Dr. Adkins is a Board Certified veterinary ophthalmologist and former clinical instructor at the School of Veterinary Medicine, University of Wisconsin-Madison. She is currently a staff ophthalmologist at the Hope Center for Advanced Veterinary Medicine in Vienna, Virginia. Her clinical and research interests include ocular pharmacology, cataractogenesis and cataract surgery.
Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review.
J Med Internet Res. 2019 Jul 22;21(7):e12869
Authors: Lattie EG, Adkins EC, Winquist N, Stiles-Shields C, Wafford QE, Graham AK
BACKGROUND: College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment.
OBJECTIVE: This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs.
METHODS: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias.
RESULTS: A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies.
CONCLUSIONS: Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
PMID: 31333198 [PubMed - in process]
Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study.
J Med Internet Res. 2018 Jun 11;20(6):e10141
Authors: Schueller SM, Neary M, O'Loughlin K, Adkins EC
BACKGROUND: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use.
OBJECTIVE: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing.
METHODS: Participants were recruited from Northwestern University's Center for Behavioral Intervention Technologies' research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps.
RESULTS: Survey participants commonly found health apps through social media (45.1%, 366/811), personal searches (42.7%, 346/811), or word of mouth (36.9%, 299/811), as opposed to professional sources such as medical providers (24.6%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps.
CONCLUSIONS: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people's adoption and use of such technologies. Our findings indicated that a number of factors-ease of use, aesthetics, and individual experience-drove adoption and use and highlighted areas of focus for app developers and disseminators.
PMID: 29891468 [PubMed - in process]
Management of Ocular Human herpesvirus 1 Infection in a White‑faced Saki Monkey (Pithecia pithecia).
Comp Med. 2018 Jun 15;:
Authors: Bauer KL, Steeil JC, Adkins EA, Childress AL, Wellehan JFX, Kerns KL, Sarro SJ, Holder KA
A 20-y-old male intact white-faced saki monkey (Pithecia pithecia) presented with an acute ocular disease of the righteye.Clinical signs included periocular swelling, conjunctivitis, and anisocoria with a miotic right pupil. Conjunctival swabs werepositive for Human herpesvirus 1 (HHV1) according to PCR amplification with sequencing. Initial clinical signs resolvedwith supportive treatment, and the animal was managed chronically by using acyclovir (5 mg/kg PO twice daily) during flare-ups. After more than 2 y, the progression of clinical disease led to enucleation of the right eye. At 2 mo after surgery, acute presentation of severe neurologic signs, including ataxia and blindness, resulted in euthanasia. Histopathology, PCRanalysis, and sequencing results were consistent with viral encephalitis due to HHV1; coinfection with Pithecia pithecialymphocryptovirus 1 was identified. This report describes the first case of managed HHV1 infection in a platyrrhine primateand the first case of HHV1 in a white-faced saki monkey that was not rapidly fatal.
PMID: 29907165 [PubMed - as supplied by publisher]
Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.
Psychol Serv. 2017 May;14(2):238-245
Authors: Adkins EC, Zalta AK, Boley RA, Glover A, Karnik NS, Schueller SM
Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record
PMID: 28481610 [PubMed - in process]
Oncology drugs for orphan indications: how are HTA processes evolving for this specific drug category?
Clinicoecon Outcomes Res. 2017;9:327-342
Authors: Adkins EM, Nicholson L, Floyd D, Ratcliffe M, Chevrou-Severac H
Orphan drugs (ODs) are intended for the diagnosis, prevention, or treatment of rare diseases. Many cancer subtypes, including all childhood cancers, are defined as rare diseases, and over one-third of ODs are now intended to treat oncology indications. However, market access for oncology ODs is becoming increasingly challenging; ODs are prone to significant uncertainty around their cost-effectiveness, while payers must balance the need for these vital innovations with growing sensitivity to rising costs. The objective of this review was to evaluate different mechanisms that have been introduced to facilitate patient access to oncology ODs in five different countries (Australia, Canada, England, France, and Sweden), using eight oncology ODs and non-orphan oncology drugs as examples of their application. A targeted literature review of health technology assessment (HTA) agency websites was undertaken to identify country-specific guidance and HTA documentation for recently evaluated oncology ODs and non-orphan oncology drugs. None of these countries were found to have explicit HTA criteria for the assessment of ODs, and therefore, oncology ODs are assessed through the usual HTA process. However, distinct and additional processes are adopted to facilitate access to oncology ODs. Review of eight case-study drugs showed that these additional assessment processes were rarely used, and decisions were largely driven by proving cost-effectiveness using standard incremental cost-effectiveness ratio (ICER) thresholds. The predominant implication arising from this study is that application of standard HTA criteria to oncology ODs in many countries fails to take into account any uncertainties around their clinical- and cost-effectiveness, resulting in disparities in HTA reimbursement decisions based on differences in addressing or accepting uncertainty. In order to address this issue, HTA agencies should adopt a more flexible approach to cost-effectiveness, as typified by the Tandvårds-och Läkemedelsförmånsverket in Sweden, which takes into account the small patient numbers involved, limited budget impact, and high unmet medical needs.
PMID: 28652787 [PubMed - in process]
An investigation comparing the efficacy of topical ocular application of tacrolimus and cyclosporine in dogs.
Vet Med Int. 2011;2011:487592
Authors: Hendrix DV, Adkins EA, Ward DA, Stuffle J, Skorobohach B
The purpose of this paper was to determine the efficacy and safety of topical tacrolimus, compared to cyclosporine, for treating keratoconjunctivitis sicca (KCS) in dogs. This study was a two-phase, randomized, controlled, masked clinical trial. Phase 1 evaluated ophthalmic 0.03% tacrolimus in normal dogs. Ocular examinations were performed daily. Phase 2 evaluated the efficacy of tacrolimus in treating KCS. Half the dogs received 2% cyclosporine A; the others received 0.03% tacrolimus, both diluted in olive oil. Four ophthalmic examinations were done over 12 weeks. There was no significant difference between groups in phase I. In phase 2, there was no significant difference in Schirmer tear test I (STT) results between the two groups, and both groups had a significant increase in STT over time. Both drugs were effective in increasing the STT in dogs naïve to lacrimostimulants. Tacrolimus was effective in increasing the STT in 4 dogs currently nonresponsive to cyclosporine.
PMID: 21647338 [PubMed]
Canine anterior uveitis.
Compend Contin Educ Vet. 2010 Nov;32(11):E1
Authors: Wasik B, Adkins E
Canine anterior uveitis can be a debilitating, painful, vision-threatening disease. Several local and systemic diseases can cause anterior uveitis. Because the eye is limited in its ability to respond to injury, different diseases produce similar clinical signs, making an etiologic diagnosis difficult but imperative to improve the likelihood of a successful outcome. A thorough history and complete ocular and physical evaluations are necessary to ensure timely and accurate diagnosis. This article reviews the pathophysiology, most common causes, diagnostic recommendations, current therapeutic options, potential complications, and prognosis for canine anterior uveitis.
PMID: 21882168 [PubMed - indexed for MEDLINE]