Background: First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective: This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods: A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results: The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions–web-based, videoconferences, and mHealth–were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions: The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration: PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9

(1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literature review and meta-analysis on SRA for MDD was carried out. Patient-level data were extracted from articles reporting validated depression measures (Beck Depression Inventory (BDI), Montgomery–Åsberg Depression Rating Scale (MADRS)), pre- and at least six months post surgery. To accommodate different outcome measures, the standardised mean difference (SMD) between both scores was used as the principal effect size. Data were synthesised using a random-effects model. (3) Results: Five distinct studies were identified, comprising 116 patients (64 included in meta-analysis). Effect size comparing post- vs. pre-operative scores was 1.66 (CI 1.25–2.07). Anterior cingulotomy (two studies, n = 22) and anterior capsulotomy (three studies, n = 42) showed similar effect sizes: 1.51 (CI 0.82–2.20) vs. 1.74 (CI 1.23–2.26). Multiple procedures were performed in 30 of 116 (25.9%) patients. Based on patient-level data, 53% (n = 47) were responders (≥50% improvement), of which 34% reached remission (MADRS ≤ 10 or BDI ≤ 11). BDI mean improvement was 16.7 (44.0%) after a second procedure (n = 19). (4) Conclusions: The results are supportive of the benefit of SRA in selected patients with refractory MDD.

Background: Epilepsy and other seizure disorders account for a high disease burden in Germany. As a timely diagnosis and accurate treatment are crucial, improving the management of these disorders is important. Outside of Germany, outpatient long-term video EEGs (ALVEEGs) have demonstrated the potential to support the diagnosis and management of epilepsy and other seizure disorders. This study aims to evaluate the implementation of ALVEEGs as a new diagnostic pathway in eastern parts of Germany to diagnose epilepsy and other seizure disorders and to assess if ALVEEGs are equally effective as the current inpatient-monitoring gold standard, which is currently only available at a limited number of specialized centers in Germany. Methods: ALVEEG is a prospective, multicenter, randomized controlled equivalence trial, involving five epilepsy centers in the eastern states of Germany. Patients will be randomized into either intervention (IG) or control group (CG), using a permuted block randomization. The sample size targeted is 688 patients, continuously recruited over the trial. The IG will complete an ALVEEG in a home setting, including getting access to a smartphone app to document seizure activity. The CG will receive care as usual, i.e., inpatient long-term video-EEG monitoring. The primary outcome is the proportion of clinical questions being solved in the IG compared to the CG. Secondary outcomes include hospital stays, time until video EEG, time until diagnosis and result discussion, patients’ health status, quality of life and health competence, and number and form of epilepsy-related events and epileptiform activity. Alongside the trial, a process implementation and health economic evaluation will be conducted. Discussion: The extensive evaluation of this study, including an implementation and health economic evaluation, will provide valuable information for health policy decision-makers to optimize future delivery of neurological care to patients affected by epilepsy and other seizure disorders and on the uptake of ALVEEG into standard care in Germany. Trial registration: German Clinical Trials Register (DRKS00032220), date registered: December 11, 2023.

Objective: To assess the effects of waiting time for outpatient psychotherapeutic interventions on patient-reported outcomes in adolescents and adults with eating disorders. Method: MEDLINE, Embase, APA PsycInfo, CENTRAL and BASE were searched on 12 August 2025. Quantitative studies of adolescents (≥ 10 years) and adults with eating disorders that examined waitlist conditions prior to outpatient psychotherapeutic interventions and measured eating disorder pathology with the Children's Eating Attitudes Test (chEAT) or Eating Disorder Examination-Questionnaire (EDE-Q) were eligible. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A within-group random-effects meta-analysis was performed assessing pre–post change scores of the EDE-Q Global Score (primary analysis) and EDE-Q subscales (secondary analyses). A full protocol has been pre-registered on PROSPERO (registration number: CRD420251090691). Results: Nine waitlist-controlled studies (total n = 647, waitlisted n = 283) including adult participants with bulimia nervosa, binge-eating disorder and 'eating disorder not otherwise specified' met our eligibility criteria. Eight studies (waitlisted n = 273) were included in the meta-analysis. Participants entered the waiting period with high EDE-Q Global Scores, ranging from 3.08 to 4.65 across studies. The pooled pre–post effect estimate was Hedges’ g = − 0.17 (95% CI − 0.30 to − 0.05), indicating a negligible reduction in eating disorder pathology. Certainty of evidence was rated as moderate, given the high risk of bias across studies. Discussion: Based on our results, waiting in waitlist control groups represents a period during which substantial eating disorder pathology and associated distress persist without therapeutic intervention. Further research is needed to better understand the effects of waiting time for regular eating disorder treatment outside a study setting.

