Psychoeducational social anxiety mobile apps : systematic search in app stores, content analysis, and evaluation

Background: The wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets. Objective: This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety. Methods: This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps. Results: In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus$3.99) and US $3.69 (Aus$5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E). Conclusions: The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps

Cultural Humility: A Collaborative Approach to Recruiting Patients with Deliberate Self-Harm into a Multi-Hospital Randomized Controlled Trial

Objectives: The ‘SMS SOS’ Deliberate Self-Harm (DSH) Aftercare Study was conducted in Western Sydney, Australia (October 2017 to December 2020) across three large public hospitals. During this randomized controlled trial (RCT), it was observed that knowledge exchange between key stakeholders and their ‘cultural’ perspectives (for example, Mental Health Clinicians, Lived Experience Mental Health Consultants—Patient Representatives, Administrative Officers, and Researchers) was essential to effective recruitment of patients experiencing DSH. Knowledge exchange within and between cultural groups was maximised and assessed using a communication matrix. This process, transferable to other trials engaging multiple ‘cultures’, aimed to promote the early identification of wider-team strengths as well as active management of emergent issues that would otherwise impede patient recruitment, and to maximise funding and human resources. Methods: A descriptive study was conducted with a convenience sample of team members who represented different cultures in the study. Qualitative data were elicited from a ‘know and tell’ matrix. Through an iterative process, themes were generated that encapsulated what team members needed to know from and tell to their colleagues concerning the study. Results: Factors that impacted participation in the study included clinician workload, the level of motivation/ commitment/confidence of clinicians to recruit patients, clinician-patient engagement, perception and expectations of study involvement, inter-cultural communication, and clinician training and support. The findings of this multidisciplinary consultation informed a composite model of knowledge exchange and the development of educational briefing/ orientation modules that make explicit team members’ roles and responsibilities to foster group member participation and enhance patient recruitment. Conclusions: It is incumbent upon multidisciplinary team members of large-scale studies to adopt a similar ‘knowledge exchange’ strategy early in the planning and design stage. Adoption of such a strategy has the potential to mitigate risk of delay in project timelines, improve project outcomes, and ensure the efficient use of research funding, particularly in newly established research teams within clinical settings and with members newer to formal research collaborations. Keywords: cultural humility; deliberate self-harm; engagement; participant recruitment; participatory research; randomized controlled tria

State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS)

PCOS, a heterogeneous disorder characterized by cystic ovarian morphology, androgen excess, and/or irregular periods, emerges during or shortly after puberty. Peri- and post-pubertal obesity, insulin resistance and consequent hyperinsulinemia are highly prevalent co-morbidities of PCOS and promote an ongoing state of excess androgen. Given the relationship of insulin to androgen excess, reduction of insulin secretion and/or improvement of its action at target tissues offer the possibility of improving the physical stigmata of androgen excess by correction of the reproductive dysfunction and preventing metabolic derangements from becoming entrenched. While lifestyle changes that concentrate on behavioral, dietary and exercise regimens should be considered as first line therapy for weight reduction and normalization of insulin levels in adolescents with PCOS, several therapeutic options are available and in wide use, including oral contraceptives, metformin, thiazolidenediones and spironolactone. Overwhelmingly, the data on the safety and efficacy of these medications derive from the adult PCOS literature. Despite the paucity of randomized control trials to adequately evaluate these modalities in adolescents, their use, particularly that of metformin, has gained popularity in the pediatric endocrine community. In this article, we present an overview of the use of insulin sensitizing medications in PCOS and review both the adult and (where available) adolescent literature, focusing specifically on the use of metformin in both mono- and combination therapy

A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists

Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists’ different experiences of burnout in Australia.Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists’ natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding ‘first order constructs’ and then axial code ‘second order constructs.’Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients’ expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints.Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of working as a solo-practicing clinical psychologist. Findings from this study should lead to an increased understanding of the complexities of burnout, and ultimately reduced cases of burnout, absenteeism, and staff disengagement

[In Press] Impact of Covid-19 physical distancing policies on incidence of intentional self-harm in Western Sydney

There have been suggestions that the social and economic disruption associated with non-pharmaceutical interventions implemented in response to the Covid-19 pandemic (such as physical distancing and restrictions on gatherings) has led to increases in suicidal behaviour, and that these impacts may be differentially affecting younger and more marginalised cohorts in populations

Cultural Humility: A Collaborative Approach to Recruiting Patients with Deliberate Self-Harm into a Multi-Hospital Randomized Controlled Trial

