Best-practice Interventions Research Articles

Supporting psychiatric mental health nurse practitioners’ preparedness to treat mental health concerns during pregnancy: Results from a grounded theory study

Background and objective: Pregnant persons are less likely to be screened and treated for depression and anxiety during pregnancy compared to the pre- and post-natal periods, despite adverse effects associated with untreated mental health concerns during pregnancy. Patients have reported that maternal and mental health providers seem unable or unwilling to discuss treatment with psychopharmacological options during pregnancy. Literature concerning this pattern has not included the perspective of psychiatric mental health nurse practitioners (PMHNP). The objective of this study was to identify the barriers and needs of PMHNPs regarding the treatment of mental health concerns during pregnancy.Methods: In this constructivist grounded theory study, data were collected between February 2023 and February 2024 through in-depth interview. Eligible participants were PMHNPs, or PMHNP students, working with patients who might become pregnant in an outpatient setting.Results: Seventeen PMHNPs or students participated in this study. Many believed they were unprepared to treat pregnant patients and described barriers and needs that impede their comfort and willingness to treat people who are pregnant. These included inadequate training, limited research, and concerns about legal liability. PMHNPs requested more information about perinatal mental health and its treatment to be incorporated into training programs and clinical experience.Conclusions: Many PMHNPs were unaware or underinformed of available resources and best practices for treatment during pregnancy. In addition to best practices for the treatment of people who are pregnant, PMHNP programs should consider including preparation for the emotional consequences of practice as well as clear and accurate information about malpractice and liability risks.

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment.

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring. PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

Best practices for treatment of adolescent SUDs

Best practices for treatment of adolescent SUDs

New resource: Best practices for treatment of adolescent SUDs

New resource: Best practices for treatment of adolescent SUDs

A Blast and Burn Hand Injury Caused by an Exploding Vaping Device in a Pediatric Patient: A Case Report.

In this report, we present an injury to the hand caused by an exploding vaping device. This report summarizes the burn, blast and chemical injury, and discusses best practice for treatment. This case provides a warning to healthcare professionals and the public about the potential for and the seriousness of this injury. We hope to emphasize the rising incidence of vaping among children, the injuries that may occur, and the methods for treatment.

Identification of Gaps in Quality of Care and Good Practice Interventions in Rheumatoid Arthritis: Insights From a Literature Review and Qualitative Study of Nine Centers in North America

ObjectiveQuality of care (QoC) delivery in rheumatoid arthritis (RA) continues to suffer from various challenges (eg, delay in diagnosis and referral) that can lead to poor patient outcomes. This study aimed to identify good practice interventions that address these challenges in RA care in North America.MethodsThe study was conducted in three steps: (1) literature review of existing publications and guidelines (April 2005 to April 2021) on QoC in RA; (2) in‐person visits to >50 individual specialists and health care professionals across nine rheumatology centers in the United States and Canada to identify challenges in RA care and any corresponding good practice interventions; and (3) collation and organization of findings of the two previous methods by commonalities to identify key good practice interventions, followed by further review by RA experts to ensure key challenges and gaps in RA care were captured.ResultsSeveral challenges and eight good practice interventions were identified in RA care. The interventions were prioritized based on the perceived positive impact on the challenges in care and ease of implementation. High‐priority interventions included the use of technology to improve care, streamlining specialist treatment, and facilitating comorbidity assessment and care. Other interventions included enabling patient access to optimal medication regimens and improving patient self‐management strategies.ConclusionLearnings from the study can be implemented in other rheumatology centers throughout North America to improve RA care. Although the study was completed before the COVID‐19 pandemic, the findings remain relevant.

