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Introduction Approximately 30% of somatic hospital inpatients experience psychosocial distress, contributing to increased (re-)hospitalisation rates, treatment resistance, morbidity, and direct and indirect costs. However, such distress often remains unrecognised and unaddressed. We established ‘SomPsyNet’, a ‘stepped and collaborative care model’ (SCCM) for somatic hospital inpatients, aiming at alleviating this issue through early identification of distress and provision of appropriate care, providing problem-focused pathways and strengthening collaborative care. We report the protocol of the ‘SomPsyNet’ study, aiming to evaluate implementation and impact of the SCCM on distressed patients’ health-related quality of life. Secondary objectives include assessing efficacy of the screening procedures, influence of SCCM on other health outcomes and associated costs.Methods and analysis Our stepped wedge cluster randomised trial conducted at three tertiary hospitals comprises three conditions: treatment as usual (TAU) without screening for distress (phase 0), TAU with screening but without consequences (phase I, main comparator) and TAU with screening and psychosomatic-psychiatric consultations for those distressed (phase II). The time-of-transition between phases I and II was randomised. Sample size target is N=2200–2500 participants, with 6 month follow-up for distressed (anticipated n=640–700) and a subsample of non-distressed (anticipated n=200) patients. Primary outcome is mental health-related quality of life (SF-36 ‘Mental Health Component Summary score’); secondary outcomes include psychosocial distress, anxiety, depressive and somatic symptoms, symptom burden and distress, resilience, social support and qualitative of life, assessed by internationally accepted instruments, with good psychometric properties. Further, health claims data will be used to assess SCCM’s impact on direct and indirect costs.Ethics and dissemination SomPsyNet adheres to the Helsinki Declaration and is approved by the ‘Ethikkommission Nordwest- und Zentralschweiz’ (2019–01724). Findings will be published in peer-reviewed journals and communicated to participants, healthcare professionals and the public.Trial registration number Swiss National Clinical Trials Portal; ClinicalTrials.gov (NCT04269005, updated 19.09.2023).

The efficacy of prebiotics and probiotics (synbiotics when combined) to improve symptoms associated with autism spectrum disorder (ASD) has shown considerable inter-study variation, likely due to the complex, heterogeneous nature of the disorder and its associated behavioral, developmental, and gastrointestinal symptoms. Here, we present a precision synbiotic supplementation study in 296 children and adults diagnosed with ASD versus 123 age-matched neurotypical controls. One hundred seventy ASD participants completed the study. Baseline and post-synbiotic assessment of ASD and gastrointestinal (GI) symptoms and deep metagenomic sequencing were performed. Within the ASD cohort, there were significant differences in microbes between subpopulations based on the social responsiveness scale (SRS2) survey ( Prevotella spp. , Bacteroides, Fusicatenibacter , and others) and gluten and dairy-free diets ( Bifidobacterium spp., Lactococcus, Streptococcus spp., and others). At the baseline, the ASD cohort maintained a lower taxonomic alpha diversity and significant differences in taxonomic composition, metabolic pathways, and gene families, with a greater proportion of potential pathogens, including Shigella, Klebsiella, and Clostridium, and lower proportions of beneficial microbes, including Faecalibacterium compared to controls. Following the 3-month synbiotic supplementation, the ASD cohort showed increased taxonomic alpha diversity, shifts in taxonomy and metabolic pathway potential, and improvements in some ASD-related symptoms, including a significant reduction in GI discomfort and overall improved language, comprehension, cognition, thinking, and speech. However, the open-label study design may include some placebo effects. In summary, we found that precision synbiotics modulated the gut microbiome and could be used as supplementation to improve gastrointestinal and ASD-related symptoms., Importance: Autism spectrum disorder (ASD) is prevalent in 1 out of 36 children in the United States and contributes to health, financial, and psychological burdens. Attempts to identify a gut microbiome signature of ASD have produced varied results. The limited pre-clinical and clinical population sizes have hampered the success of these trials. To understand the microbiome associated with ASD, we employed whole metagenomic shotgun sequencing to classify microbial composition and genetic functional potential. Despite being one of the most extensive ASD post-synbiotic assessment studies, the results highlight the complexity of performing such a case-control supplementation study in this population and the potential for a future therapeutic approach in ASD., Competing Interests: J.P., D.N., S.J., T.M., S.D., K.B., and S.T. are employed by Sun Genomics Inc. D.C.C. was co-supported by Sun Genomics Inc. J.A. and R.K.-B. are co-founders of Gut-Brain Axis Therapeutics Inc., which is developing microbiome-based treatments for autism and other disorders.

Irritable bowel syndrome (IBS) is characterized by abdominal discomfort and irregular bowel movements and stool consistency. As such, the gut microbiome has been posited as being influential for the syndrome. However, identifying microbial features associated with IBS symptom heterogeneity is difficult without large cohorts. Our aim was to identify microbial features associated with IBS and IBS subtypes compared to healthy controls and to determine if a synbiotic supplementation intervention could decrease the proportion of those microbial features. Stool samples from 490 individuals with IBS (including all dominant subtypes) and 122 individuals without IBS were analyzed with metagenomic sequencing. One hundred thirty-four IBS subjects were followed over time while receiving daily synbiotic supplementation, the composition of which varied between participants. IBS participants had significantly lower alpha diversity, an enrichment in Gram-negative bacteria, and a reduction in pathways associated with short-chain fatty acid and vitamin synthesis. Shigella species were significantly associated with IBS, while Eubacterium rectale and Faecalibacterium prausnitzii were associated with healthy controls. Random forest identified unique and overlapping microbial features associated with each IBS subtype. Longitudinal assessment of 134 IBS subjects receiving synbiotic supplements demonstrated a significant difference in microbial features and an increase in probiotic abundance across time. We identified microbial features that differentiate healthy and IBS subtypes. Synbiotic supplementation in IBS subjects did not result in alpha diversity change in the microbiome but did demonstrate changes in microbial features. Future work is needed to determine if the observed microbiome changes are associated with IBS symptom improvement. IMPORTANCE An estimated 35 million people in the United States and 11.5% of the population globally are affected by IBS. Immunity, genetics, environment, diet, small intestinal bacterial overgrowth (SIBO), and the gut microbiome are all factors that contribute to the onset or triggers of IBS. With strong supporting evidence that the gut microbiome may influence symptoms associated with IBS, elucidating the important microbes that contribute to the symptoms and severity is important to make decisions for targeted treatment. As probiotics have become more common in treating IBS symptoms, identifying effective probiotics may help inform future studies and treatment.

Background: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging., Methods: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations., Results: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%)., Conclusion: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice., Clinical Trial Registration: NCT00470587, http://clinicaltrials.gov/show/NCT00470587., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background and Objective: The delivery of needs-based health care services requires a team-based and collaborative approach of different health professionals, which is not yet sufficienctliy implemented on a day to day basis. Interprofessional learning activities aim to respond to this in future. The cross-university pilot project interTUT used peer-assisted learning approaches and extracurricular tutorials in order address this issue., Methodology: During the pilot phase, eight students and trainees have been acquired. Together, they prepared and led four extracurricular tutorials on core topics of interprofessional cooperation and documented them in procedure manuals. The course was evaluated using a standardized participant survey (n=72) and two focus groups (n=3, n=5) in which participants were asked to reflect on their individual learning experiences. Descriptive statistics were used to analyze the survey data and the focus group material was interpreted using qualitative content analysis., Results: The results indicated a high level of satisfaction, acceptance of and further demand for peer-supported learning activities. The students and trainees reported changed attitudes and subjective knowledge growth regarding the other professional groups. The constructive learning atmosphere as well as having access to a forum for interprofessional exchange were equally valued., Conclusions: Extracurricular tutorials offer a low-threshold and very promising point of contact for the facilitation of interprofessional teaching and learning. However, this should be viewed against the background that, as part of the pilot project, only a small number of students and trainees who were already interested in the topic could be reached by this optional course. A comprehensive, long-term trial of this teaching and learning format, its linkage to curricular courses, and further research on its education-specific and practice-related effects are, therefore, necessary.

Unlabelled: We aimed to prospectively derive and validate a novel 0-/1-hour algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for the early "rule-out" and "rule-in" of acute myocardial infarction (AMI)., Methods: In a prospective multicenter diagnostic study, we enrolled 1,500 patients presenting with suspected AMI to the emergency department. The final diagnosis was centrally adjudicated by 2 independent cardiologists blinded to hs-cTnI concentrations. The hs-cTnI (Siemens Vista) 0-/1-hour algorithm incorporated measurements performed at baseline and absolute changes within 1 hour, was derived in the first 750 patients (derivation cohort), and then validated in the second 750 (validation cohort)., Results: Overall, AMI was the final diagnosis in 16% of patients. Applying the hs-cTnI 0-/1-hour algorithm developed in the derivation cohort to the validation cohort, 57% of patients could be classified as "rule-out"; 10%, as "rule-in"; and 33%, as "observe." In the validation cohort, the sensitivity and the negative predictive value for AMI in the "rule-out" zone were 100% (95% CI 96%-100%) and 100% (95% CI 99%-100%), respectively. The specificity and the positive predictive value (PPV) for AMI in the "rule-in" zone were 96% (95% CI 94%-97%) and 70% (95% CI 60%-79%), respectively. Negative predictive value and positive predictive value of the 0-/1-hour algorithm were higher compared to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001)., Conclusion: The hs-cTnI 0-/1-hour algorithm performs very well for early rule-out as well as rule-in of AMI. The clinical implications are that used in conjunction with all other clinical information, the 0-/1-hour algorithm will be a safe and effective approach to substantially reduce time to diagnosis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Malnutrition is a common problem in in-patients nursing homes. A body mass index (BMI) that is lowerthan 18.5 kg/m2 is the first indication for malnutrition. In three studies BMI and other data were therefore collected. Family members and nurses of wards for residents suffering from dementia were interviewed and nursing documentation was analysed. Almost every tenth resident has a BMI that is lower than 18.5 kg/m2. The results clarify the need to identify malnutrition in the early stages by screening and assessment as well as the need for a nutrition supply that is focussed on the demands and needs of residents. A standard for in-patients nursing homes has been worked out based on the results of the studies.

