Unpacking Support Types in Online Health Communities: An Application of Attraction-Selection-Attrition Theory

Online communities are increasingly becoming part of the healthcare ecosystem, as they allow patients, family members and carers to connect and support each other at any time and from any location. This support can take many forms, including information, advice, esteem support and solidarity. Prior research has identified the Attraction-Selection-Attrition Theory as a promising framework for modelling and explaining how participants join, participate, and leave organizations in general (and online communities specifically), and how the actions of individuals effect the organization as a whole. However, it has not previously been applied specifically to online health communities (i.e. those that focus on physical and/or mental health). We propose to gather empirical evidence from a large online community that provides support for Australians effected by cancer. In doing so, we hope to develop evidence-based policies and procedures for growing, maintaining and moderating these communities

Randomized controlled trials of malaria intervention trials in Africa, 1948 to 2007: a descriptive analysis

<p>Abstract</p> <p>Background</p> <p>Nine out of ten deaths from malaria occur in sub-Saharan Africa. Various control measures have achieved some progress in the control of the disease, but malaria is still a major public health problem in Africa. Randomized controlled trials (RCTs) are universally considered the best study type to rigorously assess whether an intervention is effective. The study reported here provides a descriptive analysis of RCTs reporting interventions for the prevention and treatment of malaria conducted in Africa, with the aim of providing detailed information on their main clinical and methodological characteristics, that could be used by researchers and policy makers to help plan future research.</p> <p>Methods</p> <p>Systematic searches for malaria RCTs were conducted using electronic databases (Medline, Embase, the Cochrane Library), and an African geographic search filter to identify RCTs conducted in Africa was applied. Results were exported to the statistical package STATA 8 to obtain a random sample from the overall data set. Final analysis of trial characteristics was done in a double blinded fashion by two authors using a standardized data extraction form.</p> <p>Results</p> <p>A random sample of 92 confirmed RCTs (from a total of 943 reports obtained between 1948 and 2007) was prepared. Most trials investigated drug treatment in children with uncomplicated malaria. Few trials reported on treatment of severe malaria or on interventions in pregnant women. Most trials were of medium size (100-500 participants), individually randomized and based in a single centre. Reporting of trial quality was variable. Although three-quarter of trials provided information on participants' informed consent and ethics approval, more details are needed.</p> <p>Conclusions</p> <p>The majority of malaria RCT conducted in Africa report on drug treatment and prevention in children; there is need for more research done in pregnant women. Sources of funding, informed consent and trial quality were often poorly reported. Overall, clearer reporting of trials is needed.</p

The Effect of α2-δ and Other Accessory Subunits on Expression and Properties of the Calcium Channel α1G

The effect has been examined of the accessory α2-δ and β subunits on the properties of α1G currents expressed in monkey COS-7 cells and Xenopus oocytes. In immunocytochemical experiments, the co-expression of α2-δ increased plasma membrane localization of expressed α1G and conversely, the heterologous expression of α1G increased immunostaining for endogenous α2-δ, suggesting an interaction between the two subunits. Heterologous expression of α2-δ together with α1G in COS-7 cells increased the amplitude of expressed α1G currents by about 2-fold. This finding was confirmed in the Xenopus oocyte expression system. The truncated δ construct did not increase α1G current amplitude, or increase its plasma membrane expression. This indicates that it is the exofacial α2 domain that is involved in the enhancement by α2-δ. β1b also produced an increase of functional expression of α1G, either in the absence or the presence of heterologously expressed α2-δ, whereas the other β subunits had much smaller effects. None of the accessory subunits had any marked influence on the voltage dependence or kinetics of the expressed α1G currents. These results therefore suggest that α2-δ and β1b interact with α1G to increase trafficking of, or stabilize, functional α1G channels expressed at the plasma membrane

Intensive training methods for nurses and peer volunteers who deliver a complex, psychosocial intervention in a Phase III trial