Background: Epilepsy and other seizure disorders are medical conditions that impose a substantial health economic burden on society given their considerable costs of illness and use of healthcare resources. The ALVEEG trial aims to tackle resource shortages in clinical settings and optimize patient management by evaluating outpatient ambulatory long-term video electroencephalograms (ALVEEGs) as a new diagnostic pathway to diagnose and manage epilepsy and other seizure disorders. The health economic evaluation alongside this trial aims to determine the cost-effectiveness and cost-utility of ALVEEGs for affected patients presenting themselves at participating epilepsy centers in Germany. Methods: This study protocol comprises the rationale and methods of the health economic evaluation of ALVEEGs embedded into the ALVEEG project. We will perform cost-effectiveness and cost-utility analyses, with the outcomes being a priori defined endpoint measures of the main trial. We will consider the proportion of solved clinical queries (primary endpoint), the number of hospital stays, the in-patient length of stay, and quality-adjusted life years for the here presented health economic evaluation. Costs will be collected by the participating health insurance companies alongside the trial, with the evaluation being conducted from a statutory health insurance perspective within the German healthcare system. The reporting of the economic evaluation follows the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Discussion: The health economic evaluation of ALVEEGs for patients affected by epilepsy and other seizure disorders within the German healthcare system will deliver insightful evidence on the cost-effectiveness and cost-utility of the intervention and hence guide policy and decision makers regarding a potential inclusion of ALVEEGs into the health benefit basket of the statutory health insurance scheme. Trial registration: German Clinical Trials Register (DRKS00032220), date registered: December 11, 2023.

Background: Many European countries have recognised the challenge of providing high-quality long-term care (LTC). We explored how selected European countries organise and fund primary and specialist healthcare services for nursing home residents requiring 24-hour nursing and social care in view of understanding which approaches might offer better outcomes. Approach: A rapid literature search of the databases MEDLINE, Embase Ovid, Google Scholar and Google was performed, complemented by inputs from national experts and practitioners. The following European countries were included, representing a variety of health systems and models of care provision in nursing homes: England (UK), Germany, the Netherlands, Norway, Poland, Spain and Sweden. Results: The organisation, financing and provision of LTC, as well as of primary and specialised care for nursing home residents, varies substantially between and within European countries, even among those with similar social, cultural, health and funding systems. In most included countries, LTC services are covered and financed similarly to health services, but co-payments often play a substantially larger role in LTC than in healthcare spending. Nursing staff or care assistants provide 24-hour nursing care, while GPs tend to be responsible for providing medical care. However, most GPs working in nursing homes are self-employed and community-based rather than employed by the facility. Nursing homes in all of the selected countries engage allied health professionals, such as physiotherapists, occupational therapists and speech and language therapists. These professionals usually work in private practices and provide nursing home services either on-site or at their own practice. Whether health professionals are directly employed by the nursing home or work on a freelance basis depends on various factors; however, direct employment is rare. Similarly, specialists are often brought in as consultants, rather than being part of the nursing home’s permanent staff, as they typically work in private practices and may offer nursing home visits. The Netherlands is the only country in our sample where it is common practice for nursing homes to employ specially trained elderly care physicians (ECPs), although some nursing homes in Norway follow the same model. There is some evidence that the ECP model can help to reduce the demand for specialised services, avoid unnecessary hospitalisations and lead to higher patient satisfaction with primary care services. Implications: European countries largely separate health services from LTC, but initial evidence from more integrated models like those in the Netherlands and Norway suggests potential benefits. Decisions on ownership structures and quality assurance, as well as on access to primary care, allied health professionals and specialised care will need to take into account their impact on care integration and facilitating transitions between care settings. Improved coordination between different care providers could reduce avoidable hospitalisations while improving discharge processes. These decisions should be explicit and opened up to public consultation, but have so far been made implicitly and by default.