PLoS Medicine Research Articles

A New Normal?: The COVID-19 pandemic has heralded different ways of working, triage of workload, collaborative research and cold-site surgery.

A New Normal?: The COVID-19 pandemic has heralded different ways of working, triage of workload, collaborative research and cold-site surgery.

Advocating for reproducibility

As guest editors, we are excited to publish this special double issue of IASSIST Quarterly. The topics of reproducibility, replicability, and transparency have been addressed in past issues of IASSIST Quarterly and at the IASSIST conference, but this double issue is entirely focused on these issues.
 In recent years, efforts “to improve the credibility of science by advancing transparency, reproducibility, rigor, and ethics in research” have gained momentum in the social sciences (Center for Effective Global Action, 2020). While few question the spirit of the reproducibility and research transparency movement, it faces significant challenges because it goes against the grain of established practice.
 We believe the data services community is in a unique position to help advance this movement given our data and technical expertise, training and consulting work, international scope, and established role in data management and preservation, and more. As evidence of the movement, several initiatives exist to support research reproducibility infrastructure and data preservation efforts:
 
 Center for Open Science (COS) / Open Science Framework (OSF)[i]
 Berkeley Initiative for Transparency in the Social Sciences (BITSS)[ii]
 CUrating for REproducibility (CURE)[iii]
 Project Tier[iv]
 Data Curation Network[v]
 UK Reproducibility Network[vi]
 
 While many new initiatives have launched in recent years, prior to the now commonly used phrase “reproducibility crisis” and Ioannidis publishing the essay, “Why Most Published Research Findings are False,” we know that the data services community was supporting reproducibility in a variety of ways (e.g., data management, data preservation, metadata standards) in wellestablished consortiums such as Inter-university Consortium for Political and Social Research (ICPSR) (Ioannidis, 2005).
 The articles in this issue comprise several very important aspects of reproducible research:
 
 Identification of barriers to reproducibility and solutions to such barriers
 Evidence synthesis as related to transparent reporting and reproducibility
 Reflection on how information professionals, researchers, and librarians perceive the reproducibility crisis and how they can partner to help solve it.
 
 The issue begins with “Reproducibility literature analysis” which looks at existing resources and literature to identify barriers to reproducibility and potential solutions. The authors have compiled a comprehensive list of resources with annotations that include definitions of key concepts pertinent to the reproducibility crisis.
 The next article addresses data reuse from the perspective of a large research university. The authors examine instances of both successful and failed data reuse instances and identify best practices for librarians interested in conducting research involving the common forms of data collected in an academic library.
 Systematic reviews are a research approach that involves the quantitative and/or qualitative synthesis of data collected through a comprehensive literature review. “Methods reporting that supports reader confidence for systematic reviews in psychology” looks at the reproducibility of electronic literature searches reported in psychology systematic reviews.
 A fundamental challenge in reproducing or replicating computational results is the need for researchers to make available the code used in producing these results. But sharing code and having it to run correctly for another user can present significant technical challenges. In “Reproducibility, preservation, and access to research with Reprozip, Reproserver” the authors describe open source software that they are developing to address these challenges. 
 Taking a published article and attempting to reproduce the results, is an exercise that is sometimes used in academic courses to highlight the inherent difficulty of the process. The final article in this issue, “ReprohackNL 2019: How libraries can promote research reproducibility through community engagement” describes an innovative library-based variation to this exercise.
 
 Harrison Dekker, Data Librarian, University of Rhode Island
 Amy Riegelman, Social Sciences Librarian, University of Minnesota
 
 References 
 Center for Effective Global Action (2020), About the Berkeley Initiative for Transparency in the Social Sciences. Available at: https://www.bitss.org/about (accessed 23 June 2020).
 Ioannidis, J.P. (2005) ‘Why most published research findings are false’, PLoS Medicine, 2(8), p. e124. doi: https://doi.org/10.1371/journal.pmed.0020124
 
 [i] https://osf.io
 [ii] https://www.bitss.org/
 [iii] http://cure.web.unc.edu
 [iv] https://www.projecttier.org/
 [v] https://datacurationnetwork.org/
 [vi] https://ukrn.org

Advances in clinical trial design: Weaving tomorrow's TB treatments.

Christian Lienhardt and co-authors discuss the conclusions of the PLOS Medicine Collection on advances in clinical trial design for development of new tuberculosis treatments.

