Lower Dropout Rates Research Articles

N-Gage

The study of student engagement has attracted growing interests to address problems such as low academic performance, disaffection, and high dropout rates. Existing approaches to measuring student engagement typically rely on survey-based instruments. While effective, those approaches are time-consuming and labour-intensive. Meanwhile, both the response rate and quality of the survey are usually poor. As an alternative, in this paper, we investigate whether we can infer and predict engagement at multiple dimensions, just using sensors. We hypothesize that multidimensional student engagement level can be translated into physiological responses and activity changes during the class, and also be affected by the environmental changes. Therefore, we aim to explore the following questions: Can we measure the multiple dimensions of high school student's learning engagement including emotional, behavioural and cognitive engagement with sensing data in the wild? Can we derive the activity, physiological, and environmental factors contributing to the different dimensions of student learning engagement? If yes, which sensors are the most useful in differentiating each dimension of the engagement? Then, we conduct an in-situ study in a high school from 23 students and 6 teachers in 144 classes over 11 courses for 4 weeks. We present the n-Gage, a student engagement sensing system using a combination of sensors from wearables and environments to automatically detect student in-class multidimensional learning engagement. Extensive experiment results show that n-Gage can accurately predict multidimensional student engagement in real-world scenarios with an average mean absolute error (MAE) of 0.788 and root mean square error (RMSE) of 0.975 using all the sensors. We also show a set of interesting findings of how different factors (e.g., combinations of sensors, school subjects, CO2 level) affect each dimension of the student learning engagement.

Unique Mortality Profile in Japanese Patients with COPD: An Analysis from the Hokkaido COPD Cohort Study.

PurposeCauses of death may be unique and different in Japanese patients with COPD because they are generally older, thinner, experience fewer exacerbations, and live longer than those in other countries. We investigated the detailed mortality profile in the Hokkaido COPD cohort study, which completed a 10-year follow-up with a very low dropout rate.Patients and MethodsWe prospectively examined the 10-year natural history in 279 Japanese patients with COPD (GOLD 1, 26%; GOLD 2, 45%; GOLD 3, 24%; and GOLD 4, 5%). The majority of patients were male, and the average age at baseline was 69 years old. About 95% of all patients had accurate mortality data. The risk factors for mortality were also analyzed.ResultsDuring the 10 years, 112 patients (40%) died. Their median survival time was 6.1 years (interquartile range: 4.7–7.9 years), and age at death was 79 ± 6 years old (mean ± SD). Respiratory diseases, including pneumonia, were the leading causes of death in 45 (40%), followed by lung cancer in 24 (21%), other cancers in 18 (16%), and cardiovascular diseases in 12 (11%). In particular, lung cancer-related death was equally distributed across all COPD stages, with a higher proportion of lung cancer in the relatively younger generation (<64 years old). Older age at baseline, lower BMI, and severer emphysema were significant risk factors for all-cause mortality.ConclusionThe unique mortality profile observed in this study should be considered when designing strategies for the management of patients with COPD in any geographic region.

School reorganization reforms: the case of multi-site schools in Colombia

ABSTRACT To contribute to the debate about the reorganization of public-school supply, we analyze a reform introduced in Colombia in 2001 that merged independent schools into a single institution. Specifically, we estimate differences in achievement, dropout rates, teacher characteristics, and technological infrastructure between sites belonging to multi-site schools and single-site schools. Our results suggest that there are no differences in test scores, but lower dropout rates in multi-site schools. Also, we found that sites belonging to multi-site schools, especially in larger networks (more than six sites) and far away from the main site of the school, have younger teachers with lower salaries who are more likely to have a temporary contract. Finally, we provide suggestive evidence that more isolated sites from large-sized schools have less access to the internet and a computer room than single-site schools. These results provide evidence for reforms to increase cooperation between sites.