Physician barriers and dilemmas in the execution of clinical trials impacting decision-making in the DAHANCA 35 proton therapy trial for head and neck cancer

BackgroundPhysicians manage multiple obligations, providing best-practice treatment and patient- centred care in the standard treatment pathway while contributing to clinical trials simultaneously. These multifaceted responsibilities may introduce barriers and dilemmas to clinical trial execution, potentially impacting the clinical trial decision- making process. This study explores physicians’ barriers and dilemmas in executing clinical trials and the impact on clinical trial decision-making. MethodQualitative semi-structured interviews were conducted with experienced oncologists. Moreover, participant observations were performed during clinical encounters involving discussions about clinical trials. The analysis followed a structured approach: (1) transcription of data, (2) inductive text coding, (3) exploration of patterns, and (4) interpretation, leading to the results. The results were discussed and validated by the study participants. ResultsThe results comprise (1) a description of the clinical practice, which presents the setting of clinical trial execution; (2) results regarding physicians’ barriers and dilemmas in executing clinical trials, leading to (3) the impact on clinical trial decision- making. The results involve barriers to time constraints for clinical trial tasks, dilemmas emerging from trial requirements or deviations from standard guidelines, and challenges with providing sufficient trial communication and adequate decision-making support, balancing between a paternalistic approach and respecting patient autonomy. ConclusionThe demanding obligations of clinical practice constitute a complex setting for executing clinical trials, resulting in numerous barriers and dilemmas that impact the decision-making process in clinical trials. The study emphasises the need for tailored clinical trial decision-making interventions to facilitate supportive, informed, and non-directive clinical trial decision-making.

An Acupuncture Protocol for the Treatment of Erectile Dysfunction: A Delphi Process

Plain Language SummaryAs many as 322 million men may be afflicted by erectile dysfunction (ED) (impotence) by 2025. The health consequences are substantial with an increased risk of cardiovascular diseases and higher mortality in addition to reduced quality of life. Acupuncture may be a potential treatment option with a low side-effect profile; however, a standardised treatment protocol has been lacking for the use in the clinic and in clinical trials. This study aimed to develop a best-practice acupuncture treatment protocol for the treatment of ED. Eleven acupuncture experts have by the means of a Delphi process reached tool consensus on a diagnostic and a treatment protocol for men suffering from ED. This is the first attempt in modern times and in the West to provide clinical acupuncturists and researchers with a treatment protocol for this common health issue.

Exploring the support needs of Australian parents of young children with Usher syndrome: a qualitative thematic analysis

BackgroundAdvancements in genetic testing have led to Usher syndrome now being diagnosed at a much earlier age than in the past, enabling the provision of early intervention and support to children and families. Despite these developments, anecdotal reports suggest there are substantial gaps in the services and supports provided to parents of children with Usher syndrome. The current study investigated the support needs of parents of children with Usher syndrome Type 1 when their child was aged 0 to 5 years.MethodPurposive sampling was used, and six semi-structured interviews were conducted with Australian parents of children with Usher syndrome, Type 1. Data was analysed using modified reflexive thematic analysis.ResultsFour key themes were identified as being central to the support needs of parents of children with Usher syndrome aged 0 to 5 years. (1) Social Needs referred to parents’ need for various sources of social support, (2) Informational Needs described the lack of information parents received regarding Usher syndrome from treating professionals, (3) Practical Needs included supports needed to assist parents in managing the day-to-day tasks of caring for a child with a disability, and (4) Emotional Needs represented the emotional support (both formal and informal) that parents needed to be a positive support to their child.ConclusionsFindings provide rich information for relevant support groups, policy makers, individual healthcare professionals, and professional governing bodies regarding the education of stakeholders and the development and implementation of best-practice treatment guidelines.

