Strategic Medical Equipment Incorporation Process: A Proposed Model to be used by the Lebanese Healthcare Organizations

Background: The Improvement in healthcare as provided by new modern equipment is associated with the rise in healthcare cost. Lebanon’s economy and its public healthcare sector might be struggling with a crisis stimulated by the absence of any legal limit for the sophisticated medical equipment number per population density. Purpose: to assess the current methodology for health technology incorporation used by the Lebanese hospitals, and to propose an incorporation model guiding them in medical devices acquisition. Methodology: combination of quantitative and qualitative approaches were used in addition to a proposed incorporation models with an applied case study on it. Questionnaires were distributed among 34 hospitals, with a response rate of 82.35%, and interviews were conducted with five biomedical managers. Results: The study shows that only 7% of mangers know what Health Technology Assessment (HTA) means, and none of these hospitals use HTA reports. Additionally, 71% of hospitals don’t monitor their incorporation process and only 4% evaluate the purchased devices’ utilization. Based on the qualitative analysis, the lack of proper need assessment, market study, and poor supplier evaluation were the main reasons behind poor incorporation processes. Conclusion: We found that hospitals lack a proper incorporation process as evident in their poor methodology, hence recommendations were to follow a formalized process for medical device incorporation. However when it comes to the Ministry of Public Health, the recommendations were to formalize and apply new laws and regulations for the certificate of needs

The swinging self : the costs of shifting between self-images in Alzheimer’s disease

Background: We investigated the ability of patients with Alzheimer’s disease (AD) to shift between different self-images. Methods: We developed an original task (shifting-self task) in which we invited 28 patients with AD and 30 control participants to generate “who am I” statements that describe 2 alternative self-images (ie, physical-self vs psychological-self). In a control task, participants had to generate 2 blocks of “who am I” statements (ie, physical-self block and psychological-self block). Results: Analyses showed longer completion time in both the shifting-self and control task in patients with AD than in control participants. Completion time on the shifting-self task was longer than that on the control task in patients with AD, suggesting a shifting cost in AD. Conclusion: We propose that one feature of the diminished sense of self in AD is the difficulty of patients to shift between different alternating self-images

Hallucinations in a Patient with Alzheimer's Disease During the COVID-19 Crisis: A Case Study.

peer reviewedWhile social distancing may be deemed necessary in order to avoid COVID-19 infections, the lockdown may impact mental health of patients with Alzheimer's disease (AD). We present a case study involving hallucinations in a patient with AD who lives in a nursing home during the COVID-19 crisis. We compared this patient's hallucination scores before and during the lockdown. We observed increased hallucinations during, compared to before, the lockdown. These increased hallucinations can be attributed to a number of elements such as the decreased in daily activities, social distancing, lack of physical contact with family members, and loneliness during the lockdown

Time reproduction during high and low attentional tasks in Alzheimer’s Disease “A watched kettle never boils”

A wealth of empirical evidence suggests that directing attention to temporal processing increases perceived duration, whereas drawing attention away from it has the opposite effect. Our work investigates this phenomenon by comparing perceived duration during a high attentional and a low attentional task in Alzheimer‟s Disease (AD) patients since these participants tend to show attentional deficits. In the high attentional task, AD patients and older adults were asked to perform the interference condition of the Stroop test for 15s while in the low attentional task, they had to fixate on a cross for the same length of time. In both conditions, participants were not aware they would be questioned about timing until the end of the task when they had to reproduce the duration of the previously-viewed stimulus. AD patients under-reproduced the duration of previously-exposed stimulus in the high attentional relative to the low attentional task, and the same pattern was observed in older adults. Due to their attentional deficits, AD patients might be overwhelmed by the demand of the high attentional task, leaving very few, if any, attentional resources for temporal processing

Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature

According to the United Nations, an estimated 26.6 million people worldwide were refugees in 2021. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. A possible strategy to close this gap might be to offer smartphone-delivered mental health care. This systematic review summarizes the current state of research on smartphone-delivered interventions for refugees, answering the following research questions: (1) Which smartphone-delivered interventions are available for refugees? (2) What do we know about their clinical (efficacy) and (3) nonclinical outcomes (e.g., feasibility, appropriateness, acceptance, and barriers)? (4) What are their dropout rates and dropout reasons? (5) To what extent do smartphone-delivered interventions consider data security? Relevant databases were systematically searched for published studies, gray literature, and unpublished information. In total, 456 data points were screened. Twelve interventions were included (nine interventions from 11 peer-reviewed articles and three interventions without published study reports), comprising nine interventions for adult refugees and three for adolescent and young refugees. Study participants were mostly satisfied with the interventions, indicating adequate acceptability. Only one randomized controlled trial (RCT; from two RCTs and two pilot RCTs) found a significant reduction in the primary clinical outcome compared to the control group. Dropout rates ranged from 2.9 to 80%. In the discussion, the heterogeneous findings are integrated into the current state of literature

Hallucinations and Covid-19: Increased Occurrence of Hallucinations in Patients with Alzheimer's Disease During Lockdown.