Minorities and culture of learning: an anthropological study of the Muslim community in Telangana state in India

ABSTRACT What are the factors hindering educational development among Muslims in India in general and the newly born Telangana state in particular, is the key sociological question confronting the educationists and policymakers? The current paper based on empirical study provides an anthropological perspective to understand a number of socio-cultural factors responsible for lower retention and higher dropout rates among Muslims in public schools across the class and gender lines. It highlights that with positive state interventions, the enrolment and retention levels of Muslim working-class children have increased enormously besides a significant improvement in the same among Muslim girls also. Thus the paper argues that a relaxation in school protocols facilitates Muslim children integrating the academic demands and socio-cultural obligations they deem necessary while addressing culturally sensitive issues in curriculum and pedagogic practices foster attitudinal changes together which contribute immensely to the educational advancement among them.

A brief clinical report documenting a novel therapeutic technique (MEmory Specificity Training, MEST) for depression: a summary of two pilot randomized controlled trials.

Depression has a profound effect on quality of life (QoL) and is associated with rumination, hopelessness and social difficulties. It is important to explore novel intervention techniques that may reduce depression, and also improve rumination, hope and QoL. In this brief clinical report, we report the findings of two pilot randomized controlled trials examining the feasibility of a potentially important novel clinical technique (MEmory Specificity Training, MEST) on depression, social problem-solving (Study 1), rumination, hope and QoL (Study 2). In Study 1, Iranian women with depression (n = 24) completed the Beck Depression Inventory-II and Means-Ends Problem-Solving test at baseline, post-training and 2-month follow-up. In Study 2, female students with moderate depression (n = 24) completed the Ruminative Response Scale, Adult Hope Scale and Short-Form Health Survey at baseline and post-training. Assessors were blind to group allocation. In both studies participants were randomly assigned to MEST or a non-active control group. In both studies, MEST was found to be feasible and associated with low drop-out rates and high rates of self-reported patient and group facilitator satisfaction. There was preliminary evidence that MEST may bring about clinical benefit in terms of depression, social problem-solving (Study 1), QoL, rumination and hope (Study 2). MEST is a promising technique in the treatment of depression.

Using Home Language as a Pedagogical Resource: Working Collaboratively with Ontario Educators to Support English Language Learners in the Classroom

Coherent policies to address the implications of linguistic diversity for instruction are lacking at all levels of schooling in Canada (Cummins, 2014; Volante et al., 2020). Many English language learners (ELLs)—often refugees or those of lower socioeconomic status—experience academic difficulties (Volante et al., 2017). Teachers report low self-efficacy and a lack of preparedness to meet the professional challenges of continually rising numbers of ELLs in their classrooms (Faez, 2012). Numerous studies demonstrate that students who have the opportunity to maintain and develop their Home Language (L1) at school outperform their peers in English-only programs, achieve better academic outcomes, and experience lower drop-out rates (Baker, 2011; Genesee et al., 2006; Thomas &amp; Collier, 2002). This is because the academic language and literacy skills that students acquire in their L1 readily transfer to English (Cummins, 2017). Additionally, when L1 is validated as a valuable resource for learning, students experience an affirmation of self that contributes to positive identity formation. By joining forces with educators in collaborative professional learning teams, this study connects what we know (an extensive knowledge base that argues that the use of students’ L1 is essential to their success) and what we do (instructional practice that predominantly excludes students’ L1) in the classroom. It asks: in what ways and to what extent can collaborative professional development assist educators in providing more equitable educational opportunities for English language learners in Ontario schools?

High adherence and low dropout rate in a virtual clinical study of atopic dermatitis through weekly reward-based personalized genetic lifestyle reports.

