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NCT07484009
This clinical trial aims to determine whether a ReDS-guided treatment strategy is superior to the current standard of care for adults hospitalized with heart failure. Additionally, the study will evaluate the safety and cost-effectiveness of this approach. The study seeks to answer the following key questions: 1. Does the ReDS-guided strategy reduce the risk of cardiovascular events during the first month following hospital discharge? 2. What is the safety profile of this treatment strategy? Researchers will compare the ReDS-based strategy against the current standard of care. All participants will: * Undergo daily assessments using the ReDS device throughout their hospitalization. * Attend two follow-up visits post-discharge, scheduled at 2 weeks and 30 days.
NCT07185828
The goal of this campaign is to reduce unnecessary visits to a Geisinger emergency department (ED). In this campaign, patients will be assigned to receive or not receive outreach following ED discharge with a low-acuity visit designation. Outreach will occur via a text message the day after discharge from the ED as well as information added to the patient's after visit summary (AVS). Depending on the assigned condition, it will include calls to see their primary care provider (PCP) or use an Intelligent Triage tool. The study will assess whether ED use within the following 120 days differs across patients in different outreach conditions (current standard practice vs contact your PCP vs use Intelligent Triage). It will also examine whether patients follow through on the message-specific calls to action differently across conditions.
NCT07443098
Background: This randomized study, conducted from October to December 2023 in the emergency department of Bethesda Hospital Basel, Switzerland, investigated a new model of care for patients presenting with non-urgent musculoskeletal disorders (MSKDs). It was initiated in response to two major challenges in the Swiss healthcare system: a shortage of general practitioners and a rising number of ED visits for conditions such as back, neck, and shoulder pain, sprains, and other joint or muscle complaints without serious underlying pathology. Internationally, Advanced Physiotherapy Practice (APP) roles, in which specially trained physiotherapists independently assess, diagnose, treat, and discharge patients with appropriate MSKDs, have been successfully implemented in emergency settings, but this model is still novel in Switzerland, and local evidence on safety and comparability to medical care is lacking. Methods: A total of 102 patients with musculoskeletal complaints and no signs of serious structural or systemic disease were included after informed consent. Patients were randomly assigned either to an intervention group, managed by physiotherapists working in an advanced practice role, or to a control group receiving standard care from resident physicians. Senior physicians, acting as reference standard, reviewed clinical findings, diagnoses, treatment recommendations, and discharge decisions from both groups. Agreement between each provider group and senior physicians was quantified using established measures of inter-rater reliability, specifically Cohen's Kappa (κ) and Gwet's AC1, to determine concordance beyond chance. Conclusions: This study aims to determine whether advanced practice physiotherapists can provide clinical decision-making comparable to resident physicians for non-urgent MSKDs in the ED. Demonstrating high levels of agreement in diagnosis, management, and discharge planning would support the safe integration of APP roles into Swiss emergency workflows, with potential benefits including reduced waiting times, more efficient use of physician resources, improved patient flow, and maintenance of high standards of care and patient safety, thereby informing workforce planning and task-sharing strategies in acute care.
NCT07280208
This study aimed to improve how patients with heart failure understand and manage their condition after leaving the hospital. Many heart failure patients are readmitted within 30 days due to confusion about their discharge instructions and difficulty following self-care routines. The study tested whether a structured discharge education session using the "teach-back" method-where patients repeated instructions in their own words-could help improve their knowledge and self-care behaviors. The goal was to reduce hospital readmissions and help patients feel more confident managing their heart failure at home.
NCT07428109
For several decades, hospital emergency departments have been experiencing congestion, sometimes reaching saturation point, where they are no longer able to fulfil their primary mission: to prioritise patients requiring immediate care due to a clinical situation that could be life-threatening or functionally debilitating. The main reason for this situation is a structural mismatch between medical needs, which have increased due to population ageing, and outpatient care supply, which has remained relatively stable in order to contain healthcare expenditure. As a result, a large proportion of people visiting hospital emergency departments are individuals who have been unable to find a solution to their medical needs in the community and have turned to the hospital as a last resort. These are patients seeking urgent, unscheduled care who have been unable to obtain an appointment with their general practitioner or another primary care professional. In times of extreme pressure, as sometimes happens in France during the summer, access to hospital emergency departments is limited to patients who have received prior authorisation to attend. Similarly, new ways of managing these requests for urgent or unscheduled care are being sought in the field of medical regulation. Triage of patients by telephone appears to be an essential step in medical regulation prior to access to hospital emergency departments. Indeed, if solutions are available in the city for patients who do not need to go to the emergency department, this triage will optimise the resources of the healthcare system. However, quickly assessing patients without visual contact (who may be in a state of emotional distress or face a language barrier) is a particularly delicate task. Several triage algorithms are available to assist telephone operators. However, these require structured clinical information that is not easily and quickly accessible during calls. For several years now, artificial intelligence (AI) has emerged as a promising alternative for assisting operators, as it enables the management of large amounts of unstructured data, particularly audio exchanges. AI-based classification models using audio data have shown that they could be useful in medical regulation, particularly in cases of cardiac arrest, stroke or myocardial infarction. However, to our knowledge, previous studies have focused on specific disorders, and their models are not capable of handling the vast range of cases inherent in the classification of general front-line emergency calls. In this context, researchers have developed an AI-based model to identify patients requiring referral to hospital emergency departments among outpatients seeking emergency or unscheduled care through medical call centres. To do so they used telephone calls and medical records from SOS Médecins Grand Paris, a group of approximately 150 general practitioners and emergency doctors who mainly offer same-day home visits in Paris and its neighbouring departments (more than 6.5 million inhabitants). The objective of this study is to evaluate the model's ability to identify patients requiring hospitalization based on (1) new data from SOS Médecins Grand Paris, but also (2) data from Corsica, (3) to compare the model's predictions with those of a physician, and (4) to determine the general conditions for using the predictions in current practice.
