Lessons Learned from the Implementation of a Medically Enhanced Residential Treatment (Mert) Model Integrating Intravenous Antibiotics and Residential Addiction Treatment

BACKGROUND: Hospitalizations for severe infections associated with substance use disorder (SUD) are increasing. People with SUD often remain hospitalized for many weeks instead of completing intravenous antibiotics at home; often, they are denied skilled nursing facility admission. Residential SUD treatment facilities are not equipped to administer intravenous antibiotics. We developed a medically enhanced residential treatment (MERT) model integrating residential SUD treatment and long-term IV antibiotics as part of a broader hospital-based addiction medicine service. MERT had low recruitment and retention, and ended after six months. The goal of this study was to describe the feasibility and acceptability of MERT, to understand implementation factors, and explore lessons learned. METHODS: We conducted a mixed-methods evaluation. We included all potentially eligible MERT patients, defined by those needing ≥2 weeks of intravenous antibiotics discharged from February 1 to August 1, 2016. We used chart review to identify diagnoses, antibiotic treatment location, and number of recommended and actual IV antibiotic-days completed. We audiorecorded and transcribed key informant interviews with patients and staff. We conducted an ethnographic analysis of interview transcripts and implementation field notes. RESULTS: Of the 45 patients needing long-term intravenous antibiotics, 18 were ineligible and 20 declined MERT. 7 enrolled in MERT and three completed their recommended intravenous antibiotic course. MERT recruitment barriers included patient ambivalence towards residential treatment, wanting to prioritize physical health needs, and fears of untreated pain in residential. MERT retention barriers included high demands of residential treatment, restrictive practices due to PICC lines, and perceptions by staff and other residents that MERT patients “stood out” as “different.” Despite the challenges, key informants felt MERT was a positive construct. CONCLUSIONS: Though MERT had many possible advantages; it proved more challenging to implement than anticipated. Our lessons may be applicable to future models integrating posthospital intravenous antibiotics and SUD care

Correction: Lung cancer multi-omics digital human avatars for integrating precision medicine into clinical practice: the LANTERN study

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The value-add of tailored seasonal forecast information for industry decision-making

There is a growing need for more systematic, robust and comprehensive in-formation on the value-add of climate services from both the demand and supply sides. There is a shortage of published value-add assessments which focus on the decision-making context, involve participatory or co-evaluation approaches, avoid over-simplification and address both the quantitative (e.g. economic) and qualitative (e.g. social) value of climate services. The twelve case studies which formed the basis of the European Union-funded SECLI-FIRM project were co-designed by industrial and research partners in order to address these gaps, focusing on the use of tailored sub-seasonal and seasonal forecasts in the energy and water industries. For eight of these case studies it was pos-sible to apply quantitative economic valuation methods: econometric modelling was used for five case studies while three case studies used both cost-loss (relative economic value) analysis and avoided costs. The case studies illustrate the challenges in attempting to produce quantitative estimates of the economic value add of these forecasts. At the same time, many of them highlight how practical value for users – transcending the actual economic value – can be enhanced, for example, through the provision of climate services as an exten-sion to their current use of weather forecasts and with the visualisation tailored towards the user