IntroductionClinical trials often suffer from significant recruitment barriers, poor adherence, and dropouts, which increase costs and negatively affect trial outcomes. The aim of this study was to examine whether making it virtual and reward-based would enable nationwide recruitment, identify patients with variable disease severity, achieve high adherence, and reduce dropouts.MethodsIn a siteless, virtual feasibility study, individuals with atopic dermatitis (AD) were recruited online. During the 8-week study, subjects used their smartphones weekly to photograph target AD lesions, and completed patient-oriented eczema measure (POEM) and treatment use questionnaires. In return, subjects were rewarded every week with personalized lifestyle reports based on their DNA.ResultsOver the course of the 11 day recruitment period, 164 (82% women and 18% men) filled in the form to participate, of which 65 fulfilled the inclusion criteria and signed the informed consent. Ten were excluded as they did not complete the mandatory study task of returning the DNA sample. 55 (91% women, 9% men) subjects returned the DNA sample and were enrolled throughout Denmark, the majority outside the Copenhagen capital region in rural areas with relatively low physician coverage. The mean age was 28.5 (SD ±9.5 years, range 18–52 years). The baseline POEM score was 14.5±5.6 (range 6–28). Based on the POEM, 7 individuals had mild, 28 had moderate, 17 had severe, and 3 had very severe eczema. The retention rate was 96% as 53 out of 55 enrolled completed the study. The adherence was very high, and more than 90% of all study tasks were completed. Follow up of 41 subjects showed that 90% would take part again or continue if the study had been longer.ConclusionA virtual trial design enables recruitment with broad geographic reach and throughout the full spectrum of disease severity. Providing personalized genetic reports as a reward seems to contribute to high adherence and retention.

Understanding barriers to treatment and treatment delivery preferences for individuals with symptoms of hoarding disorder: A preliminary study

Hoarding Disorder (HD) is a common and debilitating mental health condition that is characterized by low treatment uptake and high drop-out rates. The aim of the present study was to 1) provide a preliminary evaluation of the barriers to psychological help-seeking and 2) understand psychological treatment preferences of individuals with clinically significant symptoms of HD. Fifty participants (82% female; M age = 47.82, SD = 12.92) completed the study. The most frequently cited barriers to treatment were related to cost (66%), self-reliance (58%), and lack of knowledge about treatment options (42%). Likelihood of seeking treatment for HD symptoms was low and past-treatment predicted treatment-seeking intention, while symptom severity, depression, and internalized stigma were non-significant predictors (F(4, 44) = 9.40, p < .001; R2 = 0.49). Participants indicated a preference for individually-administered treatment (41.3%) or remote low intensity treatments (30.4%), over accelerated or group therapy approaches. The study highlights that individuals with HD experience significant barriers to accessing psychological treatment for HD and providing a variety of low cost, evidence-based treatment approaches may enhance treatment uptake for this population.

Intensive supportive ambulatory aftercare may increase adherence to treatment and decrease depressive symptoms in patients after a suicide attempt

Summary Objectives Patients who survive a suicide attempt present an increased risk of relapse during the three months after discharge from a hospital, referred to herein as the post-discharge period. Developing and assessing the efficacy and safety of methods that reduce the risk of relapse in the post-discharge period is critical for professionals in the field of suicide prevention. This study aimed to compare the efficacy of a new Intensive Psychosocial Care (IPC) program after discharge for a suicide attempt with a Standard Care Program (SCP) in non-hospitalized patients. Methods We conducted a open-label prospective trial to compare the outcome of patients who have attempted suicide for a duration of 6 months according to whether they were included in care program group IPC or SCP after discharge from the emergency department. Results Using the Beck Depression Inventory short-form (BDI-SF), the IPC program was significantly associated with both a decrease of the total score of the scale at 6th month, and a trend towards a decline in the time lag between discharge and the improvement of depressive symptoms. When compared to SCP, patients receiving the IPC had also a lower drop-out rate (43% versus 15% in the 6th month) and a higher adherence to treatment until the 3rd month (56% versus 41.7%). Median time to reattempt was 83.7 [95%CI: 45.8–121.7] days for IPC as compared to 75.6 [95%CI: 38.8–112.4] days for SCP, respectively. Conclusions Personalized follow-up with close contacts by the same caregivers as those who initially assessed the patient in the emergency room improved adherence to care and reduced depressive symptoms more intensely and faster after a suicide attempt.

Interaction of village and school latrines on educational outcomes in India

Abstract Research has shown that improved sanitation environments can lead to better educational outcomes. Similarly, there is some evidence that school latrines may also improve school enrollment and attendance, particularly for girls. This paper explores the interaction effect of village-level latrine coverage and school latrines on child educational outcomes. The overall improved sanitation conditions from higher latrine coverage and the presence of school latrines might produce an additive effect and improve educational outcomes even further. Using multiple years of data from the Annual Status of Education Report (ASER) in India, this paper shows that there is no evidence of an additive effect. However, across multiple models, village-level latrine coverage is associated with lower school dropout rates and higher test scores, particularly among girls. School latrines do not appear to have a strong positive association with educational outcomes.