How to evaluate adolescents’ dental anxiety? A review of instruments

How to evaluate adolescents’ dental anxiety? A review of instruments

Education, income and occupation and their influence on the uptake of cervical cancer prevention strategies: A systematic review.

To report a systematic review of the literature exploring how education, income and occupation influence the uptake of cervical screening and HPV vaccination among eligible women in developed countries, including the United Kingdom, United States, Spain, Germany and Norway. Cervical cancer remains a highly prevalent disease despite it being largely preventable through cervical screening and HPV vaccination. Incidence and mortality of cervical cancer are unequally distributed among socioeconomic groups, warranting research into how individual socioeconomic factors contribute to this unbalanced uptake of prevention strategies. Systematic review and narrative synthesis. The PRISMA guidelines (PLoS Medicine, 6, 2009, e1000097) guided the selection of papers. MEDLINE, CINHAL, PsychINFO, Science Citation Index and HMIC were searched. Ten articles were suitable. Key findings were then extracted, and a narrative synthesis was completed, using suitable guidance and the AXIS tool. Obtaining high school or college education is associated with uptake of both cervical screening and HPV vaccination. Total household income and income in respect of the countries' poverty line was measured less frequently than education, but associated with screening and vaccination in some studies. Occupation was infrequently measured in comparison to education and income, limiting conclusions of its association to uptake. Education and income have an association with uptake of cervical screening and HPV vaccination among women. However, evidence is insufficient to affirm a relationship between occupation and uptake of screening and vaccination. Further research would be advised to strengthen these findings. Interventions to promote cervical cancer prevention strategies should be targeted at women and girls with lower education levels and lower income. However, differences are displayed in the relationships between the individual socioeconomic factors and uptake of preventative strategies between countries and populations and so they should be considered separately. Nurses play a considerable role in people's perceptions and experiences of cervical screening and HPV vaccination. The review findings offer new insight that can inform future policy and nursing practice on targeting interventions to promote uptake among women who are underusing cervical cancer prevention programmes.

Inadequate Reporting of Analytical Characteristics of Biomarkers Used in Clinical Research: A Threat to Interpretation and Replication of Study Findings.

Analytical characteristics of methods to measure biomarkers determine how well the methods measure what they claim to measure. Transparent reporting of analytical characteristics allows readers to assess the validity and generalizability of clinical studies in which biomarkers are used. Our aims were to assess the reporting of analytical characteristics of biomarkers used in clinical research and to evaluate the extent of reported characterization procedures for assay precision. We searched 5 medical journals (Annals of Internal Medicine, JAMA: The Journal of the American Medical Association, The Lancet, The New England Journal of Medicine, and PLOS Medicine) over a 10-year period for the term "biomarker" in the full-text field. We included studies in which biomarkers were used for inclusion/exclusion of study participants, for patient classification, or as a study outcome. We tabulated the frequencies of reporting of 11 key analytical characteristics (such as analytical accuracy of test results) in the included studies. A total of 544 studies and 1299 biomarker uses met the inclusion criteria. No information on analytical characteristics was reported for 67% of the biomarkers. For 65 biomarkers (3%), ≥4 characteristics were reported (range, 4-8). The manufacturer of the measurement procedure could not be determined for 688 (53%) of the 1299 biomarkers. The extent of assessments of assay imprecision, when reported, did not meet expectations for clinical use of biomarkers. Reporting of the analytical performance of biomarker measurements is variable and often absent from published clinical studies. We suggest that readers need fuller reporting of analytical characteristics to interpret study results, assess generalizability of conclusions, and compare results among clinical studies.

Research on research gains steam

In 2005, John P. A. Ioannidis, a professor of medicine at Stanford University, opened a can of worms. In a paper published in PLOS Medicine, he argued that most published scholarly literature is false (DOI: 10.1371/journal.pmed.0020124). To date, Ioannidis’s study has attracted thousands of citations and helped solidify a whole field in its own right, says Jelte Wicherts, who studies research methodology at Tilburg University. The use of scientific methodology to study how science is conducted is called metascience. The discipline has become mainstream in recent years, tackling some of the thorniest problems science faces, including a lack of reproducibility of academic literature, biases in peer review, and unfair allocation of research funding. “Metascience is now a distinct species,” although it has ancestors in medical science, psychology, and other disciplines, Wicherts says. Ioannidis, who launched the Meta-Research Innovation Center at Stanford (METRICS) in 2014, is hesitant to frame metaresearch as

MS18.06 Captive Audience, Teachable Moment — Integrating Tobacco Cessation in Lung Cancer Screening

