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Tackling burnout in Australian doctors by blending a web-based cognitive-behavioural therapy program with telehealth psychological support – protocol for a three-arm randomised-controlled trial 通过将基于网络的认知行为治疗项目与远程医疗心理支持相结合,解决澳大利亚医生的职业倦怠问题——一项三组随机对照试验的协议
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-30 DOI: 10.1016/j.conctc.2025.101514
M.J. Coleshill , M.J. Black , K. Luck , K. Willis , N. Smallwood , H. Stephens , T. Gillings , L. Fraser , M. Putland , L. Kampel , A.M. Martin , N.F. Praharso , A.D. Joffe , S. Harvey , P.A. Baldwin

Background

Burnout has received limited attention in treatment programs, despite high prevalence among health professionals and the threat burnout places upon the mental health and the long-term sustainability of the Australian healthcare system. As part of The Essential Network (TEN), a blended care mental health support service for Australian health professionals, we developed Navigating Burnout – a digital cognitive-behavioural therapy program for health professional burnout. This three-arm randomised-controlled trial (RCT) will examine the effectiveness, acceptability, and cost-effectiveness of Navigating Burnout in both blended care and digital formats in reducing burnout among doctors.

Methods

Doctors (n = 207) with burnout will be randomised to (1) a blended version of Navigating Burnout combining digital resources with five fortnightly telehealth sessions with a clinical psychologist, (2) a digital-only version of Navigating Burnout, or (3) self-care psychoeducation as an active attention control. Burnout, psychosocial wellbeing, workforce engagement and attrition, and service acceptability will be measured at baseline, post-treatment, and 3 months post-treatment.

Results

At 3 months post-treatment, we hypothesise reductions in burnout across both treatment arms, with the strongest effect in the blended care arm. Similar trends are expected for psychosocial and occupational outcomes. High service acceptability across both blended care and digital-only versions of Navigating Burnout is also anticipated.

Conclusions

With this evidence, Navigating Burnout may be incorporated into TEN's person-to-person components. Further, by demonstrating the effectiveness of blended care for burnout, Navigating Burnout may provide a crucially needed service for Australian doctors and replicable model of care for other organisations and support services.
尽管职业倦怠在卫生专业人员中非常普遍,并且职业倦怠对心理健康和澳大利亚卫生保健系统的长期可持续性构成威胁,但在治疗方案中,职业倦怠受到的关注有限。作为基本网络(TEN)的一部分,我们为澳大利亚卫生专业人员提供混合护理心理健康支持服务,我们开发了导航倦怠-一个针对卫生专业人员倦怠的数字认知行为治疗计划。这项三组随机对照试验(RCT)将检验在混合护理和数字格式中导航倦怠在减少医生倦怠方面的有效性、可接受性和成本效益。方法207名出现过劳的医生将被随机分配到(1)使用混合版本的《过劳指南》,该版本结合了数字资源和与临床心理学家进行的五次两周一次的远程医疗会议,(2)使用纯数字版本的《过劳指南》,或(3)使用自我保健心理教育作为主动注意控制。将在基线、治疗后和治疗后3个月测量倦怠、心理健康、劳动力参与和流失以及服务可接受性。结果治疗后3个月,我们假设两个治疗组的倦怠都有所减少,其中混合护理组的效果最强。预计社会心理和职业结果也会出现类似趋势。预计混合护理和数字版本的导航倦怠的高服务可接受性。有了这一证据,导航倦怠可以被纳入TEN的个人对个人组件。此外,通过展示倦怠混合护理的有效性,导航倦怠可能为澳大利亚医生提供至关重要的服务,并为其他组织和支持服务提供可复制的护理模式。
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引用次数: 0
Improving youth access to behavioral health services through integrated care and task shifting: protocol for a cluster-randomized stepped wedge clinical trial 通过综合护理和任务转移改善青少年获得行为健康服务的机会:一项集群随机阶梯楔形临床试验方案
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-30 DOI: 10.1016/j.conctc.2025.101518
Brigid R. Marriott , Leslie Hulvershorn , Johnathan Oliver , Cara Jones , Lauren M. O'Reilly , Sarah E. Wiehe , Patrick O. Monahan , Sarah Kate Bearman , Lisa Saldana , Matthew C. Aalsma

Background

One promising solution for improving access to mental health services is integrated behavioral health models, in which behavioral health providers address mental health problems within the primary care infrastructure. Additionally, task-shifting, where non-specialists deliver certain services in the place of specialists, may be well-suited to address mental health provider shortages. The current study outlines the protocol for a hybrid type III implementation-effectiveness, cluster-randomized stepped wedge trial to evaluate the implementation of an adapted pediatric integrated behavioral health model (Peds IBH) that includes task-shifting services, explore the facilitators and barriers to the implementation of Peds IBH, and examine connection to behavioral health care pre- and post-implementation.