Developmental and sequenced one-to-one educational intervention (DS1-EI) for autism spectrum disorder and intellectual disability: a two-year interim report of a randomized single-blind multicenter controlled trial

BackgroundChildren with autism spectrum disorder (ASD) and moderate to severe intellectual disability (ID) face many challenges. There is little evidence-based research into educational settings for children with ID and ASD and in France. Little is known about how this unserved population could benefit from intervention and education. This study assessed the feasibility and efficacy of a new intervention model using an individualized educational approach.MethodsWe conducted a randomized, single-blind controlled trial to assess a novel intervention: the “Developmental and Sequenced One-to-One Intervention (DS1-EI)”. In DS1-EI, trained teachers worked one-to-one with each child in a small classroom setting, offering 10 h per week of the intervention. The focus was on encouraging spontaneous communication, promoting skills through play with peers, supporting positive interactions, and developmental and sequenced learning. We enrolled 5- to 9-year-old children with ASD and ID across 11 French child care institutions for children with co-occurring ASD and ID. Participants were matched in dyads by developmental quotient and randomized to the treatment-as-usual (TAU) group or the DS1-EI group. Independent raters blindly assessed the primary variables: The Childhood Autism Rating scale (CARS) and the Psychoeducational Profile, third edition (PEP-3). The secondary variables included the Vineland Adaptive Behavior Scale II (VABS-II) and the Clinical Global Assessment Scale (CGAS). Here we perform interim analyses at 24 months.ResultsAt baseline, 72 participants were randomized. Nine patients (5 in the DS1-EI group and 4 in the TAU group) dropped out of the study. Using linear mixed models, both intent-to-treat (ITT) and per-protocol (PP) analyses at the 12-, 18- and 24-month outcomes showed no significant group nor group-by-time interaction effects. However, we found significant improvements in most primary and secondary variables over time in both groups.ConclusionsThe study did not show that DS1-EI was superior to TAU in treating children with ASD and ID over 24 months. However, the low dropout rate shows that DS1-EI is feasible, and well accepted. As the study is still ongoing, we need to wait for data at 36 months to ensure whether DS1-EI could be recommended.Trial registrationANSM130282B-31 (April 16, 2013) and ACTRN12616000592448. Registered 6 May 2016, retrospectively registered, http://www.anzctr.org.au/

Monitoring Students at the University: Design and Application of a Moodle Plugin

Early detection of at-risk students is essential, especially in the university environment. Moreover, personalized learning has been shown to increase motivation and lower student dropout rates. At present, the average dropout rates among students following courses leading to the award of Spanish university degrees are around 18% and 42.8% for presential teaching and online courses, respectively. The objectives of this study are: (1) to design and to implement a Modular Object-Oriented Dynamic Learning Environment (Moodle) plugin, “eOrientation”, for the early detection of at-risk students; (2) to test the effectiveness of the “eOrientation” plugin on university students. We worked with 279 third-year students following health sciences degrees. A process for extracting information records was also implemented. In addition, a learning analytics module was developed, through which both supervised and unsupervised Machine Learning techniques can be applied. All these measures facilitated the personalized monitoring of the students and the easier detection of students at academic risk. The use of this tool could be of great importance to teachers and university governing teams, as it can assist the early detection of students at academic risk. Future studies will be aimed at testing the plugin using the Moodle environment on degree courses at other universities.

Long-Term Follow-Up of Men Invited to Participate in a Population-Based Abdominal Aortic Aneurysm Screening Program.

A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P < .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men.

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence.

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

Development and randomized-controlled evaluation of a web-based training in evidence-based trauma therapy.