NCT03261258
In the vast majority of cases, the person of trust (or contact person) is not designated by the patient (emergency, severe disease situations, coma, sedation, etc.). The healthcare team thus identifies a person who 1) may not be the person the patient would have designated and 2) may not be the most suitable to take on this responsibility. Though the first point is not easy, the main difficulty for the clinician is to know if he is dealing with the "right person for the job", meaning a person who is able to take on the responsibility of the contact person. This is a heavy responsibility in terms of the information given, of passing on this information to relatives and friends, of consulting the doctors, of help or support in medical decisions, etc. This responsibility may also be difficult for one person alone to take on and it may be helpful to share it between several friends or relatives. In a princeps study (QUENOT, 2015), it was shown that the process used by the healthcare team to designate a contact person was based on criteria such as knowledge of the wishes and values of the patient, the strength of the relationship with the patient, and the person of trust designated before admission to the ICU. However, we do not know what criteria are used by the patients themselves or those used by their close friends and relatives. This study will make it possible to determine and to measure the possible differences between the criteria used by the ICU healthcare team (REPERE I), those used by patients (REPERE III) and finally, those used by close friends and relatives (REPERE II). In order to do this, 300 persons (150 patients and 150 relatives/friends) will complete questionnaires.
NCT05405491
RESPIRE is a randomized, unblinded, controlled study to measure the impact of a strategy based on a PCR test on the adjustment of antimicrobial therapy in immunocompromised patients suspected with ventilator-associated or hospital-acquired pneumonia (VAP/HAP) requiring mechanical ventilation (MV) in Intensive Care Unit (ICU). The gold-standard microbiological diagnostic method for pneumonia in the ICU is based on culture identification and antimicrobial susceptibility testing. Results are obtained in several days after the initiation of empiric antimicrobial therapy, exposing patients to a potential inappropriate broad-spectrum antimicrobial treatment. We aim to measure the impact of a PCR-based strategy to improve the percentage of patients with VAP or HAP receiving targeted antimicrobial therapy 24 hours after diagnosis compared to standard care
NCT02996721
This study evaluates whether achieving 25-hydroxyvitamin D (25\[OH\] Vit D) levels (\>40 ng/mL) among myocardial infarction patients will result in a reduction of cardiovascular-related adverse events. Half of the patients will be randomized to receive standard of care and half will receive clinical management of 25\[OH\] Vit D levels.
NCT03594500
Aim 1: Establish the feasibility of screening for hearing loss in the ED Aim 2: Determine the acceptability of the screening procedure (among the ED population) Aim 3: Derive a preliminary estimate of the effect size of primary outcomes Aim 4: Identify the evidence that decision makers in Veteran Affair Medical Centers, ED and Audiology Services need to commit to this approach
NCT05028972
HearVA involves six VA facility emergency departments (ED) over a 3-year intervention period. The first part of this study will test whether providing personal amplifiers to Veteran ED patients who self-report hearing difficulty is acceptable to these patients, can improve their hearing, enhance understanding of discharge instructions, and can reduce the risk of coming back to the ED in a short period of time (3 days and 30 days). The second part of the study will then identify whether ED staff can implement this program and achieve similar results. The second part will give ED staff increasing levels of responsibility for screening Veterans for hearing difficulty and providing personal amplifiers when such difficulty is detected.
NCT07177508
The goal of this observational study is to explore the impact of a new prevention medicine (nirsevimab) on the burden of Respiratory Syncytial Virus (RSV) disease in children under 2 years of age. The main question it aims to answer is: How has the incidence of RSV, and Emergency Department presentations and hospital admissions for RSV-related disease changed since nirsevimab was introduced? Participants won't need to do anything extra for this research study, as only routinely collected data will be used for analysis.
NCT05576766
Prostate cancer ranks second among all malignances in men and has become a significant threat to men's health. Robot-assisted laparoscopic radical prostatectomy (RARP) has become a standard treatment for prostate cancer. How to improve recovery following RARP surgery is worth investigating. The enhanced recovery after surgery (ERAS) pathway involves a series of evidence-based procedures. It is aimed to reduce the systemic stress response to surgery and shorten the length of hospital stay. This randomized trial aims to investigate the impact of Enhanced Recovery After Surgery (ERAS) Pathway on early outcomes after RARP surgery.
