Faculty Bibliography

News of a videogame that received FDA clearance to treat youth with attention-deficit hyperactivity disorder (ADHD) garnered a great deal of media attention and raised questions about the role of digital cognitive training programs for treatment. In order for clinicians and clients to understand this news for the purposes of making treatment decisions one must have an understanding of what it means for a treatment to be considered evidence-based and an understanding of what is required to obtain FDA clearance. Finally, in order to fully inform decisions about treatment, clinicians and parents must be able to consider the evidence supporting cognitive training programs in relation to other treatments available for children with ADHD. A review of these standards and the evidence supporting cognitive training in general, and the new videogame that received recent FDA clearance (EndeavorRX^TM) specifically, revealed an overall lack of support for this approach to treatment. There are multiple psychosocial and pharmacological treatment options with much more evidence supporting their effectiveness than any commercially available cognitive training program. The contrast between receiving FDA clearance without evidence of any observable benefits to the child is explained within a description of the FDA process for clearance and approval. Finally, these conclusions are described in the context of clinicians' decisions regarding services offered and procedures for explaining this to families who may have seen the media attention related to FDA clearance.
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Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH) on students' mental health and academic outcomes. Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five school districts. School clinicians are randomized to either MATCH or usual care (UC) treatment conditions. The target sample includes 168 youths (ages 7-14) referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health. Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board (IRB14-3365). We plan to publish the findings in peer-reviewed journals and present them at academic conferences. Clinical Trial Registration: ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016.

BACKGROUND: Covid-19 disease, resulting from the virus SARS-CoV-2, has caused significant morbidity and mortality across the globe. In the acute setting, Covid-19 is characterized by its inflammatory impact, notably leading to acute respiratory distress syndrome, increased risk of blood clots, cardiomyopathy, and acute kidney injury. Long-term complications known as longhaul Covid, chronic Covid, or post-Covid syndrome include fatigue, depression, persistent respiratory complaints, and decreased quality of life. However, little research exists to elucidate the primary care needs of those who have recovered from Covid-19. This longitudinal observational study describes healthcare usage patterns and new medical diagnoses after acute Covid-19 infection.
METHOD(S): We queried the NYU Langone COVID Deidentified Dataset for adults 18+ years old with a positive SARS-CoV-2 PCR test. Patients had at least one visit in the NYU Langone Health system >2 weeks before and >2 weeks after infection (n = 2940). We further narrowed this cohort to patients with a primary care encounter where a Covid-19 related concern was documented at follow-up (n = 454; 57% female; 22%=18-42 years, 51%=43-67 years, 27%=68+ years old). The median length of follow-up was 6 weeks (IQR=3.6-10.1 weeks, max=38 weeks). ICD-10 codes and the Clinical Classification Software Refined (CCSR) categories were used to identify diagnoses newly developed after Covid-19 infection or symptoms that persisted beyond the initial 14-day infection period.
RESULT(S): Of 2,940 patients with pre and post-infection visits, only 454 (15%) sought primary care for a Covid-19 related concern. Respiratory signs and symptoms were the most common complaint. Prevalent diagnoses included cough (8%), hypoxia or respiratory failure (8%), and shortness of breath (7%). Malaise and fatigue (7%), musculoskeletal pain (6%), and generalized weakness and deconditioning (5%) were also common. Nutritional deficiencies were documented among 28 patients (6%), most often for vitamin D deficiency (5%). Palpitations (5%) and nonspecific chest pain (such as chest tightness or discomfort, 3%) as well as deep vein thrombosis and pulmonary emboli (4%) were also reported.
CONCLUSION(S): Most patients with a Covid-19 diagnosis did not seek follow-up, consistent with reports that Covid-19 predominantly causes acute illness. For patients who developed new or persistent symptoms, the most common complaints were respiratory concerns, malaise and fatigue, and musculoskeletal pain. The persistence of these symptoms in our cohort suggests that patients may indeed present a constellation of symptoms after acute Covid-19 infection. Updated longitudinal queries and further research may continue to highlight the importance of tailoring longer term primary care for those who have recovered from acute Covid infection. LEARNING OBJECTIVE #1: Identify common symptoms of patients returning to primary care more than 2 weeks after Covid-19 infection LEARNING OBJECTIVE #2: Determine need for primary care follow-up after Covid-19 recovery