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Black T, Jenkins BW, Laprairie RB, Howland JG. Therapeutic potential of gamma entrainment using sensory stimulation for cognitive symptoms associated with schizophrenia. Neurosci Biobehav Rev 2024; 161:105681. [PMID: 38641090 DOI: 10.1016/j.neubiorev.2024.105681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Schizophrenia is a complex neuropsychiatric disorder with significant morbidity. Treatment options that address the spectrum of symptoms are limited, highlighting the need for innovative therapeutic approaches. Gamma Entrainment Using Sensory Stimulation (GENUS) is an emerging treatment for neuropsychiatric disorders that uses sensory stimulation to entrain impaired oscillatory network activity and restore brain function. Aberrant oscillatory activity often underlies the symptoms experienced by patients with schizophrenia. We propose that GENUS has therapeutic potential for schizophrenia. This paper reviews the current status of schizophrenia treatment and explores the use of sensory stimulation as an adjunctive treatment, specifically through gamma entrainment. Impaired gamma frequency entrainment is observed in patients, particularly in response to auditory and visual stimuli. Thus, sensory stimulation, such as music listening, may have therapeutic potential for individuals with schizophrenia. GENUS holds novel therapeutic potential to improve the lives of individuals with schizophrenia, but further research is required to determine the efficacy of GENUS, optimize its delivery and therapeutic window, and develop strategies for its implementation in specific patient populations.
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Affiliation(s)
- Tallan Black
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Bryan W Jenkins
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert B Laprairie
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada; Department of Pharmacology, College of Medicine, Dalhousie University, Halifax, NS, Canada
| | - John G Howland
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Fritz S, Kösters M, Allgöwer A, Becker T, Kilian R, Gühne U, Riedel-Heller SG, Hasan A, Falkai P, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Breilmann J. [Influence of guideline recommendations, care structures and individual factors on the use of psychosocial therapies in severely mentally ill people]. PSYCHIATRISCHE PRAXIS 2024; 51:129-138. [PMID: 37813363 DOI: 10.1055/a-2133-3527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The influence of guideline recommendations and other factors on the utilization of psychosocial interventions in people with severe mental illness was examined. METHODS Data from a cross-sectional study of 397 people with severe mental illness were analysed descriptively. RESULTS Patients are less likely to receive therapies with a strong recommendation compared to other levels of recommendation. Various other factors are diffusely associated with utilization rates, but no ubiquitous predictors could be identified across all therapies. CONCLUSION Current practice in the use of psychosocial interventions does not follow guideline recommendation strength. Interventions with strong recommendations are probably not available across services. Consequently, routine practice is not able to follow guideline recommendations according to their strength. Other consistent predictors could not be identified.
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Affiliation(s)
- Sarah Fritz
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
| | - Markus Kösters
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Dresden und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Chemnitz
| | | | - Thomas Becker
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Reinhold Kilian
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
| | - Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | - Alkomiet Hasan
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Augsburg
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
| | - Klemens Ajayi
- kbo-Isar-Amper-Klinik für Psychiatrie und Psychotherapie Ost, kbo-Isar-Amper Klinikum Region München, Haar
| | - Jessica Baumgärtner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Augsburg
| | - Peter Brieger
- kbo-Isar-Amper-Klinik für Psychiatrie und Psychotherapie Ost, kbo-Isar-Amper Klinikum Region München, Haar
| | - Karel Frasch
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Donauwörth
| | - Stephan Heres
- kbo-Klinik für Psychiatrie und Psychotherapie Nord, kbo-Isar-Amper Klinikum Region München
| | - Markus Jäger
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kempten
| | - Andreas Küthmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Memmingen
| | - Albert Putzhammer
- Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kaufbeuren
| | - Bertram Schneeweiß
- kbo-Klinik für Psychosomatik, Psychiatrie und Psychotherapie Taufkirchen/Vils, kbo-Isar-Amper Klinikum Region München, Taufkirchen/Vils
| | - Michael Schwarz
- kbo-Isar-Amper-Klinik für Psychiatrie und Psychotherapie Ost, kbo-Isar-Amper Klinikum Region München, Haar
| | - Johanna Breilmann
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
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Zbukvic I, Bryce S, Moullin J, Allott K. The use of implementation science to close the research-to-treatment gap for cognitive impairment in psychosis. Aust N Z J Psychiatry 2023; 57:1308-1315. [PMID: 36964703 PMCID: PMC10517591 DOI: 10.1177/00048674231160987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
For people living with psychosis, cognitive impairment is common and can have significant impacts for functional recovery, impacting engagement with treatment and quality of life more broadly. There is now strong evidence for the effectiveness of cognition-focused treatments, such as cognitive remediation to improve clinical and functional outcomes for people with psychosis. However, engagement with treatment has been a long-standing issue in mental health care, including for people with psychosis, who often experience difficulties with motivation. While research on clinical effectiveness of cognition-focused treatment is growing, to date there has been little research focused on the implementation of such treatments and it is not clear how best to support uptake and engagement across diverse mental health settings. Implementation science is the study of methods and strategies to promote the adoption, application, and maintenance of evidence-based practices in routine care. To integrate cognition-focused treatments into routine practice, and improve engagement with treatment and the quality and effectiveness of care for people with psychosis, researchers need to embrace implementation science and research. This paper provides a succinct overview of the field of implementation science, current evidence for implementation of cognition-focused treatments for psychosis and practical guidance for using implementation science in clinical research. The future of psychosis research includes multidisciplinary teams of clinical researchers and implementation scientists, working together with providers and consumers to build the evidence that can improve the implementation of cognition-focused treatments.