We investigated the effects of lockdown, as implemented by retirement homes to cope with the spread of Covid-19, on hallucinatory experiences in patients with Alzheimer's disease (AD). The study included 47 patients with AD living in retirement homes and who were already experiencing hallucinations prior to the lockdown. We invited caregivers to rate hallucinatory experiences in these patients during the lockdown, and compared this rating with that provided by the same caregivers prior to the lockdown. Results demonstrated increased hallucinatory experiences in patients with AD during the lockdown, compared with before the lockdown. The decrease in social and physical activities during the lockdown, and especially, the physical separation of residents from family members, might have led to decreased sensory stimulation and increased loneliness, and consequently, to the hallucinatory experiences in patients with AD living in retirement homes during the lockdown. While the restrictive measures were necessary to cope with the spread of Covid-19, these measures have increased hallucinations in patients with AD living in retirement homes, at least in those who were already experiencing hallucinations prior to the lockdown

Associations of Depressive Symptoms, COVID-19-Related Stressors, and Coping Strategies. A Comparison Between Cities and Towns in Germany

Background: The COVID-19 pandemic has led to a wide range of stressors related to depressive symptoms. Prevention measures like physical distancing have burdened the general population, especially in highly urbanized areas. However, little is known about the associations between pandemic-related stressors, coping strategies, and depressive symptoms in highly urbanized vs. less urbanized environments. Methods: Participants were recruited in a cross-sectional online survey in Germany. Propensity score matching yielded a matched sample of city (n = 453) and town (n = 453) inhabitants. Depressive symptoms, COVID-19-related stressors, and coping strategies were compared between cities and towns. Multiple regression analysis was performed to determine associations between pandemic-related stressors and depressive symptoms for the two groups separately. Results: City inhabitants showed significantly higher depression scores than town inhabitants (t = 2.11, df = 897.95, p = 0.035). Seven coping strategies were more often used by the city sample. Depressive symptoms were associated with “restricted physical social contact” and “difficult housing conditions” (adjusted R2= 0.19, F[9,443] = 12.52, p < 0.001) in city inhabitants, and with “fear of infection” and “difficult housing conditions” (adjusted R2= 0.20, F[9,443] = 13.50, p < 0.001) in town inhabitants. Limitations: The data were collected at the end of the first wave and represent a snapshot without causal inferences. Pandemic-related stressors were measured with a newly developed scale. Conclusion: Depressive symptoms, perceived stressors, and approach/avoidance coping strategies differed between city vs. town inhabitants. These differences should be considered in policy-making and mental health care

Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood. Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD. Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets. Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment. Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Antecedentes: La evaluación desadaptativa del trauma juega un papel importante en el desarrollo y mantenimiento del trastorno de estrés postraumático (TEPT). Si bien los estudios han demostrado la eficacia de los tratamientos cognitivos y de exposición para la sintomatología del trastorno de estrés postraumático, aún no se comprende bien el efecto de dichos tratamientos en valoraciones específicas del trauma. Objetivo: El estudio investigó el efecto de un tratamiento de exposición y reestructuración cognitiva basado en Internet, sobre las valoraciones específicas del trauma en participantes de habla árabe con TEPT. Método: 334 participantes recibieron un tratamiento de exposición (n = 167) o de reestructuración cognitiva (n = 167) basado en Internet. La gravedad de los síntomas de TEPT (PCL-5 por sus siglas en inglés) y las evaluaciones de trauma específicas (TAQ por sus siglas en inglés), se evaluaron antes y después del tratamiento. Los cambios en las valoraciones específicas del trauma dentro y entre los dos tratamientos fueron analizados utilizando modelado de cambio multi-grupo. Las asociaciones entre cambios en la severidad de los síntomas de TEPT y cambios en las valoraciones del trauma fueron evaluadas usando el coeficiente de correlación de Momento-producto de Pearson. Para ambos tratamientos, se compararon los participantes con mejoría versus sin mejoría confiable respecto a cambios en valoraciones específicas del trauma usando pruebas de Welch. Los análisis se realizaron en 100 conjuntos de datos imputados múltiples. Resultados: Ambos tratamientos produjeron cambios significativos en la vergüenza, la culpa, el miedo, la ira y la alienación (todos p < 0,001). Los cambios en la traición sólo fueron significativos en el tratamiento de reestructuración cognitiva (p < 0,001). No hubo evidencia de diferencias entre tratamientos para ninguna valoración específica del trauma. Los cambios en la gravedad de los síntomas del TEPT se asociaron significativamente con cambios en las valoraciones del trauma (todos ps < 0,001). En ambos tratamientos, los participantes que experimentaron una mejora confiable en la severidad de los síntomas de TEPT mostraron cambios significativamente mayores de pre a post tratamiento en valoraciones específicas del trauma comparados con aquellos sin mejora confiable. Nuevamente, las diferencias en la traición sólo fueron significativas en el tratamiento de reestructuración cognitiva. Conclusiones: Los hallazgos indican que ambos tratamientos son efectivos para reducir las valoraciones del trauma en personas de habla árabe con TEPT. Los cambios en la valoración del trauma parecen estar asociados con cambios en la sintomatología del TEPT

An internet-based cognitive behavioural intervention for adults with depression in Arabic-speaking countries: A randomized controlled trial

Internet-based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet-based cognitive behavioural writing intervention for Arabic-speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet-based intervention over a 6-week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T-tests with change scores from pre- to post-treatment were used for data analyses. Intention-to-treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = −4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet-based cognitive behavioural writing intervention in adults from Arabic-speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment