Large Clinical Networks Research Articles

An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial.

Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap. Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models. Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings. https://drks.de, DRKS00031043.

Implementing and evaluating standardised tuberculosis incident management for nonhousehold contacts in a large clinical network.

A systematic approach to nonhousehold TB contact identified a similar number of LTBI cases to household screening over the same time period https://bit.ly/2Tq96LN

Quantifying high dependency care: a prospective cohort study in Yorkshire (UK)

High dependency care (HDC) is a level of care situated between intensive care and usual ward care with its delivery being independent of location. Inadequate definition makes it problematic to determine the number of children receiving HDC, to identify their care setting and therefore to undertake service planning. We aimed to estimate the volume of hospital inpatient HDC in a geographically defined population using a customised measurement tool in four types of paediatric hospital services (1) tertiary specialist wards, (2) tertiary paediatric intensive care units, (3) district general hospitals (DGHs) general wards and (4) wards at a major acute general hospital. A region-wide prospective cohort study during 2005 collected data to develop a 36-item HDC measurement tool, which then identified children receiving HDC by day and night. The cohort identified 1,763 children as receiving HDC during an admission to 1 of 36 hospital wards in 14 hospitals. HDC was delivered during 9,077 shift periods of 12 h or 4,538 bed days. The volume of care and patient profiles varied by hospital type, within hospital by ward type and by age and season. Tertiary specialist wards and ICUs provided 72% of HDC, with the remainder delivered at the DGHs and the major acute general hospital. The volume of admissions to tertiary specialist wards showed little seasonality and children tended to be older (26% were aged 10-15 years). By comparison, admissions to DGHs were younger with an excess during the winter months. This is the first UK study to quantify HDC from empirical data encompassing all hospital and ward types within a large clinical network. A lack of HDC-designated beds across the region resulted in HDC delivery on all types of hospital wards. The study size and representativeness makes the estimated number of HDC bed days per head of population likely to reflect the wider UK population.

The Demographic Profile of Patients with Acute Coronary Syndromes Referred for Invasive Treatment in a Large Clinical Network Using a Novel Web-based Triage and Transfer System

Background: An electronic Acute Coronary Syndrome (ACS) referral and triage system in South East Queensland links two tertiary and ten non-metropolitan hospitals using a web-based application. Methods: We sought to analyse patient demographics, triage category and ACS presentation between 01/01/2007 and 31/12/2010. Baseline characteristics were collected: gender, age, bodymass index (BMI), diabetes andsmoking history. Triage and ACS category were collected. Comparisons were made between those transferred and not transferred. Results: 4845 patientswere referred ofwhom4021 (83%) were transferred. There was no statistical difference for mean age 66.6± 0.20 years or mean BMI 28.5± 0.09. The prevalence of diabetes was 17.58%. Those transferred were more likely to be male (64.5%, p= 0.046) and curr d ( l 1 o ( c w ( e N u

A Public Health Approach to Pharmacogenomics and Gene-Based Diagnostic Tests

While the human genome project is likely to lead to fundamental changes in our understanding of disease causation and our ability to screen for disease predisposition and treatment responsiveness, the current healthcare system is not properly aligned to ensure the proper use of these advances. As the pace of genetic technology development increases and new pharmacogenetic drugs and gene-based diagnostic tests increasingly impact providers, patients, health plans, payers and employers, it will be crucial to develop an evidence-based framework by which to evaluate these new tests and treatments. In order to increase the level of evidence available and allow for informed decisions in the face of strong marketing and advocacy forces, the authors suggest the development of one (or more) large clinical networks with the purpose of systematically evaluating the clinical effectiveness of new genomic applications, including pharmaceuticals and gene-based diagnostic tests, in 'real world' settings.

Selecting patients for long-acting novel antipsychotic therapy

Objective: As new psychopharmacological agents for the management of schizophrenia are introduced into clinical practice, inappropriate patient selection may often lead to disappointing outcomes for the patient, the family and services. Recently, the first and only long-acting novel antipsy chotic was made available in Australia. Based on criteria used in a large clinical network in Victoria, this paper sets out to present six selection profiles for patients with schizophrenia who may be suitable candidates for treatment with this class of medication.Conclusions: Optimizing outcome for patients with enduring psychotic disorders involves enabling a stable psychopharmacological platform upon which to build a psychosocial therapies programme. Too often, problems with adherence undermine the recovery process. Long-acting novel anti psychotics ensure adherence, with all the advantages inherent in second generation antipsychotics. Identifying patients a priori who might best respond to the long-acting novel antipsychotics may lead to improving the efficiency of the recovery process.

Selecting Patients for Long-acting Novel Antipsychotic Therapy

As new psychopharmacological agents for the management of schizophrenia are introduced into clinical practice, inappropriate patient selection may often lead to disappointing outcomes for the patient, the family and services. Recently, the first and only long-acting novel antipsychotic was made available in Australia. Based on criteria used in a large clinical network in Victoria, this paper sets out to present six selection profiles for patients with schizophrenia who may be suitable candidates for treatment with this class of medication. Optimizing outcome for patients with enduring psychotic disorders involves enabling a stable psychopharmacological platform upon which to build a psychosocial therapies programme. Too often, problems with adherence undermine the recovery process. Long-acting novel antipsychotics ensure adherence, with all the advantages inherent in second-generation antipsychotics. Identifying patients a priori who might best respond to the long-acting novel antipsychotics may lead to improving the efficiency of the recovery process.