18 research outputs found
A high dimensional immune monitoring model of HIV-specific CD8 T cell responses accurately identifies subjects achieving spontaneous control of viral replication
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The E Sibling Project - exploratory randomised controlled trial of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis
Background:Siblings of individuals with first episode psychosis are natural partners to promote service usersârecovery and are themselves vulnerable to mental ill health due to the negative impact of psychosis withinthe family. This study aims to develop and undertake a preliminary evaluation of the efficacy of an onlinemulti-component psychoeducational intervention for siblings of individuals with first episode psychosis. Theimpetus for the intervention arose from siblings' expressed needs for peer support and information on psychosis,coping and management strategies for common symptoms and ways to promote recovery.
Methods/Design:The project design draws on the Medical Research Council framework for the design andevaluation of complex interventions. Mixed methods comprising collection of qualitative focus group data,systematic review and expert advisory group consultation are used to develop the theoretical basis for and designof the intervention. This protocol focuses on the modelling and piloting phase which uses a randomised controlledtrial with factorial design to test the efficacy of the intervention. Outcome data on participantsâmental wellbeing,knowledge, perceived self-efficacy and experiences of caregiving will be assessed at baseline, at end of theintervention (10 weeks later) and at 10 week follow-up. In addition, a post-intervention semi-structured interviewwith 20% of the participants will explore their experiences and acceptability of the intervention.
Discussion:This multi-component online psychoeducational intervention aims to enhance siblings' knowledgeabout psychosis and their coping capacity, thus potentially improving their own mental wellbeing and promotingtheir contribution to service usersârecovery. The factorial design randomised controlled trial with a supplementaryprocess evaluation using semi-structured interviews and usage-monitoring will collect preliminary evidence ofefficacy, feasibility and acceptability, as well as feedback about the barriers and strategies to using such aninnovative resource. The RCT will provide data for estimating the likely effect size of the intervention on outcomesfor siblings and inform the development of a definitive future trial
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Effectiveness of psychoeducational interventions for family carers of people
Psychoeducational interventions for family carers of people with psychosis are effective for improving compliance and preventing relapse. Whether carers benefit from these interventions has been little explored. This systematic review investigated the effectiveness of psychoeducation for improving carers' outcomes, and potential treatment moderators. We searched for randomised controlled trials (RCTs) published in English or Chinese in eight databases. Carers' outcomes included wellbeing, quality of life, global morbidities, burden, and expressed emotion. Thirty-two RCTs were included, examining 2858 carers. Intervention duration ranged from 4 to 52 weeks, and contact times ranged from 6 to 42 hours. At post intervention, findings were equivocal for carers' wellbeing (SMD 0.103, 95% CI â 0.186 to 0.392). Conversely, psychoeducation was superior in reducing carers' global morbidities (SMD â 0.230, 95% CI â 0.386 to â 0.075), perceived burden (SMD â 0.434, 95% CI â 0.567 to â 0.31), negative caregiving experiences (SMD â 0.210, 95% CI â 0.396 to â 0.025) and expressed emotion (SMD â 0.161, 95% CI â 0.367 to â 0.045). The lack of available data precluded meta-analysis of outcomes beyond short-term follow-up. Meta-regression revealed no significant associations between intervention modality, duration, or contact time and outcomes. Further research should focus on improving carers' outcomes in the longer-term and identifying factors to optimise intervention design
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Effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis.
Psychoeducational interventions for family carers of people with psychosis are effective for improving compliance and preventing relapse. Whether carers benefit from these interventions has been little explored. This systematic review investigated the effectiveness of psychoeducation for improving carers' outcomes, and potential treatment moderators. We searched for randomised controlled trials (RCTs) published in English or Chinese in eight databases. Carers' outcomes included wellbeing, quality of life, global morbidities, burden, and expressed emotion. Thirty-two RCTs were included, examining 2858 carers. Intervention duration ranged from 4 to 52weeks, and contact times ranged from 6 to 42hours. At post intervention, findings were equivocal for carers' wellbeing (SMD 0.103, 95% CI -0.186 to 0.392). Conversely, psychoeducation was superior in reducing carers' global morbidities (SMD -0.230, 95% CI -0.386 to -0.075), perceived burden (SMD -0.434, 95% CI -0.567 to -0.31), negative caregiving experiences (SMD -0.210, 95% CI -0.396 to -0.025) and expressed emotion (SMD -0.161, 95% CI -0.367 to -0.045). The lack of available data precluded meta-analysis of outcomes beyond short-term follow-up. Meta-regression revealed no significant associations between intervention modality, duration, or contact time and outcomes. Further research should focus on improving carers' outcomes in the longer-term and identifying factors to optimise intervention design
Eyes wide open: perceived exploitation and its consequences
Drawing on the array of literature on exploitation from several social science disciplines, we propose a new way of seeing employer-employee relationships by introducing the concept of perceived exploitative employee-organization relationships, distinguish it from related concepts, and conduct five studies to develop a scale and test our theoretical model of the effects of such employee perceptions. Contributing to the Employee-Organization Relationships and workplace emotions literatures, perceived exploitation is defined as employeesâ perceptions that they have been purposefully taken advantage of in their relationship with the organization, to the benefit of the organization itself. We propose and find that such perceptions are associated with both outward-focused emotions of anger and hostility toward the organization and inward-focused ones of shame and guilt at remaining in an exploitative job. In two studies including construction workers and a time-lagged study of medical residents, we find that the emotions of anger and hostility partially mediate the effects of perceived exploitation on employee engagement, revenge against the organization, organizational commitment, and turnover intentions, whereas the emotions of shame and guilt partially mediate the effects of perceived exploitation on employee burnout, silence, and psychological withdrawal
Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19
IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19.
Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 nonâcritically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022).
INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes.
RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ supportâfree days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively).
CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570