...]

Background Scientific communities focusing on cancer research have urged for the development of trials that address patient-centered outcome measures instead of solely focusing on cancer as a disease-centered process. This is important for a patient with lung cancer because of the rapid course of disease and generally poor prognosis. We set out to determine the characteristics and study objectives of the current clinical trials in pulmonary malignancies. Methods The United States National Institutes of Health clinical trial registry was searched on April 23rd 2015, for currently recruiting phase I, II, or III clinical trials in lung cancer. Trial characteristics and study objectives were extracted from the registry website. Results Of the 419 clinical trials included in this review, patient-centered outcome measures are investigated in a minority of the trials. Outcome measures as quality of life, functional capacity, and health care utilization are included in a small number of trials (20, 4, and 2 % respectively). Treatment completion is included in 1 % of the trials. Research goals are most frequently toxicity (78 %) and progression-free survival (76 %). Conclusion Patient-centered outcome measures are included in a minority of the currently recruiting clinical trials in pulmonary malignancies. If we do not investigate these outcome measures, it is not possible to increase our knowledge of the optimal treatment, as this should aim to optimize the patient's wellbeing as well as the course of disease. One option could be to incorporate combinations of patient- and disease-centered endpoints, for instance by using overall treatment utility or quality-adjusted outcome measures., Author(s): Karlijn J. G. Schulkes[sup.1] [sup.2] , Cindy Nguyen[sup.3] , Frederiek van den Bos[sup.4] , Marije E. Hamaker[sup.1] , Leontine J. R. van Elden[sup.2] Author Affiliations: (1) Department of Geriatric [...]

Little is known about outcomes for individuals with autism spectrum disorders (ASD) into adulthood. Several characteristics of individuals with ASD predict long-term outcomes, and the family environment may also play a role. The present study uses a prospective, longitudinal design to describe and predict trajectories of autism symptoms and maladaptive behaviors over 8.5 years in a large, community-based sample of adolescents and adults with ASD. Overall, autism symptoms and maladaptive behaviors were observed to improve over the study period. Above and beyond the adult's gender, age, and level of intellectual disability, greater improvements were associated with higher levels of maternal praise (based on maternal speech samples) and higher quality mother-child relationships. Implications for future research and intervention are discussed. Keywords Autism symptoms * Maladaptive behaviors * Praise * Mother-child relationship quality * Autism, Introduction Autism spectrum disorder (ASD) results in lifelong disability with pervasive impacts across multiple domains of development (American Psychiatric Association 2013). Once considered rare, ASD is now recognized as a [...]