Objectives: The ‘SMS SOS’ Deliberate Self-Harm (DSH) Aftercare Study was conducted in Western Sydney, Australia (October 2017 to December 2020) across three large public hospitals. During this randomized controlled trial (RCT), it was observed that knowledge exchange between key stakeholders and their ‘cultural’ perspectives (for example, Mental Health Clinicians, Lived Experience Mental Health Consultants—Patient Representatives, Administrative Officers, and Researchers) was essential to effective recruitment of patients experiencing DSH. Knowledge exchange within and between cultural groups was maximised and assessed using a communication matrix. This process, transferable to other trials engaging multiple ‘cultures’, aimed to promote the early identification of wider-team strengths as well as active management of emergent issues that would otherwise impede patient recruitment, and to maximise funding and human resources. Methods: A descriptive study was conducted with a convenience sample of team members who represented different cultures in the study. Qualitative data were elicited from a ‘know and tell’ matrix. Through an iterative process, themes were generated that encapsulated what team members needed to know from and tell to their colleagues concerning the study. Results: Factors that impacted participation in the study included clinician workload, the level of motivation/ commitment/confidence of clinicians to recruit patients, clinician-patient engagement, perception and expectations of study involvement, inter-cultural communication, and clinician training and support. The findings of this multidisciplinary consultation informed a composite model of knowledge exchange and the development of educational briefing/ orientation modules that make explicit team members’ roles and responsibilities to foster group member participation and enhance patient recruitment. Conclusions: It is incumbent upon multidisciplinary team members of large-scale studies to adopt a similar ‘knowledge exchange’ strategy early in the planning and design stage. Adoption of such a strategy has the potential to mitigate risk of delay in project timelines, improve project outcomes, and ensure the efficient use of research funding, particularly in newly established research teams within clinical settings and with members newer to formal research collaborations. Keywords: cultural humility; deliberate self-harm; engagement; participant recruitment; participatory research; randomized controlled tria

Staphylococcus aureus FtsZ and PBP4 bind to the conformationally dynamic N-terminal domain of GpsB

In the Firmicutes phylum, GpsB is a membrane associated protein that coordinates peptidoglycan synthesis with cell growth and division. Although GpsB has been studied in several bacteria, the structure, function, and interactome of Staphylococcus aureus GpsB is largely uncharacterized. To address this knowledge gap, we solved the crystal structure of the N-terminal domain of S. aureus GpsB, which adopts an atypical, asymmetric dimer, and demonstrates major conformational flexibility that can be mapped to a hinge region formed by a three-residue insertion exclusive to Staphylococci. When this three-residue insertion is excised, its thermal stability increases, and the mutant no longer produces a previously reported lethal phenotype when overexpressed in Bacillus subtilis. In S. aureus, we show that these hinge mutants are less functional and speculate that the conformational flexibility imparted by the hinge region may serve as a dynamic switch to fine-tune the function of the GpsB complex and/or to promote interaction with its various partners. Furthermore, we provide the first biochemical, biophysical, and crystallographic evidence that the N-terminal domain of GpsB binds not only PBP4, but also FtsZ, through a conserved recognition motif located on their C-termini, thus coupling peptidoglycan synthesis to cell division. Taken together, the unique structure of S. aureus GpsB and its direct interaction with FtsZ/PBP4 provide deeper insight into the central role of GpsB in S. aureus cell division

SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging

Abstract Background Hospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Since brief contact interventions (BCIs) may reduce the risk of DSH repetition, we aim to evaluate whether a SMS (Short Message Service) text message Intervention plus Treatment As Usual (TAU) compared to TAU alone will reduce hospital DSH re-presentation rates in Western Sydney public hospitals in Australia. Methods/design Our study is a 24-month randomized controlled trial (RCT). Adult patients who present with DSH to hospital emergency, psychiatric, and mental health triage and assessment departments will be randomly assigned to an Intervention condition plus TAU receiving nine SMS text messages at 1, 2, 3, 4, 5, 6, 8, 10 and 12-months post-discharge. Each message will contain telephone numbers for two mental health crises support tele-services. Primary outcomes will be the difference in the number of DSH re-presentations, and the time to first re-presentation, within 12-months of discharge. Discussion This study protocol describes the design and implementation of an RCT using SMS text messages, which aim to reduce hospital re-presentation rates for DSH. Positive study findings would support the translation of an SMS-aftercare protocol into mental health services at minimal expense. Trial registration and ethics approval This trial has been registered with the Australian and New Zealand Clinical Trials Registry (Trial registration: ACTRN12617000607370. Registered 28 April 2017) and has been approved by two Local Health Districts (LHDs). Western Sydney LHD Human Research Ethics Committee approved the study for Westmead Hospital and Blacktown Hospital (Protocol: HREC/16/WMEAD/336). Nepean Blue Mountains LHD Research Governance Office approved the study for Nepean Hospital (SSA/16/Nepean/170)

How much do we throw away in the intensive care unit? : an observational point prevalence study of Australian and New Zealand ICUs

Objective: During the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs. Design: This is a prospective cross-sectional point prevalence study, as part of the 2021 ANZICS Point Prevalence Program. Specific questions related to waste and sustainability practices were asked at the site and patient level. Setting and participants: ANZ adult ICUs and their patients on the day of the study. Main outcome measures: Amount of single use items disposed of per shift, as well as the engagement of the site with sustainability and recycling practices. Results: In total, 712 patients (median number of patients per ICU = 17, IQR 11–30) from 51 ICUs across ANZ were included in our study; 55% of hospitals had a sustainability officer, and recycling paper (86%) and plastics (65%) were frequent, but metal recycling was limited (27%). Per patient bed space per 12-h shift there was recycling of less than 40% paper, glass, intravenous fluid bags, medication cups and metal instruments. A median of 10 gowns (IQR 3–19.5), 10 syringes (4.5–18) and gloves 30 (18–49) were disposed of per bed space, per 12-h shift. These numbers increased significantly when comparing patients with and without infection control precautions in place. Conclusions: In ANZ ICUs, we found utilisation of common ICU consumables to be high and associated with low recycling rates. Interventions to abate resource utilisation and augment recycling are required to improve environmental sustainability in intensive care units