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Health Information Technology
Published in Kelly H. Zou, Lobna A. Salem, Amrit Ray, Real-World Evidence in a Patient-Centric Digital Era, 2023
Joseph P. Cook, Gabriel Jipa, Claudia Zavala, Lobna A. Salem
Several examples of real-time platforms FDA approved might be relevant, as they were implemented as real-time technology solutions. An AI-driven service received FDA’s permit (Commissioner, 2020) as the first AI diagnostic system in 2018 based on a clinical study of retinal images obtained from 874 patients to detect more than mild positive conditions. The solution (IDx-DR, 2021) uses a specialized fundus camera to capture two images per eye followed by AI service processing and diagnosis, providing immediate results. The use of the camera to generate fundus images, to feed a predictive model demonstrates how a trained model can be used in an end-to-end AI application. The model training used a publicly available dataset of labeled images, Messidor-2 (Decencière et al., 2014; Abramoff et al., 2016).Another example of the use of Digital Therapeutics is for treating Chronic Insomnia, by providing a web based CBT-I (Cognitive Behavioral Therapy for Insomnia, a psychological intervention) platform showing robust clinical efficacy, providing salience stimulus using mobile capabilities or sleep diary, being a cost-effective treatment (Morin, 2020). This combines various technologies to deliver a specific clinical outcome.
Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
Cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line therapy. It is the most widely used among nonpharmacologic interventions. CBT-I has been found to be effective in a wide variety of clinical populations and is considered as the first-line treatment for insomnia.21
Sleep and pregnancy complications
Published in Moshe Hod, Vincenzo Berghella, Mary E. D'Alton, Gian Carlo Di Renzo, Eduard Gratacós, Vassilios Fanos, New Technologies and Perinatal Medicine, 2019
Cognitive behavioral therapy for Insomnia (CBT-I) is the first line of treatment recommended for insomnia in the nonpregnant population. Data on the use of CBT-I in pregnancy are lacking, but observational studies show improvement in sleep measures in women with insomnia who were treated with CBT-I (46). A recent review of sleep-promoting medications in pregnancy showed no clear correlation of increased risk of congenital malformation; however, benzodiazepines and hypnotic benzodiazepine receptor agonists may increase rates of preterm birth, low birth weight, and/or small for gestational age infants (47).
A Scoping Study of Insomnia Symptoms in School Teachers
Published in Behavioral Sleep Medicine, 2023
Madelaine Gierc, Robyn A. Jackowich, Sandra Halliday, Judith R. Davidson
Although mindfulness programs and a fitness intervention were associated with improved sleep, only one intervention was adequately tested in randomized controlled trials. This was an online cognitive behavioral program (GET.ON) for insomnia symptoms as well as work-related rumination, which produced superior improvements in sleep ratings compared to a waitlist control (Ebert et al., 2015; Thiart et al., 2015). The program contained stimulus control therapy and sleep restriction, which are central components of cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line treatment for chronic insomnia (Qaseem et al., 2016; Riemann et al., 2017). The effect sizes for the sleep improvements found in these studies are comparable to those for CBT-I alone, presented in various formats, including digital (Kaldo et al., 2015; Koffel et al., 2015; Okajima et al., 2011). It is unknown to what extent the sleep improvements were due to these sleep-specific components of the program versus the techniques for reducing worry and rumination and fostering detachment from work. Ebert et al. (2015) believe that sleep improvement was mediated by a reduction in perseverative cognitions. Conventional CBT-I has not yet been tested for treating insomnia specifically in teachers. More information is needed on whether and how to tailor sleep programs to teachers. An important question is if the addition of targeted interventions for teaching-specific stressors improves sleep or treatment acceptability beyond providing CBT-I alone.
Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention
Published in Behavioral Sleep Medicine, 2023
Sarah N. Price, Heidi A. Hamann, Laila Halaby, Juanita I. Trejo, Fernanda Corella, Karen L. Weihs
Management of sleep disturbance in patients with cancer generally includes sleep hygiene education plus either pharmacologic and/or psychosocial intervention (Denlinger et al., 2014). To date, exploration of methods to manage sleep disturbance in patients with cancer is limited but growing, with much efficacy data extrapolated from non-cancer populations. Pharmacotherapy may include sedative-hypnotic medications such as non-benzodiazepines like eszopiclone and zolpidem, benzodiazepines, antidepressants (such as mirtazapine and trazodone) and antihistamines (such as diphenhydramine; Qaseem et al., 2016). Psychosocial interventions may include Cognitive Behavioral Therapy for Insomnia (CBT-I), Brief Behavioral Therapy for Insomnia (BBT-I), or exercise/mind-body interventions (such as yoga, Tai Chi, or Qigong; Denlinger et al., 2014). Although further research is needed, psychosocial intervention (specifically CBT-I) is generally recommended over pharmacotherapy for insomnia among both the general population and among patients with cancer given lower risk of harm (Denlinger et al., 2014; Qaseem et al., 2016).
Zolpidem as a high risk factor for elderly suicide in South Korea
Published in Archives of Suicide Research, 2022
Eun Kim, Jae Hee Lee, Duk Hee Lee
Therefore, physicians should be very careful when issuing hypnotic and sedative prescriptions for patients over 65 years old, as their physical and mental conditions make them especially vulnerable to adverse drug reactions. Physicians should be aware of the importance of monitoring patients’ drug ingestion behavior and of seeking alternative approaches such as sleep education and cognitive behavioral approach. Reducing dysfunctional attitudes about sleep by checking their falsity and behavioral control of sleep environments are the main components of insomnia treatment. This approach demonstrated effectiveness in reducing depression and suicidality. Cognitive behavioral therapy for insomnia (CBT-I) has been known to be very effective in reducing insomnia severity through a six-session treatment over 4 weeks (Trockel, Karlin, Taylor, & Manber, 2014), and it could be a better way to start with CBT-I for patients with mild insomnia. When their insomnia is severe, zolpidem may be effective in controlling suicidal ideation (Hamilton & Buysse, 2019). That is, cognitive-behavioral therapy should be considered in conjunction with drug therapy. A tailored therapy for each patient is needed, such as sleep quality and the behavior towards their own sleep cycle. A proper sleep education for each patient is recommended. For instance, each patient should be aware of false beliefs about sleep and sleep quality.