Methods

The trial will include 25 pediatric primary care clinics across 13 counties in a large healthcare system. Clinics will be randomized to one of three cohorts, stepped in at 6-month intervals, with a 12-month implementation period. The Peds IBH program will: 1) incorporate task-shifting to treat mild to moderate anxiety, depression, and conduct problems with flexible, transdiagnostic cognitive-behavior therapy to be delivered by bachelor's level interventionists, 2) leverage existing child psychiatry provider consultation programs, and 3) increase sustainability through a different billing model. Quantitative data collection will include surveys (primary care team members, behavioral health providers, and youth and caregivers) and tracking of implementation strategies. Qualitative interviews will be conducted with primary care providers and staff.

Discussion

This trial will evaluate the implementation of the Peds IBH program. While the focus is implementation outcomes, we will assess effectiveness to inform future dissemination efforts.

Trial registration

N/A.
背景改善获得精神卫生服务的一个有希望的解决办法是综合行为卫生模式,其中行为卫生提供者在初级保健基础设施内处理精神卫生问题。此外,任务转移,非专业人员代替专业人员提供某些服务,可能非常适合解决精神卫生提供者短缺的问题。目前的研究概述了一项混合III型实施有效性、集群随机阶梯形试验的方案,以评估包括任务转移服务在内的适应性儿科综合行为健康模型(Peds IBH)的实施情况,探索实施Peds IBH的促进因素和障碍,并检查实施前后与行为健康保健的联系。该试验将包括一个大型医疗保健系统中13个县的25个儿科初级保健诊所。诊所将被随机分配到三个队列中的一个,每隔6个月介入一次,实施期为12个月。儿科IBH项目将:1)结合任务转移,以治疗轻度至中度焦虑、抑郁和行为问题,由本科水平的干预医生提供灵活的、跨诊断的认知行为疗法;2)利用现有的儿童精神病学提供者咨询项目;3)通过不同的计费模式增加可持续性。定量数据收集将包括调查(初级保健小组成员、行为保健提供者、青年和照顾者)和跟踪实施战略。将对初级保健提供者和工作人员进行定性访谈。本试验将评估儿科IBH项目的实施情况。虽然重点是执行结果,但我们将评估有效性,为今后的传播工作提供信息。审判registrationN /。
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引用次数: 0
The use of consumer-grade physical activity monitors: Insight into psychosocial determinants and technology acceptance 使用消费级体育活动监测器:洞察心理社会决定因素和技术接受
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-30 DOI: 10.1016/j.conctc.2025.101516
Brenda A.J. Berendsen , Rianne H.J. Golsteijn , Lilian Lechner , Catherine Bolman , Denise A. Peels

Background

Consumer-grade physical activity (PA) monitors are used to optimize enrollment in clinical trials, to evaluate PA behavior, or to promote PA. Insight is needed into characteristics of people who use PA monitors and who do not, to enhance recruitment and generalizability of trials. We assessed demographics, psychosocial determinants and technology acceptance of (non-)users of PA monitors.

Methods

Dutch speaking adults were recruited via social media, email and personal contact. In an online questionnaire 533 participants (70 % women, age 43 ± 14 years) reported PA monitor use, PA and psychosocial determinants, and technology acceptance of PA monitors. Concepts were derived from the theory of planned behavior and the technology acceptance model. Primary outcome of the study was use of a consumer-grade PA monitor in the past month, analyzed with a stepwise logistic regression model, including psychosocial determinants, technology acceptance and PA and past tracking behavior.

Results

Of the participants, 40 % reported using a PA monitor in the past month. Demographics and psychosocial determinants of PA explained 12 % of PA monitor use. The odds for using a PA monitor was higher with higher feelings of autonomy (1.772; CI:1.128–2.783). Adding technology acceptance to the regression model increased the explained variance to 66 %, with significant ORs of perceived ease of use (2.403; CI:1.479–3.904), perceived usefulness (0.405; CI:0.224–0.731), attitude towards PA monitors (2.235; CI:1.222–4.087), affective quality (2.293 CI:1.252–4.201), intention to use PA monitors in the near future (4.174; CI:2.320–7.512), and subcultural appeal (0.660; CI:0.455–0.958).

