AI-based chatbot micro-intervention for parents: Meaningful engagement, learning, and efficacy.

Introduction: Mental health issues have been on the rise among children and adolescents, and digital parenting programs have shown promising outcomes. However, there is limited research on the potential efficacy of utilizing chatbots to promote parental skills. This study aimed to understand whether parents learn from a parenting chatbot micro intervention, to assess the overall efficacy of the intervention, and to explore the user characteristics of the participants, including parental busyness, assumptions about parenting, and qualitative engagement with the chatbot. Methods: A sample of 170 parents with at least one child between 2-11 years old were recruited. A randomized control trial was conducted. Participants in the experimental group accessed a 15-min intervention that taught how to utilize positive attention and praise to promote positive behaviors in their children, while the control group remained on a waiting list. Results: Results showed that participants engaged with a brief AI-based chatbot intervention and were able to learn effective praising skills. Although scores moved in the expected direction, there were no significant differences by condition in the praising knowledge reported by parents, perceived changes in disruptive behaviors, or parenting self-efficacy, from pre-intervention to 24-hour follow-up. Discussion: The results provided insight to understand how parents engaged with the chatbot and suggests that, in general, brief, self-guided, digital interventions can promote learning in parents. It is possible that a higher dose of intervention may be needed to obtain a therapeutic change in parents. Further research implications on chatbots for parenting skills are discussed.

Online micro intervention for mood improvement: The role of confidence, motivation, and activity type.

BACKGROUND: Internet interventions provide a unique opportunity to increase widespread accessibility of treatment at reduced and scalable costs (Muñoz, 2010). Previous research has explored the impact of specific types of activities on participant's main depressive symptoms i.e., anhedonia, or enjoyment levels, and mood (Bunge et al., 2017).The aim of the current study is to improve the understanding of the effects of online micro interventions targeting motivation, enjoyment levels, and mood. METHODS: A total of 838 participants recruited from Amazon Mechanical Turk participated in an online calendar activity to improve mood. RESULTS: A regression analysis showed that confidence and motivation were significantly associated with mood (R2 = 0.467, p < .001). The total number of activities reported in the last two days was associated with participants' current mood (R2 = 0.203, p < .001) and enjoyment (R2 = 0.156, p < .001). Interestingly, only mastery and meaningful activities improved mood but not pleasant activities. Regarding enjoyment, pleasant and meaningful activities impacted current enjoyment of the day but not mastery activities. Lastly, only individuals who engaged with the calendar showed a significant increase in motivation and confidence. LIMITATIONS: Depression may moderate engagement and was not analyzed in the present study. Additionally, there were no follow-up analyses that looked at the long-term effects of the intervention or changes in actual activity engagement. CONCLUSIONS: Online micro interventions have a promising future as an intervention that can impact the mood and motivation for change. Future studies should examine increasing engagement to facilitate confidence and motivation to enact change.

HPV prevalence in women attending cervical screening in rural Malawi using the cartridge-based Xpert® HPV assay.

BACKGROUND AND OBJECTIVES: Early experience with Cepheid Xpert® HPV assay (Xpert® HPV) suggests that its quick turnaround time and ease of application might make it a relevant contender for routine use in low and middle income countries (LMICs). In the context of a cervical screening service in rural Malawi, we aimed to assess practicalities of local laboratory testing with Xpert® HPV and provide preliminary high-risk HPV (HR-HPV) prevalence data. STUDY DESIGN: Liquid-based cytology (LBC) specimens were collected from women attending cervical screening clinics in Nkhoma, Malawi. Xpert® HPV testing was carried out according to manufacturer's instructions. Partial genotyping results were obtained immediately (HPV 16, 18/45 and HR-HPV 'other'). Review of individual channel data provided further breakdown of other HR-HPV types into HPV 31 and related; HPV 51/59 and HPV 39 and related. RESULTS: Valid HR-HPV results were obtained from 750/763 samples. Most samples were from previously unscreened women, with 92.3% aged between 20 and 60 years. Overall HR-HPV positivity was 19.9%, with HR-HPV 'other' being more than twice as frequent as HPV 16 or HPV 18/45 and HPV 31-related (HPV 31, 33, 35, 52 or 58) most prevalent. Known HIV status was low (7.3%), but HR-HPV positivity in this group was much higher (43.4%). CONCLUSIONS: HR-HPV testing using Xpert® HPV was practical in a small rural laboratory. The rapid turnaround (within 2h) could facilitate a 'see and treat' programme. Partial genotyping allows assessment of risk beyond HPV 16/18. The high prevalence of HPV 31 and related types warrants further investigation.

Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model.

BACKGROUND: In July 2010 a new multiple hub-and-spoke model for acute stroke care was implemented across the whole of London, UK, with continuous specialist care during the first 72 hours provided at 8 hyper-acute stroke units (HASUs) compared to the previous model of 30 local hospitals receiving acute stroke patients. We investigated differences in clinical outcomes and costs between the new and old models. METHODS: We compared outcomes and costs 'before' (July 2007-July 2008) vs. 'after' (July 2010-June 2011) the introduction of the new model, adjusted for patient characteristics and national time trends in mortality and length of stay. We constructed 90-day and 10-year decision analytic models using data from population based stroke registers, audits and published sources. Mortality and length of stay were modelled using survival analysis. FINDINGS: In a pooled sample of 307 patients 'before' and 3156 patients 'after', survival improved in the 'after' period (age adjusted hazard ratio 0.54; 95% CI 0.41-0.72). The predicted survival rates at 90 days in the deterministic model adjusted for national trends were 87.2% 'before' % (95% CI 86.7%-87.7%) and 88.7% 'after' (95% CI 88.6%-88.8%); a relative reduction in deaths of 12% (95% CI 8%-16%). Based on a cohort of 6,438 stroke patients, the model produces a total cost saving of £5.2 million per year at 90 days (95% CI £4.9-£5.5 million; £811 per patient). CONCLUSION: A centralized model for acute stroke care across an entire metropolitan city appears to have reduced mortality for a reduced cost per patient, predominately as a result of reduced hospital length of stay.

Improving ward management.

This article describes the development, implementation and evaluation of an audit process--the nursing annual audit review--to improve nursing management systems on wards in a large NHS foundation trust. It is set in the context of healthcare governance and improving the quality of services provided by healthcare organisations.

A guide to peer appraisal.

The experience of peer appraisal can be a positive one. The process can help to establish a shared understanding of what is needed for individual, team and organisational objectives to be achieved. Traditional appraisals tend to be about 'me'; the peer approach is about 'us'. The benefits can include a greater sense of ownership, empowerment and responsibility, more support within peer groups and better communication. It may be considered for nurses in all fields.