This article presents the central results of a survey including all persons insured by the BfA (Bundesversicherungsanstalt für Angestellte, German Federal Insurance Institute for Employees) who had participated in outpatient orthopaedic rehabilitation between March and August of 2002. A total of 3838 insured persons were addressed, 69 % replied (n = 2660 questionnaires). The standardized survey included an appraisal of the outpatient rehabilitation measure, the care provided by physicians, psychologists and therapists, the organisation and performance of the rehabilitation measure, as well as of the stressors and general conditions specific to various outpatient measures. The assessment of treatment outcome, physical and psychosocial improvements, and the attainment of therapy goals were of particular importance. Overall, the results show a positive appraisal of outpatient rehabilitation but also indicate the necessity for optimisation--particularly with regard to resting rooms, physician and psychological care, as well as the suitability of the therapy for everyday life. Above all, however, the comparison of the rehabilitation centres shows a great variance in quality of care. Some rehabilitation centres show extraordinary results in many aspects of quality, whereas others reveal systematic deficits of quality.

The survey of psychosocial, somatic and economic outcomes is regarded as standard in establishing the effectiveness of various rehabilitative forms of medical care. Another important part is the patient's perspective for the subjective valuation of the entire measure or different facets of the rehabilitation measure. During a comparison of the effectiveness of different forms of care of orthopaedic rehabilitation (inpatient, outpatient in the hospital, outpatient) 1176 patients were questioned in writing at 4 different time points. The results concerning the general measurement of the satisfaction with the rehabilitation measure showed a high level and a high acceptance in all forms of medical care at the end of and after the measure. The result relating to the selection of the correct hospital for the specific troubles of the patient was positive as well. This can also be stated for the patients' estimation of the contacts between the doctors and the physiotherapists. At the end of measure, all the patients in every form of care viewed these contacts as being helpful. The outpatient offers were viewed a bit better by the patients concerning the contacts to doctors and physiotherapists. The extent of the care specific to the different occupational groups was estimated by almost all patients of all forms as being just about right. Additionally, the course organization and the work of the administration had a good evaluation - with slight advantages for the inpatient forms.

This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.

In addition to outcome quality, the quality of structure and process is an essential parameter for health care. In the context of a study comparing the outcome and costs of inpatient and different outpatient rehabilitation settings, the structural and procedural quality of the participating rehabilitation facilities were examined as well. Data were collected using questionnaires, interviews, treatment plans and visitations of the rehabilitation facilities. The analyses show a great correspondence of structural and procedural quality between the different rehabilitation settings. Particularly the data gathered by questionnaires show few differences. Points of significant difference include the more extensive equipment and the more favorable personnel key with regard to physicians in the inpatient clinics and the outpatient settings within these clinics. The outpatient rehabilitation facilities outside of rehabilitation clinics are characterized by a stronger accentuation of functional therapy, in particular physiotherapy and sports therapy. Functional therapy is of greater importance in the self-concept of the outpatient rehabilitation facilities and is also applied there more often.

This article analyses various methods of predicting whether patients in orthopaedic rehabilitation will return to work. In this regard, items of patients, physicians in charge of rehabilitation and general practitioners have been collected and compared to working time lost due to illness. In total, 72 % of patients had successfully returned to work after one year. The patients whose reintegration could not be achieved could be identified best by asking if they believed that they would be in a position to work until the statutory retirement age (96 % identified) on the one hand and on the other hand by the physicians' estimate as to the degree the last gainful activity might be resumed (90 % identified). In this context, the criteria have to be laid down very restrictively in order to sufficiently filter out patients not likely to return to work. The patients likely to return to work are identified best by means of the following characteristics: lack of intention to retire early (96 % identified), planning to return to work directly after rehabilitation (88 % identified), and little working time lost due to illness prior to rehab (86 % identified). In general, a major percentage of patients not likely to return to work can be identified by these statements of patients and physicians. The statements of general practitioners are clearly less valuable for prediction and show only weak correlation with the respective statements of the physicians in charge of rehabilitation.