Conclusions

This study confirmed the value of integrating consumer-grade PA in clinical trials, since they were used regardless of the amount of leisure time PA, motivation, age, and educational level. This indicates that trials that use people's own PA trackers to recruit and screen participants or in interventions likely includes a generalizable sample. Furthermore, the results provide concrete pointers within technology acceptance that could contribute to recruitment in trials relying on participants' own PA monitors.
消费级身体活动(PA)监测仪用于优化临床试验的入组,评估PA行为,或促进PA。需要深入了解使用PA监测器和不使用PA监测器的人的特征,以加强试验的招募和推广。我们评估了(非)PA监测器用户的人口统计学、社会心理决定因素和技术接受程度。方法通过社交媒体、电子邮件和个人联系招募说荷兰语的成年人。在一份在线问卷调查中,533名参与者(70%为女性,年龄43±14岁)报告了心电监护仪的使用情况、心电监护仪和心理社会决定因素以及对心电监护仪的技术接受程度。概念来源于计划行为理论和技术接受模型。该研究的主要结果是在过去一个月使用消费级PA监测仪,用逐步逻辑回归模型进行分析,包括心理社会决定因素、技术接受程度、PA和过去跟踪行为。结果:在参与者中,40%的人报告在过去的一个月里使用过PA监测器。人口统计学和心理社会因素解释了12%的PA监测仪的使用。自主性越强,使用PA监护仪的几率越高(1.772;置信区间:1.128—-2.783)。在回归模型中加入技术接受度将解释方差增加到66%,感知易用性的or显著(2.403;CI: 1.479-3.904),感知有用性(0.405;CI: 0.224-0.731),对PA监测器的态度(2.235;CI: 1.222-4.087),情感品质(2.293 CI: 1.252-4.201),近期使用PA监视器的意向(4.174;CI: 2.320-7.512),亚文化吸引力(0.660;置信区间:0.455—-0.958)。本研究证实了在临床试验中整合消费级PA的价值,因为它们与休闲时间PA的数量、动机、年龄和教育水平无关。这表明,使用人们自己的PA追踪器来招募和筛选参与者或干预措施的试验可能包括一个可推广的样本。此外,结果在技术接受方面提供了具体的指针,这可能有助于在依靠参与者自己的PA监视器的试验中招募人员。
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引用次数: 0
Experience and lessons learned relating to investigational product supply in the design and delivery of a paediatric investigator-initiated clinical trial 在设计和交付儿科研究者发起的临床试验中与研究产品供应有关的经验和教训
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-30 DOI: 10.1016/j.conctc.2025.101517
Mandy Wan , Mark A. Turner , Gilles Cambonie , Ruth Kemper , Naouel Bouafia , Lea Levoyer , Alpha Diallo , Mikko Hallman , Jean-Christophe Rozé
The management of investigational product (IP) supply is a complex endeavour when designing and delivering clinical trials. In contrast to industry-sponsored trials where IP supplies are coordinated by teams of specialists working together throughout the entire supply chain, investigator initiated clinical trials often face IP-related challenges that can result in substantial trial delays, higher costs, and even early termination of the trial. Despite the challenges faced by investigators, there has been relatively few discussions on this topic in the literature. In this short communication, we describe our experiences and the lessons learned in managing IP supply during the design and execution of a multinational paediatric investigator initiated clinical trial. These experiences are shared to provide researchers with tools and strategies to improve the future implementation of investigator-initiated clinical trials.
在设计和提供临床试验时,研究产品(IP)供应的管理是一项复杂的工作。与由行业赞助的试验相比,知识产权供应由整个供应链中的专家团队共同协调,研究者发起的临床试验经常面临与知识产权相关的挑战,这些挑战可能导致大量的试验延迟,更高的成本,甚至提前终止试验。尽管研究人员面临着挑战,但文献中关于这一主题的讨论相对较少。在这篇简短的交流中,我们描述了我们在设计和执行一项多国儿科研究者发起的临床试验期间管理知识产权供应的经验和教训。分享这些经验,为研究人员提供工具和策略,以改进未来研究者发起的临床试验的实施。
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引用次数: 0
Study protocol for a randomized controlled effectiveness trial of THRIVE group and peer coaching to promote suicide recovery in crisis stabilization centers THRIVE小组和同伴辅导促进危机稳定中心自杀康复的随机对照有效性试验研究方案
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-23 DOI: 10.1016/j.conctc.2025.101511
Jennifer D. Lockman , Anthony R. Pisani , M. Alexis Kirk , Kimberly A. Van Orden , Ian J. Cero , Margaret E. Balfour , Kristina Mossgraber , David Jacobowitz , Kenneth R. Conner
Crisis Stabilization Centers (CSCs) offer a person-centered, community-based alternative to Emergency Departments for suicide prevention. CSCs may facilitate the expansion of the 988 Suicide Prevention Lifeline by providing callers with places to go in communities to receive treatment. However, new, recovery-focused psychological interventions for suicide prevention that can be rapidly implemented in CSCs are needed to be effective. This pilot study examines the feasibility, acceptability, and target engagement of the Toward Recovery, Hope, Interpersonal Connection, Values, and Engagement (i.e., THRIVE) for CSCs. THRIVE includes a psychotherapy group and peer-led recovery coaching calls after discharge. This project consists of three phases to adapt, pilot, and test THRIVE in CSCs in preparation for a full-scale effectiveness trial. In phase I, we will use the Model for Implementation Design and Impact (i.e., MADI) to adapt THRIVE to CSCs’ implementation needs (n = 25). In phase II, we will assess the feasibility and acceptability of THRIVE through CSC Stakeholder feedback and completing a pilot trial of THRIVE with CSC guests (n = 20). In phase III, we will complete a pilot randomized effectiveness trial of THRIVE (n = 162) to test the effectiveness of THRIVE on treatment initiation. We will also examine target engagement (i.e., as thwarted belongingness, and perceived burdensomeness) of the THRIVE intervention. Participants will be randomized to (a) Thrive + Discharge & Safety Planning as Usual (i.e., Intervention Arm): or (b) Discharge & Safety Planning as Usual (i.e., Control Arm). Participants complete assessments at baseline, discharge, 1 month, and 3 months. This protocol demonstrates strategies for involving community-based practice partners in research and is the first randomized controlled trial in a CSC sponsored by the National Institute of Mental Health (NIMH).
危机稳定中心(CSCs)提供了一个以人为本,以社区为基础的替代自杀预防急诊科。社区服务中心可为988预防自杀热线的人士提供社区内接受治疗的地方,以促进该热线的扩展。然而,新的、以康复为重点的自杀预防心理干预措施需要在csc中迅速实施才能有效。本初步研究考察了面向社会服务提供者的康复、希望、人际关系、价值观和参与(即茁壮成长)的可行性、可接受性和目标参与。THRIVE包括一个心理治疗小组和出院后的同伴康复辅导电话。该项目分为三个阶段,分别在csc中适应、试点和测试THRIVE,为全面的有效性试验做准备。在第一阶段,我们将使用实施设计和影响模型(即MADI)使THRIVE适应CSCs的实施需求(n = 25)。在第二阶段,我们将通过CSC利益相关者的反馈来评估THRIVE的可行性和可接受性,并在CSC客户(n = 20)中完成THRIVE的试点试验。在III期,我们将完成一项THRIVE的随机有效性试验(n = 162),以测试THRIVE在治疗开始时的有效性。我们还将研究THRIVE干预的目标参与(即受挫的归属感和感知负担)。参与者将被随机分配到(a)茁壮成长+放电;一如既往的安全计划(即干预臂);或(b)放电&安培;一如既往的安全规划(即控制臂)。参与者在基线、出院、1个月和3个月完成评估。该方案展示了将社区实践伙伴纳入研究的策略,并且是由国家精神卫生研究所(NIMH)赞助的CSC中的第一个随机对照试验。
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引用次数: 0
Pilot optimization trial of a sexual and reproductive health program for Latina teens and their female caregivers: A study protocol 拉丁裔青少年及其女性照顾者性健康和生殖健康项目的试点优化试验:一项研究方案
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-23 DOI: 10.1016/j.conctc.2025.101512
Katherine G. Merrill , Jacqueline Silva , Wendy Chu , Gisel Romero , Vanessa Melgoza , Blanca Gabino , Corin Mora , Sara Vargas , Jacqueline Fuentes , Caitlin Kelleher-Montero , Nicholle Courrejolles , Kate Guastaferro , Felicia Scott-Wellington , Susana Salgado , Angela Sedeño