European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour – because words matter

Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman’s life. Substandard care refers to the use of interventions that are not considered best-practice, to the inadequate execution of interventions, to situations where best-practice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients’ dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term “obstetric violence” is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women’s experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect

CONDUCTING A NEEDS ASSESSMENT TO INFORM AGE-FRIENDLY HEALTH SYSTEMS INITIATIVE FOR UNIVERSITY OF UTAH HEALTH

Abstract Today, people live longer and more productive lives than ever. The number of adults aged 65 and older is projected to nearly double 98 million by 2060 to 24% of the U.S. population (Administration on Aging & Administration for Community Living, 2018). Increased life expectancy, coupled with the exponential growth of the older adult population will create more demand for healthcare professionals to meet the care needs of older adults living with chronic conditions. Chronic conditions can lead to complex care and increase the usage of healthcare systems (Axon & Kamel, 2021). The Age-Friendly Health Systems initiative provides specific evidenced-based best-practice interventions to all older adults in a health system setting (Fulmer et al., 2022). An Age-Friendly Health System is one in which every older adult’s care is guided by an essential set of evidence-based practices known as the 4Ms framework: What Matters, Medications, Mentation, and Mobility (Institute for Healthcare Improvement, 2022). This project developed and delivered a Needs Assessment to providers practicing in the U Health Ambulatory Care Clinics to identify baseline knowledge, gaps in knowledge, and current practices related to the AFHS 4Ms Framework. The Needs Assessment consists of using online surveys and semi-structured interviews. Significant findings were that: 1) U Health ambulatory care clinic providers have very little to no baseline knowledge of the AFHS 4Ms Framework, 2) U Health ambulatory care providers are already providing care that aligns with the 4Ms framework, 3) There are barriers and challenges to providing Age-Friendly care.

Effectiveness of interventions to reduce sexually transmitted infections and blood-borne viruses in incarcerated adult populations: a systematic review protocol.

This review will identify, synthesize, and make recommendations regarding the effectiveness of interventions to reduce sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in incarcerated adult settings. High-risk sexual behaviors, intravenous drug use, piercing, and tattooing are well documented within incarceration environments. Despite the World Health Organization's Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 and the Global Health Sector Strategies on, Respectively, HIV, Viral Hepatitis, and Sexually Transmitted Infections for the Period 2022-2030, STI rates within adult incarceration environments continue to rise. Identifying and implementing best-practice interventions to prevent and manage STIs and BBVs will aid infection reduction in correctional settings. The review results will inform the development of educational programs, health promotion, and policies and procedures to improve health outcomes for incarcerated populations. This review will consider studies in any language from any adult incarceration facility. Studies set in juvenile facilities or detention centers will be excluded. Any intervention for preventing or reducing STI and/or BBV transmission will be included. This review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched will include PubMed, CINAHL (EBSCO), Ovid Library, PsycINFO (EBSCO), Cochrane CENTRAL, and Scopus. Two independent reviewers will screen titles and abstracts and assess full-text citations against inclusion criteria. Methodological quality will be appraised using JBI's standardized critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, findings will be presented in narrative format. Certainty of evidence will be ascertained using the GRADE approach. PROSPERO CRD42022325077.

“I Don’t Think There’s a Cookie-Cutter Way of Working With People With Autism”: Mothers of Children With Autism and Their Experiences With Counseling Services

Clinical mental health counselors can play a critical role in treating children diagnosed with autism spectrum disorder (ASD) as they age toward adulthood. While best practice for treatment of children with ASD should be individualized and include a family-centered approach, the experience of the mother receiving mental health services has not been previously explored in counseling research. For this study, we utilized interpretative phenomenological inquiry to examine the lived experiences of mothers (n = 8) who navigated the complexities of the counseling services for their child(ren) with ASD. Implications for clinical mental health counselors and counselor educators were presented to better serve this ever-increasing client population.