Background: All clinical trials require strict adherence to study protocol and processes. Non-pharmacological, complex intervention trials can only be successful if the intervention is delivered in a standard manner and according to protocol. This can be achieved by selecting appropriate individuals and providing comprehensive, evidence-based training and ongoing supervision. Objective: To describe an intensive program of recruitment, training and supervision of nurses and peers (survivors of gynaecological cancer) delivering a complex, psychosocial intervention in PENTAGON, a national Phase III trial. Methods: Two standardised manuals were developed for both nurses and peers specifying (a) the intervention content and (b) the training and supervision procedures. Nurses and potential peer volunteers were identified via the gynaecological multidisciplinary team at each site. Potential peers were sent invitation letters, interviewed by Cancer Council experts and those identified as appropriate were invited to attend training. Both nurses and peers attended separate two-day training workshops which incorporated evidence-based modules on gynaecological cancer treatment and side-effects, psychosexual issues, promoting adherence, communication skills and motivational interviewing (nurses only). Training, which was facilitated by experts, emphasised adherence to protocol, prevention of intervention diffusion and, for peers, confidentiality, boundaries and self-care. Interactive discussion, audio or video taped examples of intervention delivery and facilitated group role-play with simulated patients were used to deliver the training. Expectation and evaluation forms assessed perceived improvement in key skills and provide feedback on workshop delivery and content. Post-workshop nurse and peers completed practice phone calls with a simulated patient. A communications skills expert provided written and verbal feedback. Ongoing supervision of intervention sessions is being provided. Results: In total, 9 nurses and 15 peers have completed training. Workshop participants reported improvement in skills, high approval of facilitators, no aspects of the workshops were identified as 'least valuable' and the peers particularly, enjoyed meeting other participants. Expert assessment of practice calls demonstrated use of communication skills, general adherence to study processes and correct completion of documentation. Conclusions: A rigorous, multi-stage process of recruitment, training and supervision for individuals delivering a psychosocial intervention was designed and found to be acceptable and effective. Such programs underpin standardizing the delivery of complex interventions and are critical to the success these types of trials

Implementing systematic screening and structured care for distressed callers using cancer council's telephone services: Protocol for a randomized stepped-wedge trial

Doran, CM ORCiD: 0000-0002-9009-4906Background: Structured distress management, comprised a 2-stage screening and referral model, can direct supportive care resources toward individuals who are most likely to benefit. This structured approach has yet to be trialed in Australian community-based services such as Cancer Council New South Wales (NSW) and Victoria Cancer Information and Support (CIS) 13 11 20 lines who care for a large community of cancer patients and caregivers. Objective: The aim of this study was to evaluate the effectiveness of structured screening and referral in (1) increasing the proportion of distressed CIS callers who accept supportive care referrals and (2) reducing distress levels at 6-month follow-up. Methods: In this stepped-wedge trial, Cancer Council NSW and Victoria CIS consultants are randomized to deliver structured care during inbound 13 11 20 calls in accordance with 3 intervention periods. Eligible callers are patients or caregivers who score 4 or more on the Distress Thermometer; NSW or Victorian residents; aged 18 years or older; and English proficient. Study data are collected via computer-assisted telephone interviews (CATIs) at 3-and 6-month follow-up and CIS record audit. CATIs include demographic and service use items and the General Health Questionnaire (GHQ-28) to assess distress. An economic analysis of the structured care model will be completed. Results: The structured care model was developed by guideline review and identification of service characteristics to guide mapping decisions; place-card methodology; and clinical vignettes with think-aloud methodology to confirm referral appropriateness. The model includes an additional screening tool (Patient Health Questionnaire-4) and a referral model with 16-20 CIS services. Descriptive statistics will be used to assess referral uptake rates. Differences between GHQ-28 scores for structured and usual care callers will be tested using a generalized linear mixed model with fixed effects for intervention and each time period. The trial will recruit 1512 callers. The sample size will provide the study with approximately 80% power to detect a difference of 0.3 SD in the mean score of the GHQ-28 at an alpha level of.05 and assuming an intra-cluster correlation of.04. A random sample of recorded calls will be reviewed to assess intervention fidelity and contamination. To date, 1835 distressed callers have been invited to participate with 60.71% (1114/1835) enrolled in the study. A total of 692 participants have completed 6-month CATIs. Recruitment is anticipated to end in late 2019. Conclusions: This trial is among the first to rigorously test the outcomes of a community-based structured approach to distress management. The model is evidence-informed, practice-ready, and trialed in a real-world setting. The study outcomes will advance the understanding of distress management internationally for both patients and caregivers. © Elizabeth A Fradgley, Anna Boltong, Lorna O'Brien, Allison W Boyes, Katherine Lane, Annette Beattie, Tara Clinton-McHarg, Paul B Jacobsen, Christopher Doran, Daniel Barker, Della Roach, Jo Taylor, Christine L Paul

A single-blind, parallel-group randomised trial of a Technology-assisted and remotely delivered Cognitive Behavioural Therapy intervention (Tech-CBT) versus usual care to reduce anxiety in people with mild cognitive impairment and dementia: study protocol for a randomised trial

Abstract Background Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology. Methods A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care. Discussion This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia. Trial registration This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022]