Background

Latina teens experience sexual and reproductive health disparities; however, few effective interventions designed for Latina teens and their families exist. Floreciendo is a sexual and reproductive health intervention for Latina teens (14–18 years) and their female caregivers (e.g., mothers, sisters), delivered by trained staff at community partner organizations (CPOs).

Methods

This protocol describes a hybrid type 2 mixed-methods study with a pilot 23 factorial experimental design which draws on the multiphase optimization strategy (MOST) framework. Small groups of teen-caregiver dyads (target n = 92 dyads/184 participants) will be randomized to 1 of 8 conditions across four CPOs. All will receive the Foundations in Sexual Risk Prevention (i.e., constant) component. Groups of dyads will be randomized to different combinations of three intervention components of Floreciendo, which are either “on” or “off”: 1) Condoms and Contraception, 2) Family Strengthening, and 3) Gender and Relationships. Our aim is to examine the feasibility of using a factorial design and the acceptability of the intervention components. We will also explore effectiveness outcomes—including risky sexual behavior (primary) and incidence of sexually transmitted infections and unplanned pregnancy (secondary)—and implementation outcomes, including appropriateness, feasibility, adoption, sustainability, cost, and fidelity. Qualitative data will build on quantitative data. We will conduct focus group discussions and key informant interviews with Latina teens, female caregivers, facilitators, CPO leadership, and collaborators.

Discussion

Results will be used to guide intervention component and implementation refinement and will inform plans to conduct a fully powered optimization trial of Floreciendo.
拉丁裔青少年在性健康和生殖健康方面存在差距;然而,为拉丁裔青少年及其家庭设计的有效干预措施很少。Floreciendo是一项针对拉丁裔青少年(14-18岁)及其女性照顾者(如母亲、姐妹)的性健康和生殖健康干预措施,由社区伙伴组织训练有素的工作人员提供。方法采用多阶段优化策略(MOST)框架,采用2型混合方法进行23因子试验设计。小组青少年监护人(目标n = 92对/184名参与者)将被随机分配到四个cpo的8个条件中的1个。所有人都将获得预防性风险基础(即恒定)部分。二人组将被随机分配到Floreciendo的三种干预成分的不同组合中,这三种干预成分要么是“开”的,要么是“关”的:1)避孕套和避孕,2)加强家庭,3)性别和关系。我们的目的是检验使用因子设计的可行性和干预成分的可接受性。我们还将探讨有效性结果——包括危险的性行为(主要)、性传播感染和意外怀孕的发生率(次要)——以及实施结果,包括适当性、可行性、采用、可持续性、成本和保真度。定性数据将以定量数据为基础。我们将与拉丁裔青少年、女性看护人、辅导员、CPO领导和合作者进行焦点小组讨论和关键线人访谈。讨论结果将用于指导干预组件和实施改进,并将告知进行Floreciendo全动力优化试验的计划。
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引用次数: 0
Virtual sailing exercise to improve major depressive disorder: A pilot clinical trial protocol 虚拟帆船运动改善重度抑郁症:一项试点临床试验方案
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-20 DOI: 10.1016/j.conctc.2025.101510
Radietya Alvarabie , Yang Yun , Alexandra Gaillard , Oren Tirosh , Gurdeep Sarai , Elissa Burjawi , Denny Meyer , Junhua Xiao

