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Augmenting outpatient alcohol treatment as usual with online approach bias modification training

Previous research shows that automatic tendency to approach alcohol plays a causal role in problematic alcohol use and can be retrained by Approach Bias Modification (ApBM). ApBM has been shown to be effective for patients diagnosed with alcohol use disorder (AUD) in inpatient treatment. This study aimed to investigate the effectiveness of adding an online ApBM to treatment as usual (TAU) in an outpatient setting compared to receiving TAU with an online placebo training. 139 AUD patients receiving face-to-face or online treatment as usual (TAU) participated in the study. The patients were randomized to an active or placebo version of 8 sessions of online ApBM over a 5-week period. The weekly consumed standard units of alcohol (primary outcome) was measured at pre-and post-training, 3 and 6 months follow-up. Approach tendency was measured pre-and-post ApBM training. No additional effect of ApBM was found on alcohol intake, nor other outcomes such as craving, depression, anxiety, or stress. A significant reduction of the alcohol approach bias was found. This research showed that approach bias retraining in AUD patients in an outpatient treatment setting reduces the tendency to approach alcohol, but this training effect does not translate into a significant difference in alcohol reduction between groups. Explanations for the lack of effects of ApBM on alcohol consumption are treatment goal and severity of AUD. Future ApBM research should target outpatients with an abstinence goal and offer alternative, more user-friendly modes of delivering ApBM training.

Augmenting outpatient alcohol treatment as usual with online approach bias modification training

Previous research shows that automatic tendency to approach alcohol plays a causal role in problematic alcohol use and can be retrained by Approach Bias Modification (ApBM). ApBM has been shown to be effective for patients diagnosed with alcohol use disorder (AUD) in inpatient treatment. This study aimed to investigate the effectiveness of adding an online ApBM to treatment as usual (TAU) in an outpatient setting compared to receiving TAU with an online placebo training. 139 AUD patients receiving face-to-face or online treatment as usual (TAU) participated in the study. The patients were randomized to an active or placebo version of 8 sessions of online ApBM over a 5-week period. The weekly consumed standard units of alcohol (primary outcome) was measured at pre-and post-training, 3 and 6 months follow-up. Approach tendency was measured pre-and-post ApBM training. No additional effect of ApBM was found on alcohol intake, nor other outcomes such as craving, depression, anxiety, or stress. A significant reduction of the alcohol approach bias was found. This research showed that approach bias retraining in AUD patients in an outpatient treatment setting reduces the tendency to approach alcohol, but this training effect does not translate into a significant difference in alcohol reduction between groups. Explanations for the lack of effects of ApBM on alcohol consumption are treatment goal and severity of AUD. Future ApBM research should target outpatients with an abstinence goal and offer alternative, more user-friendly modes of delivering ApBM training.

Vernieuwend auditen: een combinatie van toetsing en motivatie

Wanneer een kwaliteitsmanagementsysteem net is opgezet, is het zinvol om een interne audit te beperken tot het onderzoeken of datgene wat is beschreven ook in de praktijk zo wordt uitgevoerd. Naarmate een interne audit vaker wordt gehanteerd, dient het doel te verschuiven van non-conformiteit naar sturing. Pas dan kan de auditor nagaan of doelstellingen van processen en management daadwerkelijk worden behaald en ontstaan zinvolle verbeteracties. Wanneer men bij interne audits blijft steken in het toetsen van non-conformiteiten, bestaat het risico dat het kwaliteitsmanagementsysteem niet verder wordt ontwikkeld en verbeterd. Uit de resultaten van een pilot onderzoek in het Medisch Centrum Alkmaar blijkt dat een combinatie van verschillende procedures voor auditing aanbeveling verdient. Aldus worden resultaten verkregen op meerdere management niveaus en op meer terreinen dan alleen het werkproces als zodanig. Discrepanties tussen de praktijksituatie en de beschreven procedures komen snel aan het licht, evenals opties voor verbetering van de efficiëntie van processen en procedures. De informatie is een belangrijke impuls voor verbetering van werkprocessen en biedt tevens aanknopingspunten voor verbetering van belangrijke thema’s en speerpunten in de organisatie.

Thermal Personalities of Older People in South Australia

An important consideration for future age-friendly cities is that older people are able to live in housing appropriate for their needs. While thermal comfort in the home is vital for the health and well-being of older people, there are currently few guidelines about how to achieve this. This study is part of a research project that aims to improve the thermal environment of housing for older Australians by investigating the thermal comfort of older people living independently in South Australia and developing thermal comfort guidelines for people ageing-in-place. This paper describes the approach fundamental for developing the guidelines, using data from the study participants’ and the concept of personas to develop a number of discrete “thermal personalities”. Hierarchical Cluster Analysis (HCA) was implemented to analyse the features of research participants, resulting in six distinct clusters. Quantitative and qualitative data from earlier stages of the project were then used to develop the thermal personalities of each cluster. The thermal personalities represent dierent approaches to achieving thermal comfort, taking into account a wide range of factors including personal characteristics, ideas, beliefs and knowledge, house type, and location. Basing the guidelines on thermal personalities highlights the heterogeneity of older people and the context-dependent nature of thermal comfort in the home and will make the guidelines more user-friendly and useful. Original publication at MDPI: https://doi.org/10.3390/ijerph17228402 © 2020 by the authors. Licensee MDPI.

Developing a Smoking Cessation Intervention for People With Severe Mental Illness Treated by Flexible Assertive Community Treatment Teams in the Netherlands

Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.

Using Augmented Reality within Cue Exposure Therapy for alcohol usage disorder treatment and prevention.

Virtual Reality-therapie voor alcoholafhankelijke patiënten met als doel de empowerment te verbeteren.

The use of a virtual reality application as an adjuvant for Alcohol Use Disorder treatment after clinical detoxification.