MS18.06 Captive Audience, Teachable Moment — Integrating Tobacco Cessation in Lung Cancer Screening

Abstract 431: Semi-automated detection, isolation and molecular analysis of single disseminated melanoma cells from lymph nodes

Abstract We recently showed that lymph node disaggregation followed by immunocytology enables precise quantification of disseminated cancer cells (DCCs) and demonstrated that this approach has a 20-fold higher sensitivity to detect melanoma DCCs than routine histopathology (Ulmer et al., PLoS Medicine, 2014). Moreover, genetic profiling of single melanoma DCCs identified a colonization signature consisting of specific copy number alterations and point mutations that identify patients with high risk of progression (Werner-Klein et al., Nature Communications 2018). Here, we present the adaptation of this method to a semi-automated workflow for detection, isolation and molecular analysis of single melanoma DCCs. The developed workflow includes a mechanical disaggregation of lymph node tissue and collection of the mononuclear cells, immunofluorescence staining against melanoma-associated markers gp100 and MCSP and depletion of CD45-positive cells. Individual melanoma cells are then detected and isolated by DEPArrayTM technology enabling single cell whole genome amplification (Ampli1TM) for subsequent molecular analysis. In total, we processed 20 lymph nodes of melanoma patients and detected melanoma DCCs in 11/20 samples (55%). The quality of isolated cells was checked by Ampli1TM QC and 174 isolated single cells were further analyzed by Sanger sequencing for specific point mutations (BRAF, NRAS and cKIT) and Ampli1TM low pass kit for Illumina for copy number variation (CNV). Successful molecular analysis was correlated with genome integrity score (GII) as determined by Ampli1TM QC, with more than 95% of cells with GII 3-4 showing good performance in low pass sequencing. In conclusion, a new DepArrayTM based application for marker-dependent single cell isolation from malignant melanoma lymph nodes was successfully established and tested on a cohort of 20 melanoma patients. Molecular analyses of isolated single cells confirmed the tumor origin by CNV profiling and mutational analysis of melanoma-associated mutations. In the future, this approach could help to select individualized therapies for melanoma patients. Citation Format: Barbara Alberter, Sebastian Scheitler, Giancarlo Feliciello, Alberto Ferrarini, Melanie Werner-Klein, Sebastian Haferkamp, Christoph A. Klein, Bernhard Polzer. Semi-automated detection, isolation and molecular analysis of single disseminated melanoma cells from lymph nodes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 431.

Business versus science: High drug prices conspire against oncological research.

e14580 Background: It has been consistently proven that pivotal clinical trials (PCT) for drug registration or new drug indications (NDI), sponsored by the pharmaceutical industry, obtain better results than independent confirmatory studies (ICS). The interplay between PCT and ICS has supported better treatment selections and more realistic expectations: hope vs hype.The aim of this paper is to analyze the amount of ICS publications in Oncology within the last decade. Methods: All new FDA approved oncological drugs or NDI for solid tumors between 2005 and 2017 were taken into account. The PCT that led to their approval were identified, and between October and November 2019 a thorough search for related ICS (published or ongoing) was conducted on MEDLINE, ASCO Abstracts, NEJM, Lancet Oncology, JAMA, JCO, Cancer, PLOS ONE, PLOS Medicine and www.Clinicaltrials.gov. Results: Fifty-five new drugs or NDI were analyzed (Abemaciclib, Abiraterone, Ado-trastuzumab emtasine, Afatinib, Alectinib, Atezolizumab, Avelumab, Axitinib, Bendamustine, Bevacizumab, Brigatinib, Cabozantinib, Ceritinib, Cobimetinib, Crizotinib, Dabrafenib, Degarelix, Denosumab, Durvalumab, Eribuline mesylate, Everolimus, Ipilimumab, Irinotecan liposome, Ixabepilone, Lapatinib, Lenvatinib, Necitumumab, Neratinib, Nilotinib, Niraparib, Nivolumab, Olaparib, Osimertinib, Paclitaxel protein bound, Palbociclib, Panitumumab, Pazopanib, Pembrolizumab, Pertuzumab, Ramucirumab, Regorafenib, Ribociclib, Rucaparib, SipuleucelT, Sonidegib, Sorafenib, Sunitinib, Topotecan, Trabectedin, Trametinib, Trastuzumab, Vandetanib, Vemurafenib, Vismodegib, Ziv-afilbercept). Until November 30, 2019, no published or ongoing ICS were found in any of the cases. Conclusions: a) For the past decade, none of the PCT used for approval of new oncological drugs or NDI were replicated by ICS (without pharmaceutical industry sponsorship). b) We ignore the reasons for these approval methods but they raise suspicion and unnecessary discomfort. c) From an ethical point of view, patients’ Informed Consent must specify that expected results for the new drug or NDI are based exclusively on trials sponsored by the selling pharmaceutical company, unless other ICS are published. d) The current state of affairs can only be reverted if regulatory agencies and the scientific community demand ICS as part of the drug approval process or post-marketing duties.

