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      ReMindCare App for Early Psychosis: Pragmatic Real World Intervention and Usability Study

      research-article
      , MSci, PhD 1 , 2 , , MD 3 , , MSci 4 , , Prof Dr 4 , , MD 1 , 2 , 5 ,
      (Reviewer), (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      app, clinical practice, mental health, psychosis, real-world intervention, telemedicine

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          Abstract

          Background

          eHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018.

          Objective

          The objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients.

          Methods

          The integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single.

          Results

          Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ 2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ 2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ 2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04).

          Conclusions

          To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis.

          International Registered Report Identifier (IRRID)

          RR2-10.1111/eip.12960

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          Most cited references35

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          A Longitudinal Study on the Mental Health of General Population during the COVID-19 Epidemic in China

          Highlights • A significant reduction in psychological impact 4 weeks after COVID outbreak. • The mean scores of respondents in both surveys were above PTSD cut-offs. • Female gender, physical symptoms associated with a higher psychological impact. • Hand hygiene, mask-wearing & confidence in doctors reduced psychological impact. • Online trauma-focused psychotherapy may be helpful to public during COVID-19.
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            The clinical global impressions scale: applying a research tool in clinical practice.

            This paper reviews the potential value in daily clinical practice of an easily applied research tool, the Clinical Global Impressions (CGI) Scale, for the nonresearcher clinician to quantify and track patient progress and treatment response over time. The instrument is described and sample patient scenarios are provided with scoring rationales and a practical charting system. The CGI severity and improvement scales offer a readily understood, practical measurement tool that can easily be administered by a clinician in a busy clinical practice setting.
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              Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update)

              Background There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health. Methods MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR). Results Forty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation. Conclusion This systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those planning implementation. New interpretations of a large amount of data across e-health systems and healthcare settings have been generated and synthesised into a set of useable recommendations for practice. This review provides a further empirical test of the CFIR and identifies areas where additional research is necessary. Trial registration PROSPERO, CRD42015017661 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0510-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                November 2020
                6 November 2020
                : 8
                : 11
                : e22997
                Affiliations
                [1 ] Department of Mental Health Sanitary Research Institute of Valencia University Clinic Hospital of Valencia Valencia Spain
                [2 ] Faculty of Medicine and Odontology University of Valencia Valencia Spain
                [3 ] Division of Digital Psychiatry Department of Psychiatry Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA United States
                [4 ] Institute of Instrumentation for Molecular Imaging Joint Centre of the Spanish National Research Council and Universitat Politècnica de València Valencia Spain
                [5 ] Centre of Biomedical Investigation in Mental Health Spanish Government Carlos III Health Institute Madrid Spain
                Author notes
                Corresponding Author: Julio Sanjuan julio.sanjuan@ 123456uv.es
                Author information
                https://orcid.org/0000-0002-7657-0590
                https://orcid.org/0000-0002-5362-7937
                https://orcid.org/0000-0003-1141-2126
                https://orcid.org/0000-0003-1692-8922
                https://orcid.org/0000-0003-3174-7927
                Article
                v8i11e22997
                10.2196/22997
                7679204
                33155986
                e64eb506-7228-4855-95df-c6fee604cddf
                ©Lucia Bonet, John Torous, David Arce, Ignacio Blanquer, Julio Sanjuan. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 06.11.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 29 July 2020
                : 15 September 2020
                : 24 September 2020
                : 16 October 2020
                Categories
                Original Paper
                Original Paper

                app,clinical practice,mental health,psychosis,real-world intervention,telemedicine

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