E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients' self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed. La telesante couvre un ensemble diversifie d'outils informatiques concus pour ameliorer la sante publique et les soins de sante. Peu d'informations sont disponibles sur les impacts des programmes de telesante, en particulier dans les pays a revenu faible et moyen. Nous avons donc effectue une etude exploratoire de la documentation publiee et non publiee pour identifier les donnees relatives aux effets de la telesante sur les resultats et les couts sanitaires. L'accent a ete mis sur l'identification des questions sans reponse pour la recherche future, en particulier sur des sujets pertinents pour les pays a revenu faible et moyen. Bien que la penetration des outils de telesante assistant la pratique clinique progresse au niveau mondial, on dispose de plus de preuves des avantages procures par les outils assistant les decisions cliniques et les systemes d'information de laboratoire que de ceux assistant l'archivage d'image et les systemes de communication. La mise en oeuvre de systemes d'information communautaires pour la surveillance des maladies a ete realisee avec succes dans plusieurs pays revenu faible et moyen. Bien que les informations relatives aux resultats fassent en general defaut, un grand projet au Bresil a expose de maniere documentee les impacts notables sur l'efficacite du systeme sanitaire. Des meta-analyses et des essais rigoureux ont expose de maniere documentee les avantages de la messagerie texte pour l'amelioration des resultats, comme ceux des soins auto-administres. Il a ete demontre que le suivi telephonique automatise et les appels d'assistance aux soins auto-administres amelioraient certains resultats de la gestion des maladies chroniques, comme le controle de la glycemie et de la tension arterielle dans les pays a revenu faible et moyen. Bien que de grands programmes de mise en oeuvre et de recherche en termes de telesante soient menes dans de nombreux pays a revenu faible et moyen, on a besoin de plus d'informations sur les impacts de la telesante en termes de resultats et de couts dans ce contexte. La cibersalud abarca un conjunto diverso de herramientas informaticas disenadas para mejorar la sanidad publica y la asistencia sanitaria. Se dispone de poca informacion acerca del impacto de los programas de cibersalud, especialmente, en paises con ingresos bajos y medios. Por ello, llevamos a cabo una revision sistematica exploratoria de la literatura publicada y no publicada para identificar datos sobre los efectos de la cibersalud en los resultados y en los costes sanitarios. Se puso enfasis en la identificacion de preguntas no respondidas para futuras investigaciones, en especial, sobre temas relacionados con paises de ingresos bajos y medios. Aunque las herramientas de cibersalud que apoyan la practica clinica se han implementado globalmente y en creciente medida, unicamente hay evidencias sobre los beneficios de las que apoyan los archivos de imagenes y los sistemas de comunicacion, pero de las herramientas que apoyan decisiones clinicas y sistemas de informacion de laboratorio. Los sistemas de informacion comunitarios para la vigilancia de enfermedades se han implementado satisfactoriamente en diversos paises con ingresos bajos y medios. Aunque, por lo general, falta informacion relativa a los resultados, un proyecto de gran amplitud en Brasil ha documentado impactos notables en el sistema sanitario. Los metanalisis y los ensayos rigurosos han documentado los beneficios de los mensajes de texto en la mejora de resultados tales como la autoasistencia de los pacientes. El control por telefono automatizado y las llamadas de autoasistencia de apoyo han demostrado que mejoran algunos resultados de gestion de enfermedades cronicas, como el control glucemico y de la presion sanguinea, en paises con ingresos bajos y medios. Aunque se han llevado a cabo amplios programas para la implementacion e investigacion de la cibersalud en muchos paises con ingresos bajos y medios, se necesita mas informacion sobre los impactos de la cibersalud y sobre los costes en estos lugares., Introduction Difficulties in achieving health targets, such as the Millennium Development Goals, and growing consumer demand have forced health planners to look for innovative ways to improve the outcomes of [...]

Accountability for quality health outcomes at low cost is a priority discussion in nearly all medical circles, but particularly among primary care providers of diabetes care. Accountable care organizations (ACOs) [...]

Objectives. This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimer's Association chapter to a wait-list (WL) control condition. Methods. One hundred and forty-two dyads were randomized in blocks to ESML (n = 96) or WL (n = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participant's quality of life; secondary outcomes included mood, family communication, and perceived stress. Results. On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (p < .001), depression (p < .01), and family communication (p < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (p < .05), improved family communication (p < .05), self-efficacy (p < .01), Medical Outcomes Study short form (SF-36) role--emotional (p < .05), SF-36 social functioning (p < .05), and SF-36 mental health components (p < .01) in improvers. Discussion, These results support the efficacy of ESML support groups for individuals with dementia. Key Words: Alzheimer's disease--Caregivers--Dementia--Depression--Quality of life. doi: 10.1093/geronb/gbq054.

Background: This study aimed to determine whether subjective dimensions of recovery such as empowerment are associated with self-report of more objective indicators such as level of participation in the community and income from employment. A secondary aim was to investigate the extent to which diagnosis or other consumer characteristics mediated any relationship between these variables. Methods: The Community Integration Measure, the Empowerment Scale, the Recovery Assessment Scale, and the Camberwell Assessment of Needs Short Appraisal Schedule were administered to a convenience sample of 161 consumers with severe mental illness. Results: The majority of participants had a primary diagnosis of schizophreniform, anxiety/depression or bipolar affective disorder. The Empowerment Scale was quite strongly correlated with the Recovery Assessment Scale and the Community Integration Measure. Participants with a diagnosis of bipolar affective disorder had signifi cantly higher recovery and empowerment scores than participants with schizophrenia or depression. Both empowerment and recovery scores were significantly higher for people engaged in paid employment than for those receiving social security benefits. Conclusions: The measurement of subjective dimensions of recovery such as empowerment has validity in evaluation of global recovery for people with severe mental illness. A diagnosis of bipolar disorder is associated with higher scores on subjective and objective indicators of recovery.

Author(s): Katherine L. Possin 1,2,*, Jennifer Merrilees 1, Stephen J. Bonasera 3, Alissa Bernstein 2,4, Winston Chiong 1, Kirby Lee 1, Leslie Wilson 5, Sarah M. Hooper 6, Sarah Dulaney [...]