Although trauma-focused interventions are effective in treating patients with PTSD, they are not frequently used in clinical practice. To address this gap, the present study aimed to develop and evaluate a web-based training for trauma-focused therapy. Our main objective was to increase the knowledge and competencies of current and future licensed psychotherapists in the core procedures that have been identified as efficacious treatment components. The web-based training consists of modules on diagnostics and psychoeducation, disease models, evidence-based interventions, coping with difficulties in therapy, and exercises to promote self-care and mental hygiene. In a wait-list controlled evaluation study, therapists (N = 499) were randomized into either an intervention or a wait-list control group. Knowledge, competencies, self-efficacy expectations, and willingness to conduct trauma-focused therapy were assessed via self-report in both groups before and after training completion. Results indicate a relatively low dropout rate and a high level of satisfaction with the content and structure of the training. In comparison to the wait-list control group, participants who successfully completed the training showed a significantly greater improvement in subjective ratings of knowledge and perceived treatment competence, perceived emotional competence, self-efficacy, and willingness to conduct trauma-focused therapy. They also improved significantly in their results on the knowledge test. In sum, results of this feasibility study suggest that the web-based training is an acceptable program to increase knowledge and competencies in terms of trauma-focused interventions. Further research should focus on evaluating whether the training increases therapists’ competence in terms of objectively-rated clinical skills.

Is Benign Prostatic Hyperplasia a Perpetrator for Periprosthetic Joint Infection?: Commentary on an article by Hamidreza Yazdi, MD, et al.: "Symptomatic Benign Prostatic Hyperplasia. A Risk Factor for Periprosthetic Joint Infection in Male Patients".

Commentary In the current era, total joint arthroplasty (TJA) is considered to be safe and cost-effective and a successful procedure to improve quality of life. However, a periprosthetic joint infection (PJI) is a huge setback to the patient, family, and surgeon alike. Although the overall incidence of PJI following TJA is low, there is high morbidity (persistent pain, prolonged hospital stay, multiple surgical procedures, functional loss) and even mortality associated with PJI. Over the last couple of decades, several hundred studies have been done on the prevention, diagnosis, treatment, and outcomes of PJI. We are certainly making progress by lowering the incidence of infection, but the search for causes is relentless. In the current study, Yazdi et al. performed a retrospective study to explore another potential cause for PJI: benign prostatic hyperplasia (BPH) in male patients. Anecdotally, I have also observed BPH to be a potential cause for PJI, given that my current practice is dominated by male patients. Yazdi et al. reviewed 12,902 patients from their institution registry database and grouped them into symptomatic and non-symptomatic BPH groups. They further matched patients with symptomatic BPH (n = 250) with a non-symptomatic BPH control group in a 1:3 ratio. The PJI rate was 7.9% in the symptomatic group compared with 2.8% in the control group. Multivariate regression analysis in unmatched groups showed that symptomatic BPH was a strong independent risk factor for PJI. Symptomatic BPH remained a significant risk factor for PJI after matching for variables related to outcomes. Yazdi et al. concluded that symptomatic BPH might be a reason for the high incidence of PJI in male patients. Interestingly, in the current study, multivariate analysis also showed that symptomatic BPH carried a risk higher than even diabetes mellitus for PJI. Another interesting finding in the current study is that symptomatic BPH showed a higher trend toward acute PJI. However, there is no obvious pathomechanism as to why BPH could cause PJI. It is hypothesized that the collection of excess urine in the bladder in the perioperative period or high post-void residual urine in patients with symptomatic BPH increases the bacterial load, subsequently potentiating the spread of the infection to the newly implanted joint prosthesis. With the current trend of patients undergoing fast-track TJA under spinal anesthesia, the incidence of postoperative urinary retention is on the rise1. The incidence of postoperative urinary retention may even be higher with symptomatic BPH and may potentially increase the risk of PJI, especially if BPH is not treated before the surgical procedure. Similarly, the current trend of multimodal perioperative pain management for TJA includes a scopolamine (anticholinergic) patch, given its ease of use and successful avoidance of postoperative nausea and vomiting2. In patients with symptomatic BPH, scopolamine might further increase BPH-related urinary retention or post-void residual urine and subsequent risk of PJI. This preliminary study identifies BPH as a potential cause for PJI in male patients. The study had several limitations: it was a retrospective study, there were potential concerns with regard to the data collection method, the duration of follow-up was 1 year, and there were no explicit data on catheterization done in the perioperative period. There are several strengths to this study as well. The Rothman Institute has a reputation for good patient follow-up with low dropout rates, this is a single-institution study, and there was a matched-cohort study design to minimize the effect of confounding variables. For these reasons, I consider this a well-conducted outcome study. The total number of TJAs performed annually has been on an upward trend globally. It is expected to reach 4 million annually by 2030 in the United States3 alone, in contrast to about 1 million per year currently. Any and every step to reduce the incidence of PJI is worth taking into consideration considering the economic and individual patient burden of treating a PJI. Kee et al. demonstrated that nearly half of all patients undergoing early revision arthroplasties had at least 1 modifiable risk factor and emphasized proper patient selection and preoperative optimization of modifiable risk factors to minimize the risk of adverse outcomes following TJA4, but BPH was not a part of the study. It would be worthwhile to also include symptomatic BPH as a modifiable risk factor and to preoperatively optimize patients to reduce PJI. This study by Yazdi et al. will serve as a great precursor for further multicenter, larger population-based studies to assess any regional or geographical biases and confounding factors.

