Evaluation of a mindfulness-based mobile application with college students: A pilot study.

Objective: This pilot study assessed the feasibility and acceptability of The Mindfulness App with college students and the utility of daily text-message reminders for increasing adherence.Participants: Students from a mid-sized Midwestern University (N = 59) during the spring and fall of 2016.Methods: Using a pretest-posttest design, a group of students used The Mindfulness App for 5 weeks. All students were sent text-message reminders to submit daily practice time and completed a series of online measures.Results: Participants consistently used the application as intended, and reported positive attitudes toward the text-message reminders and the quality of the application.Conclusions:The Mindfulness App is a feasible, well-accepted tool for delivering mindfulness interventions to college students.

Closing the Digital Health Evidence Gap: Development of a Predictive Score to Maximize Patient Outcomes.

Background: Clinical studies of telemedicine (TM) programs for chronic illness have demonstrated mixed results across settings and populations. With recent uptake in use of digital health modalities, more precise patient classification may improve outcomes, efficiency, and effectiveness. Objective: The purpose of the research was to develop a predictive score that measures the influence of patient characteristics on TM interventions. The central hypothesis is that disease type, illness severity, and the social determinants of health influence outcomes, including resource utilization, and can be precisely characterized. Methods: The retrospective study evaluated the feasibility of creating a patient "Telemedicine ImPact" (TIP) score derived from a Virginia Medicare and Medicaid claims data set. Claims were randomly selected, stratified by disease type, and matched by illness severity into a TM intervention group (N = 7,782) and a nontelemedicine "usual care" control cohort (N = 7,981). The individual records were then summarized into 15,762 cases with 80% of the cases used to develop, train, and test four predictive models (hospital utilization, readmissions, total utilization, and mortality) using 10-fold cross-validation. Results: Bayesian supervised machine learning achieved reference model performance index area under the curve for receiver operating characteristic (AUC/ROC) ≥0.85. Posterior probabilities for each outcome model were generated on a "hold-back" set of 3,082 cases. Robust parametric statistical methods enabled dimension reduction, model validation, and derivation of a reliable composite scaled score that quantified the overall health risk for each case. The TM intervention cohort demonstrated higher total utilization (representing the sum of inpatient, outpatient, and prescription use) and lower mean inpatient utilization than the usual standard of care. This finding suggests TM-based care may shift the composition of health resource utilization, reducing hospitalizations while increasing outpatient services, adjusted for patient differences. Conclusions: The creation of a patient score using machine learning to predict the effect of TM on outcomes is feasible. Adoption of the TIP score may reduce variability in results by more precisely accounting for the effects of patient characteristics on health outcomes and utilization. More consistent outcome prediction may lead to greater support for digital health.

Using videoconferencing to provide psychological services to rural children and adolescents: a review and case example.

Children and adolescents living in rural areas have difficulty accessing psychological services due to a lack of psychologists and other behavioral health professionals, especially those with expertise in treating youth. Telepsychology helps bridge this access gap. This article extends evidence supporting videoconferencing for psychological assessment and treatment in adults to support telepsychological treatment for youth. In addition, the basic components needed to begin and sustain a telepsychological practice are explored. Finally, a case example of an adolescent presenting with depression and disordered eating illustrates the practice of, and ethical standards needed for, telepsychology. Future technologies and applications around telepsychology are also discussed.

Telemedicine and adherence to national guidelines for ADHD evaluation: a case study.

The pilot project evaluated a telemedicine clinic's adherence to American Academy of Pediatrics (AAP) guidelines for attention-deficit/hyperactivity disorder (ADHD) evaluation. Real-time videoconferencing linked the patients, the families, and the specialty mental health team. The ADHD Telemedicine Clinic adherence to AAP guidelines was tracked using chart data. The study included 22 patients (Mean age = 9.3 years, SD = 2.3 years) participating in 69 telemedicine visits across 13 different school-related sites. The ADHD Telemedicine Clinic reached extremely high adherence rates across the AAP evaluation guidelines for ADHD, ranging from 95-100% across the six guidelines. No factor inherent to the telemedicine service delivery mechanism impeded adherence to national guidelines for ADHD evaluation. Telemedicine-based outreach had the greatest impact on AAP Guideline #4, stating that information should be obtained from the child's academic setting. The school-based telemedicine clinic allowed increased communication across the school and specialty mental health systems and facilitated greater input across child, parent, school personnel, and mental health professionals.

Emergency department-initiated tobacco dependence treatment.

OBJECTIVE: To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. METHODS: The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. RESULTS: Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. CONCLUSIONS: An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.

Psychosocial factors, quality of life, and psychological distress: ethnic differences in patients with heart failure.

Advances in treatment have prolonged life in heart failure (HF) patients, leading to increased attention to quality of life (QOL) and psychological functioning. It is not clear if ethnic differences exist in factors associated with psychological well-being. We examined psychosocial factors associated with depression and anxiety in 97 HF patients. Medical records were reviewed and patients (M age 53, 50% African American) completed surveys examining social support, coping, spirituality, and QOL for their association with depression and anxiety. Multiple regressions suggested that psychosocial factors were associated with psychological health. Patients with lower social support, lower meaning/peace and more negative coping reported greater depression; positive coping, and lower meaning/peace were associated with higher anxiety. Ethnicity stratified models suggested that spiritual well-being was associated with depression only among African Americans and QOL partially mediated this relationship. Findings suggest the importance of considering the unique psychosocial needs of diverse populations to appropriately target clinical interventions.

Enhancing survey data collection among youth and adults: use of handheld and laptop computers.

Tobacco use, alcohol and other drug use, early sexual behavior, dietary practices, physical inactivity, and activities that contribute to unintentional and intentional injuries are a significant threat to the health of young people. These behaviors have immediate and long-term consequences and contribute to diminished health, educational, and social outcomes. Research suggests that health risk behaviors exhibited during adolescence and adulthood have their origins earlier in childhood and preventive interventions are less successful after the risk behaviors have begun. Therefore, efforts to prevent health risk behaviors are best initiated in late childhood or early adolescence. However, to document the efficacy of these efforts, reliable, valid, and parent/child-friendly systems of data collection are required. Computerized data collection for research has been found to improve privacy, confidentiality, and portability over the paper-and-pencil method, which, in turn, enhances the reliability of sensitive data such as alcohol use or sexual activity. We developed programming tools for the personal computer and a handheld personal data assistant to offer a comprehensive set of user interface design elements, relational databases, and ample programming languages so that adults could answer 261 items and youth 346 items. The purpose of the article was to describe an innovative handheld computer-assisted survey interview method of collecting sensitive data with children aged 9 to 11. The method was developed as part of a large multisite, national study to prevent substance use.