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Pilot randomised controlled trial of a remotely delivered online intervention for adolescent mental health problems in India: lessons learned about low acceptability and feasibility during the COVID-19 pandemic
- Pattie P. Gonsalves, Bhargav Bhat, Rhea Sharma, Abhijeet Jambhale, Bindiya Chodankar, Mamta Verma, Eleanor Hodgson, Helen A. Weiss, Baptiste Leurent, Kate Cavanagh, Christopher G. Fairburn, Pim Cuijpers, Daniel Michelson, Vikram Patel
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- Journal:
- BJPsych Open / Volume 9 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 27 December 2022, e7
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Background
‘POD Adventures’ is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic.
AimsTo evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors.
MethodWe conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation.
ResultsSeventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants (n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team.
ConclusionsDespite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.
Surveillance of Healthcare-Associated Bloodstream and Urinary Tract Infections in a National Level Network of Indian Hospitals
- Purva Mathur, Paul Malpiedi, Kamini Walia, Rajesh Malhotra, Padmini Srikantiah, Omika Katoch, Sonal Katyal, Surbhi Khurana, Mahesh Chandra Misra, Sunil Gupta, Subodh Kumar, Sushma Sagar, Naveet Vig, Pramod Garg, Arti Kapil, Manoj Sahu, Arunaloke Chakrabarti, Pallab Ray, Manisha Biswal, Neelam Taneja, Priscilla Rupali, Vellore Binila Chacko, Joy Sarojini Michael, Veeraraghavan Balaji, Camilla Rodrigues, Vijaya Lakshmi Nag, Vibhor Tak, Vimala Venkatesh, Chiranjay Mukhopadhyay, KE Vandana, Muralidhar Varma, Vijayshri Deotale, Ruchita Attal, Kanne Padmaja, Chand Wattal, Neeraj Goel, Sanjay Bhattacharya, Tadepalli Karuna, Saurabh Saigal, Bijayini Behera, Sanjeev Singh, MA Thirunarayan, Reema Nath, Raja Ray, Sujata Baveja, Mammen Chandy, Sudipta Mukherjee, Manas Roy, Gaurav Goel, Swagata Tripathy, Satyajeet Misra, Anupam Dey, Tushar Mishra, Hirak Raj, Bashir Fomda, Gulnaz Bashir, Shaista Nazir, Sulochana Devi, Khuraijam Ranjana Devi, Langpoklakpam Chaoba Singh, Padma Das, Anudita Bhargava, Ujjwala Gaikwad, Neeta Khandelwal, Geeta Vaghela, Tanvi Sukharamwala, Prachi Verma, Mamta Lamba, Shristi Jain, Prithwis Bhattacharyya, Anil Phukan, Clarissa Lyngdoh, Rajeev Sharma, Rajni Gaind, Rushika Saksena, Lata Kapoor, Neil Gupta, Aditya Sharma, Daniel VanderEnde, Anoop Velayudhan, Valan Siromany, Kayla Laserson, Randeep Guleria
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s398-s399
- Print publication:
- October 2020
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Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
Funding: None
Disclosures: None