Addressing the Mathematics Gap for Students with ASD: an Evidence-Based Systematic Review of Video-Based Mathematics Interventions

This systematic review of literature synthesizes research on video-based instruction (VBI) to teach mathematics to students with autism spectrum disorder (ASD). Eleven studies, including gray literature, were included in the synthesis resulting in data analysis of performance from 29 participants. To better align with transparent reporting guidelines of PRISMA (Moher et al., PLoS Medicine 6(7), 2009), we synthesize information regarding participants, intervention outcomes, and study design. Effects of student and study-level outcomes are presented in non-overlapping data (PND) and improvement rate difference (IRD). Findings show VBI has considerable support for positive effects across types of VBI, student characteristics, and mathematical concepts. Effective interventions incorporated academic and behavioral components with evidence base. With six studies demonstrating strong evidence, 16 individual cases of effect, and research spanning at least three research teams and research locations, results indicate that VBI meets minimum evidence set forth by Reichow et al., (Journal of Autism and Developmental Disorders 38:1311–1319, 2008) to be an established evidence-based practice to teach mathematics to students with ASD.

CHRONIC LACK OF SLEEP IS ASSOCIATED WITH INCREASED SPORTS INJURY IN ADOLESCENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background:Although sleep has been identified as an important modifiable risk factor for sports injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied.Purpose:To ...

Editorial introductions

Editorial introductions

Who elects the weekend?

Chaim M. Bell and Lauren Lapointe-Shaw discuss the meaning of the "weekend effect" in outcomes for hospital admissions and surgeries, and comment on surprising new results published in PLOS Medicine this week.

Space-time cluster analysis to improve classical swine fever risk-based surveillance in Ecuador

Space-time cluster analysis to improve classical swine fever risk-based surveillance in Ecuador

Cardiometabolic risks in India

In a recent article in this journal, we discussed diabetes and Cardiovascular disease (CVD) risks in Indians living abroad. The article was written to complement the information that was published by an elite group of the American Heart Association (AHA);-”the council members of the various subcommittees.” In the journal Circulation, AHA published a scientific statement about the CVD risk of Indians living in the USA. In the June issue of the journal PLoS Medicine, The George Institute for Global Health (GIGH), Sydney, Australia, with collaborators from; Harvard T. H. Chan School of Public Health, USA; Department of Economics, University of Gottingen, Heidelberg University, Germany; School of Public Health Johannesburg, South Africa; King's College London, UK, Indian Institute of Public Health, and Public Health Foundation of India, have published a one of a kind article on, “Geographic and sociodemographic variation of CVD disease risk in India: A cross-sectional study of 797,540 adults.” I am writing this article, as a complement to the topic reviewed by the George Institutes of Global Health and associates and other expert groups. The specific objectives of this academic exercise by the GIGH were, to determine how the CVD risk- and the factors that determine risk varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. Rajeev Gupta and associates from Jaipur, under the aegis of South Asian Society on Atherosclerosis and Thrombosis, did a study in 2012, on “Regional variations in CVD risk in India: India heart watch.” The researchers found a wide regional variation in CVD mortality. They concluded, “that although no nationwide study of risk factors exists, there were significant state-level and rural-urban level differences in major CVD risk factors such as smoking, obesity, central adiposity, hypertension, hypercholesterolemia, and diabetes. They also stressed the need for uniform protocols, to assess the regional differences. Whereas, the report by the GIGH Collaborators group, did pooled analysis of CVD risk for 797,540 adults across India, and identified important variation in risk among individuals living in different States. According to them, CVD risk was the highest in the northern (Himachal Pradesh, Uttarakhand), northeastern (West Bengal, Nagaland, Manipur, and Mizoram), and Southern States (Kerala, Andhra Pradesh) of India. CVD risk was found to be higher in urban areas, that too among males, while mean body mass index was higher among wealthy, blood glucose, high systolic blood pressure was common in poor people of middle and older age. We have access to data from three important studies, related to the variation of CVD risk in Indians living in India, as well as abroad. It is high time, that we use these data to develop guidelines, guidance statements, novel clinical studies for validating safety and efficacy of complementary therapies for early risk factors such as oxidative stress, inflammation, and endothelial dysfunction, put together integrated noninvasive diagnostic platforms for risk assessment, risk prediction, and reduction or reversal of metabolic diseases. Having said that, I would like to emphasize the need for a national platform, to address the issues related to this very important public health problem, and to coordinate the prevention strategies.