Background

Major Depressive Disorder (MDD) is a prevalent and chronic psychiatric disorder associated with substantially reduced quality of life. However, current mental health management strategies— particularly for non-pharmacological interventions—to reduce this burden are limited in their efficacy. This pilot trial will, for the first time, assess if simulated sailing, combining virtual reality with recreational exercise, is a promising exercise-based therapeutic approach to reducing depression and improving the quality of life for people with MDD.

Methods

To evaluate the effectiveness of virtual sailing on MDD, 58 adults aged between 18 and 64 who have a diagnosis of MDD and can consent and participate in virtual sailing exercises will be recruited for the trial. Exclusion criteria include suicidality, severe mental illness, ongoing psychiatric treatment, and life circumstances that would hinder participation. After the pre-exercise screening, eligible participants will participate in simulated sailing sessions (30 min per session, one session per week) over six weeks. The primary outcome measurements include the evaluation of depression, anxiety, stress, quality of life, clinical improvement, and overall functioning as well as motor coordination. The second aim is to investigate if the virtual sailing program results in neuroplastic changes in the brain that restore altered resting-state functional connectivity and metabolites in MDD using Magnetic Resonance Imaging. Participants will be assessed at baseline and after the last sailing session.

Conclusion

The findings of this pilot study will inform a new therapeutic approach aimed at reducing depression and improving the quality of life for people with MDD.
背景:重度抑郁症(MDD)是一种普遍存在的慢性精神疾病,与生活质量显著下降有关。然而,目前的心理健康管理策略-特别是非药物干预-减轻这种负担的效果有限。这项试点试验将首次评估模拟帆船,将虚拟现实与休闲运动相结合,是否是一种有希望的基于运动的治疗方法,以减少抑郁症和改善重度抑郁症患者的生活质量。方法为了评估虚拟帆船运动对重度抑郁症的治疗效果,研究人员招募了58名年龄在18 - 64岁之间、被诊断为重度抑郁症且同意并参与虚拟帆船运动的成年人进行试验。排除标准包括自杀倾向、严重精神疾病、正在进行的精神治疗以及可能妨碍参与的生活环境。在运动前筛选后,符合条件的参与者将参加模拟帆船课程(每次30分钟,每周一次),为期六周。主要结果测量包括抑郁、焦虑、压力、生活质量、临床改善、整体功能和运动协调的评估。第二个目的是研究虚拟航海程序是否会导致大脑的神经可塑性变化,从而恢复MDD患者静息状态下功能连接和代谢物的改变。参赛者将在基线和最后一节帆船比赛结束后接受评估。结论本初步研究的结果将为减少抑郁症和改善重度抑郁症患者的生活质量提供新的治疗方法。
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引用次数: 0
Design and methods of an adaptive trial to test comparative effectiveness of readmission reduction approaches following infection and sepsis hospitalizations (ACCOMPLISH) 一项适应性试验的设计和方法,以测试感染和败血症住院后减少再入院方法的比较有效性(ACCOMPLISH)
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-19 DOI: 10.1016/j.conctc.2025.101504
Kristin Mayes , Victor B. Talisa , Adelina Malito , Florian B. Mayr , Kelly Williams , Kalpana Char , Richard Wadas , Elizabeth Lorenzi , Kert Viele , Rana Awdish , Derek C. Angus , Chung-Chou Ho Chang , Sachin Yende

Background

The months following hospitalization for sepsis and lower respiratory tract infection can often be very difficult for patients. Many will have subsequent clinical deterioration, which for some requires hospital readmission while, for others, transition to hospice care may be more appropriate. Unfortunately, there is a lack of high-quality evidence regarding how best to support patients in this period. Remote patient monitoring (RPM) technology can allow patients to remain at home yet be monitored for early signs of clinical deterioration. However, what should be monitored, and how any response should be coordinated, is unclear. We designed a pragmatic adaptive randomized clinical trial to determine the effect of four post-discharge RPM strategies comprising low vs. high intensity monitoring and standard versus enhanced care team response on 90-day hospital readmission rates.

Methods

Adults admitted to the hospital with sepsis or lower respiratory tract infection (index admission) are recruited and randomized to usual care (structured telephonic support [STS]) or one of four post-discharge RPM care models in addition to STS. The primary outcome is home days, a composite endpoint of 90-day mortality and the number of days a patient spends at home within 90 days after discharge to home from the index admission. Hospital readmissions will be measured primarily by health insurance claims data. Secondary endpoints, such as functional status and health-related quality of life, will be measured at baseline and 90 days. An adaptive randomization process is run quarterly, improving patients' chances to be randomized to the highest-performing intervention arms.