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Affiliation(s)
- Isabel Zbukvic
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shayden Bryce
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Joanna Moullin
- enAble Institute, Curtin University, Perth, WA, Australia
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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4
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Khorikian-Ghazari N, Lorenz C, Güler D, Halms T, Röh A, Flick M, Burschinski A, Pielenz C, Salveridou-Hof E, Schneider-Axmann T, Schneider M, Wagner E, Falkai P, Gaebel W, Leucht S, Hasan A, Gaigl G. Guideline for schizophrenia: implementation status and attitude toward an upcoming living guideline. Eur Arch Psychiatry Clin Neurosci 2023; 273:1587-1598. [PMID: 36808533 PMCID: PMC10465681 DOI: 10.1007/s00406-023-01568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 02/21/2023]
Abstract
The implementation status of clinical guidelines is, despite their important role in connecting research with practice, frequently not satisfactory. This study aims to investigate the implementation status of the current German guideline for schizophrenia. Moreover, the attitude toward a living guideline has been explored for the first time by presenting screenshots of the German schizophrenia guideline transferred to a digital living guideline format called MAGICapp. A cross-sectional online survey was performed under the participation of 17 hospitals for psychiatry and psychosomatic medicine in Southern Germany and one professional association for German neurologists and psychiatrists. 439 participants supplied sufficient data for analysis. 309 provided complete data sets. Regarding the current guideline for schizophrenia and key recommendations, a large awareness-to-adherence gap was found. Group comparisons between different professions (caregivers, medical doctors, psychologists/psychotherapists, psychosocial therapists) detected differences in the implementation status showing higher awareness and agreement with the schizophrenia guideline and its key recommendations among medical doctors compared to psychosocial therapists and caregivers. Moreover, we detected differences in the implementation status of the guideline as a whole and its key recommendations between specialist and assistant doctors. The attitude toward an upcoming living guideline was mostly positive, especially among younger healthcare professionals. Our findings confirm an awareness-to-adherence gap, not only for the current schizophrenia guideline in general but also for its key recommendations with apparent differences between professions. Overall, our results show promising positive attitudes toward the living guideline for schizophrenia among healthcare providers, suggesting that a living guideline may be a supportive tool in everyday clinical practice.
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Affiliation(s)
- Naiiri Khorikian-Ghazari
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Carolin Lorenz
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Medical Faculty, Klinikum Rechts der Isar, 81675, Munich, Germany.