Advertisement in Medical Journal – To Be or Not To Be!

Medical journals are unbiased and reliable sources of information. They disseminate knowledge to educate medical practitioners and scientists of new development in different fields of medical science. The state of research and publication in developing countries is primitive, and those that are done fail to compete to be published in reputed international journals. The regional open access journals provide an opportunity to such researchers indisseminating their work. Their work is then recorded and available for other researchers and practitioners for reference.Open access journals are good platform, but it is a tremendous task for journals to survive with the little or no resource. Common sources of revenue are sales of print version and article publication charges which are often inadequate. Survival is hard and journals have to look for other sources such as individual donations and fund from institutions or medical societies. One of such journal is PloS Medicine, which has a reputable presence. These alternative sources of income may not be available for all journals and have to turn to advertisements as a majorsource of revenue. Even some of the reputed traditional, subscription-based journals put advertisements as their reliable source of income.

Collaboration between academics and industry in clinical trials: cross sectional study of publications and survey of lead academic authors

ObjectivesTo determine the role of academic authors, funders, and contract research organisations in industry funded trials of vaccines, drugs, and devices and to determine lead academic authors’ experiences with industry...

DISSEMINATED CRYPTOCOCCUS IN AN IMMUNOCOMPETENT PATIENT

SESSION TITLE: Critical Care 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Cryptococcus is an encapsulated yeast found in bird droppings. Transmission occurs via inhalation of spores into the lungs. Whereas most infections cause symptoms ranging from asymptomatic to pneumonia-like, disseminated Cryptococcus (DC) presents most often with severe pneumonia and meningitis. DC is primarily seen in immunocompromised patients with HIV or immunosuppression (post-transplant, cancer, chemotherapy, autoimmune disease), and is rarely seen in the immunocompetent patient. CASE PRESENTATION: 84 year old woman with past medical history of CHF, COPD, atrial fibrillation, hypothyroidism, diabetes and CVA with resultant tracheostomy (chronically on a ventilator) and PEG tube who presented with hypoxia. Patient also had a history of Pseudomonal pneumonia/sepsis and carbapenem-resistant Enterobacter. The patient was nonverbal and had no family at bedside. The only history was from a nursing home packet. It said she had a SpO2 around 80% and was more short of breath than usual. In the ED, she was on minimal ventilatory settings. Initial vitals: BP 123/61, HR 95, SpO2 95% on FiO2 40%, RR 22, T 96.1F. Initial labs were pertinent for a reactive leukocytosis, influenza A/B and RSV negative, and HIV 1/2 Ab negative. Blood cultures were also taken. CXR showed hazy opacity over right hemithorax, moderate-sized left pleural effusion, and probable pulmonary vascular congestion bilaterally. Patient was started on cefepime, azithromycin and vancomycin for sepsis, and sent to the ICU. The patient became hemodynamically unstable, requiring pressors, and developed seizures. CT of the head showed extensive encephalomalacia involving both MCA territories, likely representing chronic infection, and she was started on antiepileptics. Preliminary blood cultures grew yeast and capsofungin was started for presumed candidemia; capsofungin was changed to liposomal amphotericin after histological confirmation of Cryptococcus. Eventually multiple blood cultures speciated Cryptococcus neoformans; serum cryptococcal Ag was positive and quantification >1:2560. Goals of care were eventually discussed with the family, and the patient was transitioned to hospice with antibiotic treatment and no pressors. She passed away soon after arrival. DISCUSSION: Disseminated Crytpococcus following pulmonary infection has a poor prognosis. In fact, DC central nervous system involvement – presenting with seizures, headache, altered mental status, etc. – is thought to be due to impaired cell-mediated immunity; the mortality rate is about 20% in immunosuppressed patients. Rarely is DC seen in immunocompetent patients, and if so, it is usually C. gattii. CONCLUSIONS: Although our patient had a chronic ventilator and multiple morbidities, she was able to mount an appropriate immune response at the onset of infection. Her immunocompetent state suggests that other factors, such as age and co-morbidities, predispose such patients to DC. Reference #1: Aguiar, P. A. D. F., Pedroso, R. D. S., Borges, A. S., Moreira, T. A., Araujo, L. B., & Roder, D. V. D. B. (2017). The epidemiology of cryptococcosis and the characterization of cryptococcus neoformans isolated in a brazilian university hospital. Revista do Instituto De Medicina Tropical De Sao Paulo, 59, e13-9946201759013. S0036-46652017005000208 [pii] Reference #2: Dromer, F., Mathoulin-Pelissier, S., Launay, O., Lortholary, O., & French Cryptococcosis Study Group. (2007). Determinants of disease presentation and outcome during cryptococcosis: The CryptoA/D study. PLoS Medicine, 4(2), e21. 06-PLME-RA-0445R3 [pii] Reference #3: Henao-Martinez, A. F., Gross, L., Mcnair, B., McCollister, B., DeSanto, K., Montoya, J. G., Beckham, J. D. (2016). Risk factors for cryptococcal meningitis: A single united states center experience. Mycopathologia, 181(11-12), 807-814. 10.1007/s11046-016-0048-x [doi] DISCLOSURES: No relevant relationships by Lindsay Hammons, source=Web Response No relevant relationships by Young Im Lee, source=Web Response