Discussion

The study evaluates different post-discharge monitoring and workforce strategies to increase home days. With a large, representative sample and pragmatic adaptive study design, this research aims to deliver key insights into effective remote discharge monitoring technology and workforce deployment, benefiting patients, providers, and payers.

Trial registration

This trial is registered at clinicaltrials.gov (NCT04829188). https://clinicaltrials.gov/study/NCT04829188. Date of registration: January 4, 2021.
背景:脓毒症和下呼吸道感染住院后的几个月对患者来说通常是非常困难的。许多人随后会出现临床恶化,其中一些人需要再次住院,而对另一些人来说,过渡到临终关怀可能更合适。不幸的是,关于如何在这一时期最好地支持患者,缺乏高质量的证据。远程患者监测(RPM)技术可以使患者留在家中,但可以监测临床恶化的早期迹象。然而,应该监测什么,以及应该如何协调任何应对措施,目前还不清楚。我们设计了一项实用的适应性随机临床试验,以确定四种出院后RPM策略,包括低强度与高强度监测以及标准与增强护理团队反应对90天医院再入院率的影响。方法招募因脓毒症或下呼吸道感染(指数入院)入院的成年人,随机分为常规护理(结构化电话支持[STS])或除STS外的四种出院后RPM护理模式之一。主要终点是居家天数,这是一个综合终点,包括90天死亡率和患者出院回家后90天内居家天数。再入院将主要由健康保险索赔数据来衡量。次要终点,如功能状态和健康相关生活质量,将在基线和90天进行测量。适应性随机化过程每季度进行一次,提高了患者被随机分配到表现最好的干预组的机会。本研究评估了不同的出院后监测和劳动力策略,以增加回家的时间。本研究采用了大量具有代表性的样本和实用的适应性研究设计,旨在为有效的远程出院监测技术和劳动力部署提供关键见解,使患者、提供者和支付方受益。试验注册本试验在clinicaltrials.gov注册(NCT04829188)。https://clinicaltrials.gov/study/NCT04829188。注册日期:2021年1月4日。
{"title":"Design and methods of an adaptive trial to test comparative effectiveness of readmission reduction approaches following infection and sepsis hospitalizations (ACCOMPLISH)","authors":"Kristin Mayes ,&nbsp;Victor B. Talisa ,&nbsp;Adelina Malito ,&nbsp;Florian B. Mayr ,&nbsp;Kelly Williams ,&nbsp;Kalpana Char ,&nbsp;Richard Wadas ,&nbsp;Elizabeth Lorenzi ,&nbsp;Kert Viele ,&nbsp;Rana Awdish ,&nbsp;Derek C. Angus ,&nbsp;Chung-Chou Ho Chang ,&nbsp;Sachin Yende","doi":"10.1016/j.conctc.2025.101504","DOIUrl":"10.1016/j.conctc.2025.101504","url":null,"abstract":"<div><h3>Background</h3><div>The months following hospitalization for sepsis and lower respiratory tract infection can often be very difficult for patients. Many will have subsequent clinical deterioration, which for some requires hospital readmission while, for others, transition to hospice care may be more appropriate. Unfortunately, there is a lack of high-quality evidence regarding how best to support patients in this period. Remote patient monitoring (RPM) technology can allow patients to remain at home yet be monitored for early signs of clinical deterioration. However, what should be monitored, and how any response should be coordinated, is unclear. We designed a pragmatic adaptive randomized clinical trial to determine the effect of four post-discharge RPM strategies comprising low vs. high intensity monitoring and standard versus enhanced care team response on 90-day hospital readmission rates.</div></div><div><h3>Methods</h3><div>Adults admitted to the hospital with sepsis or lower respiratory tract infection (index admission) are recruited and randomized to usual care (structured telephonic support [STS]) or one of four post-discharge RPM care models in addition to STS. The primary outcome is home days, a composite endpoint of 90-day mortality and the number of days a patient spends at home within 90 days after discharge to home from the index admission. Hospital readmissions will be measured primarily by health insurance claims data. Secondary endpoints, such as functional status and health-related quality of life, will be measured at baseline and 90 days. An adaptive randomization process is run quarterly, improving patients' chances to be randomized to the highest-performing intervention arms.</div></div><div><h3>Discussion</h3><div>The study evaluates different post-discharge monitoring and workforce strategies to increase home days. With a large, representative sample and pragmatic adaptive study design, this research aims to deliver key insights into effective remote discharge monitoring technology and workforce deployment, benefiting patients, providers, and payers.</div></div><div><h3>Trial registration</h3><div>This trial is registered at <span><span>clinicaltrials.gov</span><svg><path></path></svg></span> (NCT04829188). <span><span>https://clinicaltrials.gov/study/NCT04829188</span><svg><path></path></svg></span>. Date of registration: January 4, 2021.</div></div>","PeriodicalId":37937,"journal":{"name":"Contemporary Clinical Trials Communications","volume":"46 ","pages":"Article 101504"},"PeriodicalIF":1.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Study protocol for a pilot randomized trial building resiliency among caregivers of cancer curvivors and metavivors 一项随机试验的研究方案,在癌症幸存者和转移者的护理人员中建立弹性
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-12 DOI: 10.1016/j.conctc.2025.101506
Brett M. Goshe , Anna Barata , Lucy Finkelstein-Fox , Joanna Cloutier , Emelia Farnam , Katie Holmbeck , Elizabeth Waldron , Giselle K. Perez , Laura Malloy , Isabelle Miranda , Wren Hager , Nora Horick , Areej El-Jawahri , Elyse Park