NCT06301841
Investigators propose to conduct a multicenter, prospective, randomized, controlled, assessing the interests of an antibiotic protocol guided by the combined use of serum procalcitonin (PCT) and a broad-panel respiratory multiplex PCR (mPCR) to reduce duration of antibiotics exposure in patients with chronic obstructive pulmonary disease (COPD) hospitalized in intensive care unit (ICU) with pneumonia. The primary endpoint is the number of antibiotic-days for the treatment of pneumonia.
NCT06977971
This study retrospectively evaluated the clinical, laboratory, and radiologic factors that influence the decision to prescribe antibiotics in children under 2 years of age hospitalized with RSV-positive acute lower respiratory tract infections. The study also examined the economic impact of antibiotic use in these patients. The goal is to improve clinical decision-making and reduce unnecessary antibiotic exposure in children with viral infections.
NCT05698615
In the planned study, the effect of chess training on the cognitive abilities of children and adolescents with psychiatric and psychosomatic illnesses will be investigated in a naturalistic setting. Furthermore, the effects on therapy success and quality of life will be determined.Despite the thoroughly positive results, CRT has not yet been included in the official guidelines as an intervention in standard therapy; this is due, among other things, to too few studies and too little knowledge in the field of child and adolescent psychiatry. The planned study aims to fill the research gap in the field of chess training as an adjunctive intervention in children and adolescents and to provide further evidence on the relevance of CRT in child and adolescent psychiatry. The hypotheses of the proposed study are: 1. chess training as a six-week add-on intervention will improve cognitive functioning in adolescents with psychiatric/psychosomatic disorders compared to standard treatment. 2. chess training as a six-week add-on intervention improves quality of life in adolescents with psychiatric/psychosomatic disorders compared to standard treatment. 3. chess training as a six-week add-on intervention positively influences the course of therapy in adolescents with psychiatric/psychosomatic illnesses compared to standard treatment.
NCT06320457
The goal of this clinical trial is to assess whether a brief case management intervention aimed at promoting personal recovery and reducing the negative effects of coercion among people involuntarily admitted to a psychiatric hospital would be well accepted by them, practically feasible and useful. The main questions it aims to answer are: * Is the case management intervention acceptable and feasible? * What are the preliminary effects of the case management intervention on patients' personal recovery and its sub-dimensions, as well as on their level of perceived coercion and their global satisfaction with hospital care? Participants will be asked to take part in: * the five sessions of the case management intervention; * two evaluation sessions (pre and post-intervention); * a final in-depth semi-structured interview (optional).
NCT06904443
This project could potentially lead to better crisis management in psychiatry, using music as a mediator. The integration of a well-designed sound device could help caregivers build trust with patients, alleviate anxiety, and foster an environment conducive to healing. In addition, it would offer a less invasive and more patient-centered alternative, creating an atmosphere that facilitates communication and calming.
NCT06721000
As one of the complications of THR is post operative pain, which usually requires epidural catheter insertion. We are comparing the effect of patient control epidural versus conventional epidural for patient's satisfaction.
NCT06661304
Purpose: The purpose of this study is to examine the effects of Benson relaxation exercise applied to children and adolescents receiving inpatient treatment in a psychiatric clinic on anxiety levels and sleep quality. Design: The study is a randomized controlled trial with a pretest-posttest control group. Method: The study will be conducted in a private psychiatric hospital in Turkey between October 2024 and June 2025. When hospital records were examined, it was determined that 100 patients received inpatient treatment in the last year. Therefore, the universe of the study consisted of 100 patients. The effect of some instructions in the Benson relaxation exercise on delusions and hallucinations is unknown. Therefore, psychosis and schizophrenia patients with delusions and hallucinations will be excluded from the scope of the study. Patients who meet the inclusion criteria will be randomly assigned to the intervention and control groups. The study will be terminated when a total of 60 patients are reached, 30 in the intervention and 30 in the control group. Benson relaxation exercise will be applied to the patients in the intervention group. No application will be made to the patients in the control group. Research data will be collected with the "State-Trait Anxiety Scale" and "Pittsburgh Sleep Quality Index". Hypotheses: H1: The anxiety level of patients who applied Benson relaxation exercise is lower than the patients who did not. H2: The sleep quality of patients who applied Benson relaxation exercise is better than the patients who did not.
NCT06052761
Being hospitalized is a stressful process for the child and her family. Management of stress is important to accelerate the child's recovery process and ensure early discharge. It is thought that playing with toys made using medical materials will reduce children's stress. This project aims to determine the effect of playing with toys made with medical materials on the stress of a hospitalized child. It is planned to collect the data of the project from pediatric patients aged 4-6 years hospitalized in the pediatric clinic of a training and research hospital in the Southeastern Anatolia Region. It is planned to analyze the data obtained from pediatric patients by using the SPSS program. As a result of the project, it is aimed that the game played with toys made using medical materials will reduce the stress of children.