| | - Duygu Güler
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Theresa Halms
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Astrid Röh
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Marisa Flick
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Medical Faculty, Klinikum Rechts der Isar, 81675, Munich, Germany
| | - Charline Pielenz
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Eva Salveridou-Hof
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Schneider
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Medical Faculty, Klinikum Rechts der Isar, 81675, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Gabriele Gaigl
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
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Lorenz C, Güler D, Halms T, Khorikian-Ghazari N, Röh A, Flick M, Burschinski A, Pielenz C, Salveridou-Hof E, Schneider-Axmann T, Schneider M, Wagner E, Falkai P, Gaebel W, Leucht S, Hasan A, Gaigl G. Conventional and living guideline for schizophrenia: barriers and facilitating factors in guideline implementation. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01663-1. [PMID: 37581691 DOI: 10.1007/s00406-023-01663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Abstract
This study aims to investigate the barriers and facilitators to guideline adherence for the print format of the German schizophrenia guideline as well as for the concept of a digital living guideline for the first time. For this purpose, the schizophrenia guideline was transferred to a digital guideline format within the web-based tool MAGICapp. An online survey was performed under participation of mental healthcare professionals (medical doctors, psychologists/psychotherapists, psychosocial therapists, caregivers) in 17 hospitals for psychiatry in Southern Germany and a professional association for German neurologists and psychiatrists. 524 participants opened the survey, 439 completed the demographic questions and commenced the content-related survey and 309 provided complete data sets. Results indicate a higher occurrence of knowledge-related barriers for the living guideline. The print version is associated with more attitude-related and external barriers. Older professionals reported more attitude-related barriers to a living guideline compared to younger professionals. Differences between professions regarding barriers were found for both formats. Various barriers exist for both guideline formats and a need for facilitators was expressed across professions. Many of the mentioned obstacles and facilitators can be more easily addressed with living guidelines. However, also living guidelines face barriers. Thus, the introduction of these new formats alone cannot lead to sustainable behavior change regarding guideline adherence. Yet, living guidelines seem to be a cornerstone to improved and tailored guideline implementation as they facilitate to keep recommendations up to date and to address the need of individual professional groups.
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Affiliation(s)
- Carolin Lorenz
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Medical Faculty, Technical University of Munich, 81675, Munich, Germany.
| | - Duygu Güler
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Theresa Halms
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Naiiri Khorikian-Ghazari
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Astrid Röh
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Marisa Flick
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Medical Faculty, Technical University of Munich, 81675, Munich, Germany
| | - Charline Pielenz
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Eva Salveridou-Hof
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Schneider
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Medical Faculty, Technical University of Munich, 81675, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Gabriele Gaigl
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
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Pfennig A, Soltmann B, Riedel-Heller SG, Gühne U, Jessen F, Bauer M, Schmitt J. [Challenges and current approaches in the development of psychiatric living guidelines in Germany]. DER NERVENARZT 2023:10.1007/s00115-023-01504-5. [PMID: 37311964 DOI: 10.1007/s00115-023-01504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/15/2023]
Abstract
Outdated guidelines can cause inadequate care. To counter this problem a dynamic updating process for guidelines is being internationally discussed (living guidelines). This process has specific challenges. The rhythm of updating has to be determined and a priori criteria have to be defined, which indicate that a substantial change of the medical practice is needed in order to then update individual recommendations. Digital tools have to be identified that can support a dynamic updating. Their (further) development has to be oriented to the specific requirements and needs of the trialogically composed guideline development teams. Recommendations have to be examined from the user perspective. The current guideline development methods that are still divergent, have to be harmonized and specific needs with respect to the cross-linking of guidelines have to be taken into account. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) supports and accompanies scientific projects dealing with the challenges of the dynamics of guideline development. From the first results of "Guide2Guide", a project funded by the Innovation Fund, it can be summarized that the development of living guidelines is a complex dynamic process that has only just started internationally and in Germany. It demands a special engagement of the guideline developers including representatives of patients and relatives, to responsibly work long term and flexibly. Digital tools can be useful in various process steps but at present they still have to be meaningfully linked into the process. Central elements of the development of S3 guidelines will continue to require substantial working time of the experts in the trialogue. In order for living guidelines to be actually used dissemination and implementation have to be integrated into the dynamic process.
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Affiliation(s)
- Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Bettina Soltmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Frank Jessen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Köln, Deutschland
| | - Michael Bauer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Deutschland
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Gühne U, Weitzel EC, Schladitz K, Löbner M, Soltmann B, Jessen F, Schmitt J, Pfennig A, Riedel-Heller SG. [Expectations of guideline developers on living guidelines]. DER NERVENARZT 2023:10.1007/s00115-023-01476-6. [PMID: 37138092 DOI: 10.1007/s00115-023-01476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Guidelines are central pillars of high-quality care and care planning. The quality requirements for the development of guidelines and the associated effort are very high. Therefore, more efficient approaches are being forced. OBJECTIVE The opportunities and challenges in the introduction of a dynamic updating concept within the framework of the digitalization of guidelines were explored from the perspective of guideline developers in the field of psychiatry. This perspective should be included in the implementation. MATERIAL AND METHODS Between January and May 2022 a cross-sectional survey was conducted among guideline developers (N = 561, response 39%) based on a questionnaire developed and tested in advance. Data were analyzed descriptively. RESULTS A total of 60% were familiar with the concept of living guidelines. A large proportion endorsed a dynamic updating (83%) and digitalization (88%) of guidelines; however, various challenges are associated with the concept of living guidelines: the risk of inflationary changes (34%), the need for continuity of all actors (53%), involvement of patient and family representatives (37%) and definition of criteria regarding the decision what to change (38%). The vast majority (85%) thought it necessary that guideline development should be followed by implementation projects. CONCLUSION German guideline developers are very receptive regarding the implementation of living guidelines; however, they named numerous challenges, which need to be addressed in this approach.