Background

Caregivers of cancer survivors experience chronic stress, increasing emotional and physical health risks. Many caregivers report unmet psychosocial needs and maladaptive coping strategies, resulting in high caregiver burden and impaired quality of life. Existing interventions primarily address caregiver needs during active treatment or in relation to end-of-life care, with few providing targeted resources for caregivers coping with the challenges of post-active treatment survivorship – either for those supporting curvivors (cancer survivors who have completed curative therapy) or metavivors (patients living with metastatic disease).

Objective

This single-site pilot randomized trial, Forward Together (ForTe), aims to determine the feasibility (e.g., enrollment, survey completion, and group attendance rates), acceptability (e.g., program satisfaction and quality rating), and preliminary effects on resilience and healthcare utilization of the Stress Management and Resiliency Training: The Relaxation Response Resiliency Program (SMART-3RP) compared to Enhanced Usual Care (EUC; referral to CanCare.org caregiver and patient virtual support groups). (Clinical Trials ID: NCT05702723)

Methods

A multimodal recruitment approach, including both proactive and reactive methods, will be used to identify potential dyads for this study. Dyads (cancer survivor and caregiver) will be randomized 1:1 to SMART-3RP or EUC. Dyads randomized to the SMART-3RP will participate separately but simultaneously in 9 survivor- or caregiver-specific group sessions.

Results

This study is funded by the National Cancer Institute. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board. Study procedures are complete; data analysis is ongoing.
癌症幸存者的照顾者经历着长期的压力,增加了情绪和身体健康的风险。许多照护者报告心理社会需求未得到满足,应对策略不适应,导致照护者负担加重,生活质量受损。现有的干预措施主要针对积极治疗期间或与临终关怀相关的护理人员的需求,很少为护理人员提供有针对性的资源,以应对积极治疗后生存的挑战-无论是那些支持幸存者(已完成治愈性治疗的癌症幸存者)还是幸存者(患有转移性疾病的患者)。目的:本单点随机试验“一起向前”(ForTe)旨在确定压力管理和弹性训练的可行性(如入组、调查完成率和小组出勤率)、可接受性(如项目满意度和质量评级)以及对弹性和医疗保健利用的初步影响:放松反应弹性计划(SMART-3RP)与强化常规护理(EUC;转介到CanCare.org护理人员和患者虚拟支持小组)。(临床试验ID: NCT05702723)方法采用多模式招募方法,包括主动和被动方法,以确定本研究的潜在双性恋。二人组(癌症幸存者和护理者)将按1:1随机分为SMART-3RP组或EUC组。被随机分配到SMART-3RP的二人组将分别但同时参加9个针对幸存者或护理人员的小组会议。这项研究是由美国国家癌症研究所资助的。研究程序由丹娜-法伯哈佛癌症中心机构审查委员会批准。研究程序完整;数据分析正在进行中。
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引用次数: 0
Intranasal insulin for the treatment of alcohol use disorder: design and methodology of an alcohol interaction randomized controlled trial 鼻内胰岛素治疗酒精使用障碍:酒精相互作用随机对照试验的设计和方法
IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-06-10 DOI: 10.1016/j.conctc.2025.101509
Carolina L. Haass-Koffler , Bhavani Kashyap , Brian J. Gully , Sithara S. Nambiar , Rivkah Hornbacher , Stephanie L. Foster , Yuval Silberman , Robert M. Swift , Leah R. Hanson , William H. Frey II
Despite developments in treatments for alcohol use disorder (AUD), current pharmacotherapies face several limitations, including adverse events. Intranasal (IN) insulin has shown promise for addictive disorders. The overarching hypothesis of this trial is that by increasing brain cell energy and glucose metabolism, while reducing stress hormones, IN insulin may be an ideal approach for treating multiple domains of AUD including memory, executive function and impulsivity. Preclinical and clinical studies of IN insulin demonstrate that it is a safe and effective method for delivering insulin to the central nervous system, circumventing the blood brain barrier, and reducing adverse events associated with insulin use (hypoglycemia). The overarching goal of this Phase I/IIa, within-subject, crossover, double-blind, placebo-controlled, alcohol interaction trial is to test the IN insulin (80IU), compared to placebo (0.9 % saline) as a potential therapy for AUD. The primary aim assesses the safety and tolerability of IN insulin, compared to placebo, in individuals with AUD (N = 40) who are not currently seeking treatment. The secondary aim assesses the safety and tolerability of IN insulin, compared to placebo, when co-administered with alcohol (0.08 g/dL). Tertiary aims include assessing cognitive performance, memory, and impulsivity following IN insulin, or placebo, and alcohol administration. Finally, an alcohol cue reactivity procedure investigates the effect of IN insulin, compared to placebo, in alcohol craving. This is the first study to evaluate IN insulin in an AUD population and this manuscript describes the rationale, design, and methodology of the alcohol interaction trial. This study is designed to accelerate research for the development of novel medications to treat AUD and provide empirical evidence on the safety and efficacy of a neurotherapeutic approach to inform clinical practice.