Pharmacological interventions for the treatment of insomnia: quantitative comparison of drug efficacy

PurposeAlthough different forms of pharmacological intervention are often prescribed for insomnia disorder, the comparative efficacies among various drugs remain unclear. We therefore conducted this study to quantitatively compare the efficacy of various pharmacotherapies for insomnia by modeling. MethodsWe searched PubMed, EMBASE and Cochrane Library databases for randomized placebo-controlled trials of insomnia medications that were conducted within a designated time period (from the inception dates to May 16, 2019). Pharmacodynamic models were established to describe the time course of changes from baseline in selected sleep parameters. Sleep quality and dropout rates were also compared by a single-arm meta-analysis. ResultsIn sum, 43 studies covering 44 trials (14,535 patients) were included in the analysis. The drugs evaluated included flurazepam, quazepam, temazepam, triazolam, eszopiclone, zaleplon, zolpidem, extended-release zolpidem, suvorexant, ramelteon and doxepin. The established models revealed eszopiclone had the highest efficacy in terms of sleep latency (SL), total sleep time (TST), and sleep quality, and was also associated with the lowest dropout rates. The effect of suvorexant on the parameter ‘wake after sleep onset’ (WASO) was significantly higher than that of the other drugs analyzed. ConclusionsEach drug has its own characteristics in the treatment of insomnia, and this needs to be taken into consideration to meet individual clinical needs. These results serve as a quantitative supplement for clinical practice by reflecting the difference in efficacy of various drugs in the treatment of insomnia.

Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial

RationalePulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the...

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Background: Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. Objective: To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. Method: In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. Results: The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. Conclusions: In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

Developments of prolonged exposure in treatment effect of post-traumatic stress disorder and controlling dropout rate: A meta-analytic review.

Prolonged exposure (PE) has been proved as an efficacious psychological treatment for post-traumatic stress disorder (PTSD). There are mainly two changed formats of PE: the modified PE (mPE) and the PE combined with drug (PE/d). Symptom reduction following these two PE training formats has been reported in the patients with PTSD. However, very little is focusing on the direct comparison of mPE + PE/d and PE. Therefore, this paper aims to compare the mPE + PE/d with PE on the PTSD treatment effect and the dropout rate directly through the meta-analysis. Eighteen studies with total sample size of 1,397 met the final inclusion criteria. The results showed that mPE + PE/d had significantly lower posttreatment PTSD severity than control group (relaxation, wait list, etc.). There was no significant difference between mPE + PE/d and PE on the posttreatment, the follow-up PTSD score, and the posttreatment dropout rate. Compared with PE, lower PTSD symptoms and marginally lower dropout rate following the treatment were observed in the PE/d group. PE/d yielded a significantly larger effect size than mPE when compared with PE on the posttreatment PTSD symptom severity. The significance of the above results would not be changed even if studies causing high heterogeneity were removed. Although PE/d enhanced treatment effect and lowered dropout rate when compared with PE, it was still insufficient to draw the conclusion that formats of adjustments would specifically improve the implementation of PE. Further studies are warranted to develop an easily accomplished and efficacy-guaranteeing PE programme for PTSD patients.