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Affiliation(s)
- Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland.
| | - Elena C Weitzel
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - Katja Schladitz
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - Margrit Löbner
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - Bettina Soltmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Frank Jessen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät der Uniklinik Köln, Köln, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
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Lorenz C, Gaigl G, Güler D, Halms T, Khorikian-Ghazari N, Röh A, Schneider M, Wagner E, Schneider-Axmann T, Kapfhammer A, Flick M, Pielenz C, Salveridou-Hof E, Falkai P, Gaebel W, Hasan A, Leucht S. Structured implementation of digital, systematically updated guideline recommendations for enhanced adherence in schizophrenia (SISYPHOS)—protocol of a cluster-randomized trial. Trials 2022; 23:807. [PMID: 36153555 PMCID: PMC9509647 DOI: 10.1186/s13063-022-06749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite high acceptance rates in the field, the implementation of the 2019 published German evidence and consensus-based S3 guideline is unsatisfactory. This study aims to assess the superiority of an adaptive online version with a better visualization of the recommendations in terms of guideline conformity, application of shared decision making, and digital health expertise compared to the classic pdf print version of the guideline. Methods The study is a multicenter, controlled, cluster-randomized trial with two arms: one arm investigating the implementation of the German schizophrenia guideline in form of a digital format (intervention group using the evidence ecosystem MAGICapp), the other arm in form of the classic print pdf version (control group). Physicians and psychologists working in specialized hospitals will be included in the study. The guideline-knowledge before and after the intervention is defined as primary outcome measure. Secondary endpoints include digital health expertise and application of shared decision making. Discussion This is the first study evaluating if an adaptive-digital version of the schizophrenia guideline is superior to the classic pdf print version. Therefore, the guideline is digitally prepared in the evidence-ecosystem MAGICapp, which covers the whole process of the development of a living guideline. We intend to use the results of the cluster-randomized trial for developing the German S3 guideline for schizophrenia in form of a living guideline in future. Trial registration The study is registered (10 May 2022) in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00028895. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06749-0.
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Nihayati HE, Fitriyasari R, Tristiana RD, Anggraini Y, Iskandar I, Arifin H. Description the Importance of Developing a Self-Reliance Instrument for Schizophrenic Patients in the Hospital Setting. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background: The level of independence among schizophrenia patients is still a problem that must be resolved. The development of appropriate relevant instruments is needed. This study aims to develop a nursing rehabilitation therapy instrument to increase the independence of schizophrenia patients in the hospital setting.
Methods: This study used a research and development study design. The study was conducted in a Psychiatric Hospital in Surabaya, Indonesia from August to December 2020. The total sample in this study consisted of 100 nurses determined by a simple random sampling technique. In addition, 50 medical records were observed. The inclusion criteria were nurses who cared for patients with schizophrenia with a minimum work experience of 1 year. Respondents were excluded from the study if they did not follow the study through to completion. The data collection process was done online by filling in a Google form. The data was analysed using descriptive statistics and a FGD followed with 10 nurses to discuss the new instrument.
Results: The data found that a rehabilitation therapy instrument is not currently available (53%). The FGD results show that it is necessary to develop the nurse’s knowledge and to provide adequate facilities and rooms, as well as to develop instruments to use as measuring tools in order to evaluate the rehabilitation therapy given.
Conclusion: Rehabilitation therapy instruments are important to develop for schizophrenia patients. It is hoped that the development of the instrument in this study will optimise the rehabilitation of schizophrenia patients.