Clinical trial

NCT05988632.

Fda/ind

168417.
尽管酒精使用障碍(AUD)的治疗方法有所发展,但目前的药物治疗仍面临一些局限性,包括不良事件。鼻内胰岛素(IN)已显示出治疗成瘾性疾病的希望。本试验的首要假设是,通过增加脑细胞能量和葡萄糖代谢,同时减少应激激素,胰岛素可能是治疗AUD多个领域的理想方法,包括记忆、执行功能和冲动。IN胰岛素的临床前和临床研究表明,它是一种安全有效的方法,可以将胰岛素输送到中枢神经系统,绕过血脑屏障,减少与胰岛素使用相关的不良事件(低血糖)。这项I/IIa期、受试者内、交叉、双盲、安慰剂对照、酒精相互作用试验的总体目标是测试IN胰岛素(80IU)与安慰剂(0.9%生理盐水)作为AUD的潜在治疗方法。主要目的是评估目前未寻求治疗的AUD患者(N = 40)与安慰剂相比使用IN胰岛素的安全性和耐受性。第二个目的是评估与安慰剂相比,与酒精(0.08 g/dL)联合给药时胰岛素的安全性和耐受性。第三目的包括评估胰岛素、安慰剂和酒精治疗后的认知表现、记忆力和冲动性。最后,酒精提示反应程序研究了胰岛素对酒精渴望的影响,并与安慰剂进行了比较。这是第一项评估AUD人群中IN胰岛素的研究,本文描述了酒精相互作用试验的基本原理、设计和方法。本研究旨在加速研究开发治疗AUD的新药物,并为神经治疗方法的安全性和有效性提供经验证据,为临床实践提供信息。临床trialNCT05988632.Fda / ind168417。
{"title":"Intranasal insulin for the treatment of alcohol use disorder: design and methodology of an alcohol interaction randomized controlled trial","authors":"Carolina L. Haass-Koffler ,&nbsp;Bhavani Kashyap ,&nbsp;Brian J. Gully ,&nbsp;Sithara S. Nambiar ,&nbsp;Rivkah Hornbacher ,&nbsp;Stephanie L. Foster ,&nbsp;Yuval Silberman ,&nbsp;Robert M. Swift ,&nbsp;Leah R. Hanson ,&nbsp;William H. Frey II","doi":"10.1016/j.conctc.2025.101509","DOIUrl":"10.1016/j.conctc.2025.101509","url":null,"abstract":"<div><div>Despite developments in treatments for alcohol use disorder (AUD), current pharmacotherapies face several limitations, including adverse events. Intranasal (IN) insulin has shown promise for addictive disorders. The overarching hypothesis of this trial is that by increasing brain cell energy and glucose metabolism, while reducing stress hormones, IN insulin may be an ideal approach for treating multiple domains of AUD including memory, executive function and impulsivity. Preclinical and clinical studies of IN insulin demonstrate that it is a safe and effective method for delivering insulin to the central nervous system, circumventing the blood brain barrier, and reducing adverse events associated with insulin use (hypoglycemia). The overarching goal of this Phase I/IIa, within-subject, crossover, double-blind, placebo-controlled, alcohol interaction trial is to test the IN insulin (80IU), compared to placebo (0.9 % saline) as a potential therapy for AUD. The primary aim assesses the safety and tolerability of IN insulin, compared to placebo, in individuals with AUD (<em>N</em> = 40) who are not currently seeking treatment. The secondary aim assesses the safety and tolerability of IN insulin, compared to placebo, when co-administered with alcohol (0.08 g/dL). Tertiary aims include assessing cognitive performance, memory, and impulsivity following IN insulin, or placebo, and alcohol administration. Finally, an alcohol cue reactivity procedure investigates the effect of IN insulin, compared to placebo, in alcohol craving. This is the first study to evaluate IN insulin in an AUD population and this manuscript describes the rationale, design, and methodology of the alcohol interaction trial. This study is designed to accelerate research for the development of novel medications to treat AUD and provide empirical evidence on the safety and efficacy of a neurotherapeutic approach to inform clinical practice.</div></div><div><h3>Clinical trial</h3><div>NCT05988632.</div></div><div><h3>Fda/ind</h3><div>168417.</div></div>","PeriodicalId":37937,"journal":{"name":"Contemporary Clinical Trials Communications","volume":"46 ","pages":"Article 101509"},"PeriodicalIF":1.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Contemporary Clinical Trials Communications
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