An examination of an adapted Project ECHO model series during the COVID‐19 pandemic in Idaho

AbstractIntroductionIdaho is a medically underserved and rural state comprised mostly health professional shortage areas for primary and specialty care. Given the state shortages and barriers to access care, the testing and treatment of COVID‐19 may be improved through the implementation of telementoring education programs such as Project Extension for Community Healthcare Outcomes (ECHO). The purpose of this article was to assess session attendance and self‐reported healthcare clinician perceptions of the ECHO Idaho COVID‐19 series (2020 and 2021), a modified Project ECHO model provided during the COVID‐19 pandemic in Idaho.MethodsECHO Idaho developed a COVID‐19 ECHO series for healthcare providers to attend in 2020 and 2021. The sessions included COVID‐19 updates specific to Idaho, didactic presentations on prevention, screening, diagnosis, and evidence‐based treatments for COVID‐19, and case‐based presentations.ResultsA total of 664 individuals attended the 2020 series and 260 individuals attended the 2021 series, with 1752.5 continuing medical education hours being claimed. Participants reported series participation increased overall knowledge of COVID‐19, knowledge of best practices for treatment, and awareness of resources available in Idaho. Further, series participation was perceived to reduce feelings of isolation, enhance access to information, and support healthcare professionals (e.g., provided resources) during the pandemic.ConclusionResults of this evaluation indicate that the ECHO Idaho COVID‐19 series was a useful and valuable program to implement during a pandemic in a rural and frontier state to improve physician knowledge and specialty training.

Establishing Consensus on Essential Resources for Musculoskeletal Trauma Care Worldwide: A Modified Delphi Study.

Despite evidence that formalized trauma systems enhance patient functional outcomes and decrease mortality rates, there remains a lack of such systems globally. Critical to trauma systems are the equipment, materials, and supplies needed to support care, which vary in availability regionally. The purpose of the present study was to identify essential resources for musculoskeletal trauma care across diverse resource settings worldwide. The modified Delphi method was utilized, with 3 rounds of electronic surveys. Respondents consisted of 1 surgeon with expertise in musculoskeletal trauma per country. Participants were identified with use of the AO Trauma, AO Alliance, Orthopaedic Trauma Association, and European Society for Trauma and Emergency Surgery networks. Respondents rated resources on a Likert scale from 1 (most important) to 9 (least important). The "most essential" resources were classified as those rated ≤2 by ≥75% of the sampled group. One hundred and three of 111 invited surgeons completed the first survey and were included throughout the subsequent rounds (representing a 93% response rate). Most participants were fellowship-trained (78%) trauma and orthopaedic surgeons (90%) practicing in an academic setting (62%), and 46% had >20 years of experience. Respondents represented low-income and lower-middle-income countries (LMICs; 35%), upper-middle income countries (UMICs; 30%), and high-income countries (HICs; 35%). The initial survey identified 308 unique resources for pre-hospital, in-hospital, and post-hospital phases of care, of which 71 resources achieved consensus as the most essential. There was a significant difference (p < 0.0167) in ratings between income groups for 16 resources, all of which were related to general trauma care rather than musculoskeletal injury management. There was agreement on a core list of essential musculoskeletal trauma care resources by respondents from LMICs, UMICs, and HICs. All significant differences in resource ratings were related to general trauma management. This study represents a first step toward establishing international consensus and underscores the need to prioritize resources that are locally available. The information can be used to develop effective guidelines and policies, create best-practice treatment standards, and advocate for necessary resources worldwide. This study utilized the Delphi method representing expert opinion; however, this work did not examine patient management and therefore does not have a clinical Level of Evidence.

S14-1 Sports promotion in young people: good practice interventions in selected European countries

Abstract Purpose Which flagship sport promotion interventions for young people exist in different European countries and what could other countries gain from knowing about them? This symposium gives an overview of effective sport promotion interventions in seven European countries and presents and discusses selected promising interventions and programmes. Symposium description A research group identified effective sport promotion interventions in seven selected European countries with a potential to be transferred to Switzerland, including: Austria, Germany, England, Finland, France, The Netherlands, and Norway. National strategies with comprehensive and overarching measures or low-threshold interventions targeting less physically active subgroups in communities or schools have been identified as promising interventions. We will highlight and discuss selected examples in this symposium: The national strategy “On the Move” from Finland promotes physical activity in different settings such as schools, families, and childcare. More than 90 per cent of all comprehensive schools in Finland are “Schools on the Move”. As a result, the school culture has become more physically active. Community sport coaches in 98% of municipalities in the Netherlands provide physical activity education, organize events and activities, and advise clubs and childcare organizations. They work with local and social organizations. Girls Active and Change4Life Sports Club from England are low-threshold programmes that promote sport at school, addressing all school aged children, including those who are inactive. Conclusions This symposium will discuss benefits, barriers, and key aspects related to effectiveness of good practice interventions and identify the most important considerations that need to be addressed to transfer effective sport promotion policies or programmes from one country to another.