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Numata S, Nakataki M, Hasegawa N, Takaesu Y, Takeshima M, Onitsuka T, Nakamura T, Edagawa R, Edo H, Miura K, Matsumoto J, Yasui‐Furukori N, Kishimoto T, Hori H, Tsuboi T, Yasuda Y, Furihata R, Muraoka H, Ochi S, Nagasawa T, Kyou Y, Murata A, Katsumoto E, Ohi K, Hishimoto A, Inada K, Watanabe K, Hashimoto R. Improvements in the degree of understanding the treatment guidelines for schizophrenia and major depressive disorder in a nationwide dissemination and implementation study. Neuropsychopharmacol Rep 2021; 41:199-206. [PMID: 33704931 PMCID: PMC8340832 DOI: 10.1002/npr2.12173] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To implement clinical practice guidelines (CPGs), it is necessary for psychiatrists to deepen their understanding of the CPGs. The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide dissemination and implementation study of two sets of CPGs for schizophrenia and major depressive disorder (MDD). METHODS A total of 413 psychiatrists (n = 212 in 2016; n = 201 in 2017) learned the two CPGs in the education program of the EGUIDE project, and clinical knowledge of these CPGs was evaluated at baseline and after the programs. To improve the correct answer rate for clinical knowledge after the programs, we revised the lecture materials associated with items that had a low correct answer rate in 2016 and used the revised lecture materials with the CPGs in 2017. The rates of correct answers after the programs between the 2016 and 2017 groups were compared. RESULTS The correct answer rate of one item on the schizophrenia CPG and one item on the MDD CPG tended to be improved (S-D5 and D-C6) and that of one on the MDD CPG was significantly improved (D-D3, P = 0.0008) in the 2017 group compared to those in the 2016 group. CONCLUSIONS We reported improvements in clinical knowledge of CPGs after the EGUIDE program in the 2017 group following revision of the lecture materials based on results from the 2016 group. These attempts to improve the degree of understanding of CPGs may facilitate the successful dissemination and implementation of psychiatric guidelines in everyday practice.
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Affiliation(s)
- Shusuke Numata
- Department of PsychiatryInstitute of Biomedical ScienceTokushima University Graduate SchoolTokushimaJapan
| | - Masahito Nakataki
- Department of PsychiatryInstitute of Biomedical ScienceTokushima University Graduate SchoolTokushimaJapan
| | - Naomi Hasegawa
- Department of Pathology of Mental DiseasesNational Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
| | - Yoshikazu Takaesu
- Department of NeuropsychiatrySchool of MedicineKyorin UniversityTokyoJapan
| | - Masahiro Takeshima
- Department of NeuropsychiatryAkita University Graduate School of MedicineAkitaJapan
| | - Toshiaki Onitsuka
- Department of NeuropsychiatryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshinori Nakamura
- Department of PsychiatryShinshu University School of MedicineNaganoJapan
| | - Reon Edagawa
- Department of PsychiatryInstitute of Biomedical ScienceTokushima University Graduate SchoolTokushimaJapan
| | - Hiroaki Edo
- Department of PsychiatryInstitute of Biomedical ScienceTokushima University Graduate SchoolTokushimaJapan
| | - Kenichiro Miura
- Department of Pathology of Mental DiseasesNational Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
| | - Junya Matsumoto
- Department of Pathology of Mental DiseasesNational Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
| | | | - Taishiro Kishimoto
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hikaru Hori
- Department of PsychiatrySchool of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Takashi Tsuboi
- Department of NeuropsychiatrySchool of MedicineKyorin UniversityTokyoJapan
| | - Yuka Yasuda
- Department of Pathology of Mental DiseasesNational Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
- Medical Corporation FosterOsakaJapan
| | - Ryuji Furihata
- Department of PsychiatryNihon University School of MedicineTokyoJapan
- Kyoto University Health ServiceKyotoJapan
| | - Hiroyuki Muraoka
- Department of PsychiatryTokyo Women’s Medical UniversityTokyoJapan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineEhimeJapan
| | - Tatsuya Nagasawa
- Department of NeuroPsychiatryKanazawa Medical UniversityIshikawaJapan
| | - Yoshitaka Kyou
- Department of PsychiatrySchool of MedicineKitasato UniversityKanagawaJapan
| | - Atsunobu Murata
- Department of Pathology of Mental DiseasesNational Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
| | | | - Kazutaka Ohi
- Department of Psychiatry and PsychotherapyGifu University Graduate School of MedicineGifuJapan
| | - Akitoyo Hishimoto
- Department of PsychiatryYokohama City University Graduate School of MedicineYokohamaJapan
| | - Ken Inada
- Department of PsychiatryTokyo Women’s Medical UniversityTokyoJapan
| | - Koichiro Watanabe
- Department of NeuropsychiatrySchool of MedicineKyorin UniversityTokyoJapan
| | - Ryota Hashimoto
- Department of Pathology of Mental DiseasesNational Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
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