Suicide Prevention Program to Get Test Run This Fall

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessSuicide Prevention Program to Get Test Run This FallRebecca GreenbergRebecca GreenbergSearch for more papers by this authorPublished Online:14 Aug 2018https://doi.org/10.1176/appi.pn.2018.7b21AbstractWith suicide rates on the rise, a county in New York is introducing a pilot program that will focus on patients at high risk for suicide.A new suicide prevention model that has shown promise in Switzerland will be tested this September in the United States. The treatment is called Attempted Suicide Short Intervention Program (ASSIP). It will be implemented in Onondaga County, N.Y., as part of a statewide suicide prevention effort funded through a $3.5 million federal grant from the Substance Abuse and Mental Health Services Administration. People who have attempted suicide are known to be the most likely to die by suicide. An estimated 1.3 million adults aged 18 or older attempted suicide in 2016, according to the National Institute of Mental Health.Konrad Michel, M.D., works with patients to identify signs that they might be feeling suicidal as well as strategies they can use to stay safe.ASSIP targets patients who have recently attempted suicide. It consists of three 60- to 90-minute face-to-face sessions followed by regular, personalized letters sent to patients over two years. Konrad Michel, M.D., a professor emeritus at the University Hospital of Psychiatry in Bern, and colleagues developed the program. Michel coauthored a study in PLOS Medicine in March 2016 that showed that ASSIP was associated with an 80 percent reduction in repeat suicide attempts among 120 patients admitted to the emergency unit of the Bern University of General Hospital after a suicide attempt. Half of the patients were randomly selected for treatment as usual, which included a single clinical interview in the emergency unit followed by a risk assessment summary that was sent to the patients’ outpatient providers. The other half received treatment as usual plus ASSIP. During the 24 months of follow-up, five repeat suicide attempts were recorded in the ASSIP group, and 41 repeat suicide attempts were recorded in the control group. One person died by suicide in each group. For the first session, which is videotaped, a patient tells the therapist how he or she reached the point of wanting to die by suicide. In the second session, the patient and therapist review the tape together. In the final session, the therapist and patient identify signs that the patient may be feeling suicidal, as well as strategies the patient can use to stay safe. These are printed on a card that the patient carries at all times, along with a list of emergency numbers. Over the next two years, therapists send patients a series of personalized letters reminding them of the risk of experiencing a suicidal crisis and the importance of using safety strategies at those times.Suicide has less to do with a patient’s psychiatric diagnoses and more to do with each patient’s inner experience and narrative, Michel told Psychiatric News. “The patient is in the expert position, which gives the patient insight into his or her own suicidal crisis.”Michel said that the process allows patients to feel heard and understood, which creates trust—the basis of a strong therapeutic alliance. Creating that alliance is key to ASSIP’s patient-centered, collaborative approach.The authors noted that if ASSIP achieves similar results in the United States, the program may one day become a common evidence-based follow-up treatment that could reduce the number of deaths by suicide. “ASSIP fulfills the need for an easy-to-administer, low-cost intervention,” the authors concluded. ■“A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-Months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP)” can be accessed here. ISSUES NewArchived