S14-2 Sports promotion in children and adolescents: analysis of good practice interventions in 7 countries

Abstract Purpose There are many interesting sports promotion interventions in European countries. Which ones are effective and can serve as good practice examples among children and adolescents? What should be considered when policies or programmes are transferred to other countries? This study has examined sports promotion interventions of seven European countries. It provides an overview of effective interventions and considers transferability to other countries. Project description The Swiss Federal Office of Sports assigned a study to identify effective sport promotion interventions in seven selected European countries with a potential to be transferred to Switzerland. The seven countries were: Austria, Germany, England, Finland, France, The Netherlands, and Norway. To identify the interventions, we conducted desk research and interviews with country representatives. In total, we identified 73 sport-promoting policies, action plans or programmes in the seven countries. As part of the detailed analysis of the most promising interventions, we have examined the national strategy “On the move” of Finland and the national action plan “School sport and activity action plan” of England. These superordinate interventions stand out for their clear objectives and comprehensive implementation. In addition, we have identified several interventions for which we consider a high added value in terms of sports promotion and a feasible implementation in Switzerland or other countries. These are “The Daily Mile” from Germany (15 minutes run or walk every day at school), “Girls Active” from England (enhancing of sport and physical activity in girls in the school setting), “Doorstep Sportclub” from England and “Community Sport Coaches” from the Netherlands (both address in particular children and adolescents with a migration background or low socio-economic status and are offered through the municipality and the associations). Conclusions This study gives an overview about effective sport promotion interventions targeting children and adolescents of seven European countries. Interventions that include comprehensive measures such as a national strategy or low-threshold programmes in schools or communities that address vulnerable groups such as girls, educationally disadvantaged families, children and youth with a migration background or low socio-economic status are particularly interesting from a Swiss perspective and certainly also for other European countries.

Success or Failure? Are We Meeting the Needs of Children With Developmental Coordination Disorder?

Background. Current international clinical practice guidelines indicate that children with developmental coordination disorder (DCD) should receive therapy, yet school and community-based occupational therapy is not standard of care. Purpose. To understand parent perspectives on best practice for treatment and what supports and services are required to meet their children's needs. Method. An online cross-sectional survey (impACT for DCD) was distributed to parents of children <18 years with self-reported suspected or diagnosed DCD living in British Columbia. Data analysis included descriptive statistics and contingency analyses to explore whether access to therapy differed with income, age of child, or geographical location. Open-ended questions were analyzed using content analysis. Findings. Of the 237 respondents, 194 children had suspected/confirmed DCD; however, only 20% (38/198) of the children had received therapy at school. Some parents (32/58) pursued private therapy. Geographic location and income had no relationship with therapy access (p > 0.05). Parents expressed frustration with poor awareness and understanding of the impact of DCD among educators, health-care professionals, and community members, and identified the need for funded and accessible school and community services and supports. Conclusion. Evidenced-based occupational therapy intervention should be standard of care for children with DCD as per clinical guidelines and parent-identified need.

Changes in symptoms of anxiety, depression, and PTSD in an RCT-study of dentist-administered treatment of dental anxiety

BackgroundEducating dentists in treatment methods for dental anxiety would increase the patients’ access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD.MethodsA two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique “The Four Habits Model” (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52).ResultsAn Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found.ConclusionsThe study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators.Trial registrationThe trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.

Pruritic crusted lesions in an 89‐year‐old woman

Pruritic crusted lesions in an 89‐year‐old woman