The Greater Cincinnati/Northern Kentucky NETT Network Hub and Spoke System

描述（由申请人提供）：由急性神经系统疾病和损伤引起的紧急情况是常见的，这些疾病对患者和社会的健康负担是巨大的。许多神经系统疾病的预后通常在发病后的头几分钟内确定，在急诊科甚至在急诊科到达之前进行干预可能是必要的，以提供有意义的益处。这些疾病的最佳治疗方法实际上并不为人所知，部分原因是美国的临床研究企业并没有将研究干预措施定位于疾病进展的早期阶段。对风险如此之高、时间尺度如此之短的疾病进行多中心临床试验，需要创新思维，并重新设计临床试验科学的许多方面。为了有效和快速，神经急症治疗试验（NETT）网络将要求急症护理前线的临床医生和提供者建立当地基础设施，以便有效地招募患者参加神经急症的各种试验。通过这项申请，我们建议成为RFA-NS-06-009神经急救治疗试验（NETT）网络临床站点中心中描述的中心之一。我们将建立在我们之前的丰富经验，我们的高效，可扩展的枢纽和辐条系统基于辛辛那提大学医学院。这种结构的关键要素包括一个由急诊医生、神经科医生、神经外科医生、神经放射科医生、物理医生、院前服务提供者、儿科医生、创伤外科医生和重症监护医生组成的跨学科团队，他们都具有开展紧急临床试验的专业知识。我们的Hub and Spoke系统具有巨大的招生能力，特别是能够在我们的大型学术中心和社区医院急诊科招募患者。此外，我们还可以获得整个患者人口统计范围以及神经系统疾病过程的范围。我们得到了临床医生、管理人员和强有力的公众宣传的支持。我们将扩大我们已经证实的网络，以便为神经急症治疗试验网络（NETT）提供各种试验。我们将成为一股强大的力量，招募患者参加由NETT网络参与的广谱急性神经学临床试验。

DESCRIPTION (provided by applicant): Emergencies caused by acute neurological disorders and injuries are common and the health burden of these conditions to patients and society is enormous. The outcome of many neurological disorders is often determined within the first minutes after onset and intervention in the emergency department or even prior to emergency department arrival may be necessary to provide meaningful benefit. The optimal treatments for these conditions are not actually known, in part because the clinical research enterprise in the United States has not been oriented toward studying interventions in the earliest phases of disease progression. Conducting multicenter clinical trials of therapies for illnesses with such high stakes and contracted time scales will require innovative thinking and redesign of many aspects of the science of clinical trials. To be effective and fast, The Neurological Emergencies Treatment Trials (NETT) Network will require the clinicians and providers at the front lines of emergency care to create local infrastructures that can effectively recruit patients into trials across the spectrum of neurological emergencies. With this application we propose to become one of the Hubs described in the RFA-NS-06-009 Neurological Emergencies Treatment Trials (NETT) Network Clinical Site Hubs. We will build upon our extensive prior experience with our highly effective, scalable Hub and Spoke system based out of the University of Cincinnati, College of Medicine. The key elements of this structure include an interdisciplinary team of emergency physicians, neurologists, neurosurgeons, neuroradiologists, physiatrists, pre-hospital providers, pediatricians, trauma surgeons, and intensivists all with specific expertise in the conduct of emergent clinical trials. Our Hub and Spoke system has tremendous enrollment capabilities and specifically has the ability to enroll patients in both our large academic center as well as our community hospital emergency departments. In addition we have access to the entire span of the patient demographic as well as the gamut of neurological disease processes. We have the support of clinicians, administrators and a strong public outreach. We will expand on our already proven network to be ready to perform the diverse trials brought forward for the Neurological Emergencies Treatment Trials (NETT) Network. We will be a powerful force in recruitment of patients into the broad spectrum of acute neurological clinical trials that are engaged by the NETT Network.