Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

BACKGROUND:At least 100,000 patients with schizophrenia receive care from community mental health teams (CMHTs) in England. These patients have regular meetings with clinicians, who assess them, engage them in treatment and co-ordinate care. As these routine meetings are not commonly guided by research evidence, a new intervention, DIALOG, was previously designed to structure consultations. Using a hand-held computer, clinicians asked patients to rate their satisfaction with eight life domains and three treatment aspects, and to indicate whether or not additional help was needed in each area, with responses being graphically displayed and compared with previous ratings. In a European multicentre trial, the intervention improved patients’ quality of life over a 1-year period. The current programme builds on this research by further developing DIALOG in the UK. RESEARCH QUESTIONS:(1) How can the practical procedure of the intervention be improved, including the software used and the design of the user interface? (2) How can elements of resource-oriented interventions be incorporated into a clinician manual and training programme for a new, more extensive ‘DIALOG+’ intervention? (3) How effective and cost-effective is the new DIALOG+ intervention in improving treatment outcomes for patients with schizophrenia or a related disorder? (4) What are the views of patients and clinicians regarding the new DIALOG+ intervention? METHODS:We produced new software on a tablet computer for CMHTs in the NHS, informed by analysis of videos of DIALOG sessions from the original trial and six focus groups with 18 patients with psychosis. We developed the new ‘DIALOG+’ intervention in consultation with experts, incorporating principles of solution-focused therapy when responding to patients’ ratings and specifying the procedure in a manual and training programme for clinicians. We conducted an exploratory cluster randomised controlled trial with 49 clinicians and 179 patients with psychosis in East London NHS Foundation Trust, comparing DIALOG+ with an active control. Clinicians working as care co-ordinators in CMHTs (along with their patients) were cluster randomised 1 : 1 to either DIALOG+ or treatment as usual plus an active control, to prevent contamination. Intervention and control were to be administered monthly for 6 months, with data collected at baseline and at 3, 6 and 12 months following randomisation. The primary outcome was subjective quality of life as measured on the Manchester Short Assessment of Quality of Life; secondary outcomes were also measured. We also established the cost-effectiveness of the DIALOG intervention using data from the Client Service Receipt Inventory, which records patients’ retrospective reports of using health- and social-care services, including hospital services, outpatient services and medication, in the 3 months prior to each time point. Data were supplemented by the clinical notes in patients’ medical records to improve accuracy. We conducted an exploratory thematic analysis of 16 video-recorded DIALOG+ sessions and measured adherence in these videos using a specially developed adherence scale. We conducted focus groups with patients (n = 19) and clinicians (n = 19) about their experiences of the intervention, and conducted thematic analyses. We disseminated the findings and made the application (app), manual and training freely available, as well as producing a protocol for a definitive trial. RESULTS:Patients receiving the new intervention showed more favourable quality of life in the DIALOG+ group after 3 months (effect size: Cohen’s d = 0.34), after 6 months (Cohen’s d = 0.29) and after 12 months (Cohen’s d = 0.34). An analysis of video-recorded DIALOG+ sessions showed inconsistent implementation, with adherence to the intervention being a little over half of the possible score. Patients and clinicians from the DIALOG+ arm of the trial reported many positive experiences with the intervention, including better self-expression and improved efficiency of meetings. Difficulties reported with the intervention were addressed by further refining the DIALOG+ manual and training. Cost-effectiveness analyses found a 72% likelihood that the intervention both improved outcomes and saved costs. LIMITATIONS:The research was conducted solely in urban east London, meaning that the results may not be broadly generalisable to other settings. CONCLUSIONS:(1) Although services might consider adopting DIALOG+ based on the existing evidence, a definitive trial appears warranted; (2) applying DIALOG+ to patient groups with other mental disorders may be considered, and to groups with physical health problems; (3) a more flexible use with variable intervals might help to make the intervention even more acceptable and effective; (4) more process evaluation is required to identify what mechanisms precisely are involved in the improvements seen in the intervention group in the trial; and (5) what appears to make DIALOG+ effective is that it is not a separate treatment and not a technology that is administered by a specialist; rather, it changes and utilises the existing therapeutic relationship between patients and clinicians in CMHTs to initiate positive change, helping the patients to improve their quality of life. FUTURE RESEARCH:Future studies should include a definitive trial on DIALOG+ and test the effectiveness of the intervention with other populations, such as people with depression. TRIAL REGISTRATION:Current Controlled Trials ISRCTN34757603. FUNDING:The National Institute for Health Research Programme Grants for Applied Research programme

The autonomous mobile robot SENARIO: A sensor-aided intelligent navigation system for powered wheelchairs

The SENARIO project is developing a sensor-aided intelligent navigation system that provides high-level navigational aid to users of powered wheelchairs. The authors discuss new and improved technologies developed within SENARIO concerning task/path planning, sensing and positioning for indoor mobile robots as well as user interface issues. The autonomous mobile robot SENARIO, supports semi- or fully autonomous navigation. In semi-autonomous mode the system accepts typical motion commands through a voice-activated or standard joystick interface and supports robot motion with obstacle/collision avoidance features. Fully autonomous mode is a superset of semi-autonomous mode with the additional ability to execute autonomously high-level go-to-goal commands. At its current stage, the project has succeeded in fully supporting semi-autonomous navigation, while experiments on the fully autonomous mode are very encouraging

ASPIDA: An Observatory for Security and Privacy in the Greek e-Business Sector

Modern e-business policy aims to better frame and steer progress and advancements towards a legal and security aware framework. However, a large percentage of cases neglects the adoption of good security practices, exposing customers to potential risks. In this work, we present a hybrid approach upon self-assessment, self-improvement and self-regulation motivation, offered by the observAtory for Security and PrIvacy DAta (ASPIDA) system. To address privacy and security weaknesses we monitor and analyze a set of security and privacy metrics and indicators. The evaluation of the aforementioned criteria drives an outcome in the form of a digital badge of good practices for the specific website. This digital badge is a recognition and can be used by the e-business owners as an attraction that frames the services and content they offer to the public. © 2021 ACM

The autonomous mobile robot SENARIO: a sensor-aided intelligent navigation for powered wheelchairs

The SENARIO project is develoing a sensor-aided intelligent navigation system that provides high-level navigational aid to users of powered wheelchairs. The authors discuss new and improved technologies developed within SENARIO concerning task/path planning, sensing and positioning for indoor mobile robots as well as user interface issues. The autonomous mobile robot SENARIO, supports semi- or fully autonomous navigation. In semi-autonomous mode the system accepts typical motion commands through a voice-activated or standard joystick interface and supports robot motion with obstacle/collision avoidance features. Fully autonomous mode is a superset of semi-autonomous mode with the additional ability to execute autonomously high-level go-to-goal commands. At its current stage, the project has succeeded in fully supporting semi-autonomous navigation, while experiments on the fully autonomous mode are very encouragin

Establishing initial user requirements for PAM-AID: a mobility and support device to assist frail and elderly visually impaired persons

The PAM-AID project aims to build an intelligent, indoor mobility aid for frail and elderly visually impaired people which will provide both physical and navigational support for walking. The objective is to allow users to retain their personal autonomy and also to take independent exercise. The project involves ongoing user involvement and evaluations of the developing product. The project has five distinct phases: (1) user requirements elicitation, (2) rapid prototyping, (3) construction of a demonstrator, (4) user and carer training, and (5) system validation. This paper reports on the first two phases of the project