Established Evidence-based Practice Research Articles

A Scalable Advising Model for Part-Time, Distant Learners in Graduate Health Professions Education Programs

Abstract Problem There is a need within graduate health professions education (HPE) programs to align advising practices to support an increasing number of working adult learners, especially those studying part-time and from remote locations. Despite the recognized importance of the advisor-advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities. Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently. Approach The Department of Health Professions Education, Uniformed Services University, established a small cadre of faculty to serve as academic advisors (n = 7) in August 2018. This cadre uses an advising model based on 5 advising practices, called TOTAL Advising– train the advisors, onboard the learners, touch base frequently, annually review learners, and learner review. These advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program, while managing the demands of their personal and professional lives. TOTAL Advising provides the framework needed to achieve 3 guiding beliefs: each learner is capable of completing the program, fostering community, and providing clear communication. Outcomes Between May 2020-May 2024, learners who completed a degree (n = 21) were interviewed about their advising experiences by a program evaluator after they graduated. The themes observed from these reflect the program’s 3 guiding beliefs. Additionally, from May 2018–May 2024, of the 574 learners who enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled. Next Steps The next steps for TOTAL Advising involve a comprehensive evaluation of the effectiveness of the training program for advisors and collaborating with other graduate HPE programs to share best practices in advising, discuss emerging challenges, and shape advising practices in the broader HPE community.

Using simulation modeling to inform intervention and implementation selection in a rapid stakeholder-engaged hybrid effectiveness-implementation randomized trial

BackgroundImplementation research generally assumes established evidence-based practices and prior piloting of implementation strategies, which may not be feasible during a public health emergency. We describe the use of a simulation model of the effectiveness of COVID-19 mitigation strategies to inform a stakeholder-engaged process of rapidly designing a tailored intervention and implementation strategy for individuals with serious mental illness (SMI) and intellectual/developmental disabilities (ID/DD) in group homes in a hybrid effectiveness-implementation randomized trial.MethodsWe used a validated dynamic microsimulation model of COVID-19 transmission and disease in late 2020/early 2021 to determine the most effective strategies to mitigate infections among Massachusetts group home staff and residents. Model inputs were informed by data from stakeholders, public records, and published literature. We assessed different prevention strategies, iterated over time with input from multidisciplinary stakeholders and pandemic evolution, including varying symptom screening, testing frequency, isolation, contact-time, use of personal protective equipment, and vaccination. Model outcomes included new infections in group home residents, new infections in group home staff, and resident hospital days. Sensitivity analyses were performed to account for parameter uncertainty. Results of the simulations informed a stakeholder-engaged process to select components of a tailored best practice intervention and implementation strategy.ResultsThe largest projected decrease in infections was with initial vaccination, with minimal benefit for additional routine testing. The initial level of actual vaccination in the group homes was estimated to reduce resident infections by 72.4% and staff infections by 55.9% over the 90-day time horizon. Increasing resident and staff vaccination uptake to a target goal of 90% further decreased resident infections by 45.2% and staff infections by 51.3%. Subsequent simulated removal of masking led to a 6.5% increase in infections among residents and 3.2% among staff. The simulation model results were presented to multidisciplinary stakeholders and policymakers to inform the “Tailored Best Practice” package for the hybrid effectiveness-implementation trial.ConclusionsVaccination and decreasing vaccine hesitancy among staff were predicted to have the greatest impact in mitigating COVID-19 risk in vulnerable populations of group home residents and staff. Simulation modeling was effective in rapidly informing the selection of the prevention and implementation strategy in a hybrid effectiveness-implementation trial. Future implementation may benefit from this approach when rapid deployment is necessary in the absence of data on tailored interventions.Trial registrationClinicalTrials.gov NCT04726371

Provider attitudes toward evidence-based practice in autism: a mini-review

There are many established evidence-based practices (EBPs) for autistic youth which facilitate wellbeing and skill development across a range of domains. However, individuals on the autism spectrum are consistently underserved in mental health settings, limiting their access to these EBPs. Positive provider attitudes toward EBPs may increase their uptake or use. The current mini-review seeks to synthesize the literature regarding attitudes toward EBPs among providers working with autistic youth across a variety of settings (i.e., school, early intervention, and general mental health). Fifteen quantitative studies were included. The majority of studies (n = 13, 87%) utilized the Evidence Based Practice Attitudes Scale (EBPAS) or a variation of this scale. Attitudes toward EBPs were primarily used as a correlate or covariate, although some studies reported descriptive statistics of provider attitudes. When available, the reported results suggest that attitudes toward EBPs are moderately positive at baseline, although they vary between provider types. Two studies (13%) examined change in attitudes toward EBPs and suggested that they may be responsive to intervention. However, findings were mixed as to whether attitudes toward EBPs are predictive of EBP use/uptake. