Web-Based Rumination-Focused Cognitive Behavioural Therapy (i-RFCBT) for High-Ruminating University Students: an examination of feasibility and efficacy

Depression is both highly prevalent and highly impactful in the student population. The aim of the PhD was to assess internet-based rumination-focused cognitive-behavioural therapy (i-RFCBT) as an intervention to reduce the impact of depression in university students. The intervention was first implemented as a treatment within a university Wellbeing service. An audit of treatment usage and clinical outcomes (N = 82) found the intervention significantly reduced acute depressive and anxious symptoms. Within a case series subsample (N = 26) there were improvements in clinical outcomes as well as significant reductions in rumination, consistent with the hypothesised mechanism of change. Acute treatment has a limited impact on the disease burden of depression within a population. A greater focus on prevention is identified as a priority. A qualitative study was conducted to investigate the acceptability of i-RFCBT as a preventive intervention. Having established that the intervention was acceptable, the RESPOND randomised-controlled trial (N = 235) tested whether guided i-RFCBT was an efficacious at preventing the incidence of depression in UK undergraduates with elevated rumination and worry. The trial found that guided i-RFCBT reduced the incidence of a major depressive episode (MDE) over the course of the 12-month follow-up period by 34% relative to usual care, although this difference was not significant. Baseline stress was a significant moderator of the intervention effect, such that participants with higher stress levels experienced a significant benefit of i-RFCBT in reducing the incidence of MDE relative to usual care. Short- to- medium- term improvements in worry, rumination and depressive symptoms were also found. As guided interventions are limited in terms of scalability, an additional, quasi phase-II pilot feasibility arm was incorporated within the RESPOND trial to test the acceptability and estimate the effect sizes of unguided i-RFCBT. The pattern of effects for unguided i-RFCBT was similar to that of guided i-RFCBT. The clinical implications of the thesis findings are discussed

A systematic review and behaviour change technique analysis of remotely delivered alcohol and/or substance misuse interventions for adults

© 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Background: There has been a lack of systematic exploration of remotely delivered intervention content and their effectiveness for behaviour change outcomes. This review provides a synthesis of the behaviour change techniques (BCT) contained in remotely delivered alcohol and/or substance misuse approaches and their association with intervention promise. Methods: Searches in MEDLINE, Scopus, PsycINFO (ProQuest), and the Cochrane Library, included studies reporting remote interventions focusing on alcohol and/or substance misuse among adults, with a primary behaviour change outcome (e.g., alcohol levels consumed). Assessment of risk of bias, study promise, and BCT coding was conducted. Synthesis focussed on the association of BCTs with intervention effectiveness using promise ratios. Results: Studies targeted alcohol misuse (52 studies) or substance misuse (10 studies), with predominantly randomised controlled trial designs and asynchronous digital approaches. For alcohol misuse studies, 16 were very promising, 17 were quite promising, and 13 were not promising. Of the 36 eligible BCTs, 28 showed potential promise, with seven of these only appearing in very or quite promising studies. Particularly promising BCTs were ‘Avoidance/reducing exposure to cues for behaviour’, ‘Pros and cons’ and ‘Self-monitoring of behaviour’. For substance misuse studies, three were very promising and six were quite promising, with all 12 BCTs showing potential promise. Conclusions: This review showed remotely delivered alcohol and substance misuse interventions can be effective and highlighted a range of BCTs that showed promise for improving services. However, concerns with risk of bias and the potential of promise ratios to inflate effectiveness warrant caution in interpreting the evidence.Peer reviewe

Collaborative Strategies Used to Reduce Billing Administrative Cost

Billing inefficiencies represent 80% of wasteful healthcare administrative costs that are projected to reach $45 billion by 2018. Potentially, a reduced billing administrative cost is estimated to yield an annual savings of$60 billion that could fund other societal needs such as jobs, wage increases, and education. Through the conceptual framework of iceberg change management model, this single case study explored collaborative strategies 3 healthcare billing managers in Dallas, Texas successfully used to reduce billing administrative costs. Data were collected through semistructured interviews and the review of company documents. Using Yin\u27s procedure of examining, comparing, categorizing, and coding data, the thematic analysis exposed 5 themes: task coordination, communication, stakeholder involvement, relationship management, and performance indicators. The findings indicated that collaborative strategies might serve as a guideline for billing managers to identify and manage behaviors, attitudes, and processes that hinders the reduction of wasteful billing administrative costs. The implication for positive social change is the potential to reduce the number of individuals who forgo care due to medical billing complexities and disputes. The study may also contribute to social change by providing other billing managers and administrators with strategies for reducing healthcare billing administrative costs. Potential cost savings derived from improved billing administrative costs could fund healthcare for the uninsured and underinsured. The implementation of these collaborative strategies may improve fragmented billing processes, resulting in reduction of wasteful healthcare spending

Planning a practice for growth; Economics of accounting practice, bulletin 13

https://egrove.olemiss.edu/aicpa_news/1239/thumbnail.jp

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

Background: In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. Methods: Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. Results: The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p \u3c 0.01; current illicit drug use, 7% vs. 15%, p \u3c 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p \u3c 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (\u3c 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. Conclusions: At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives

Lindenwood College Student Handbook, 1995-1996

Information and guidelines for Lindenwood University students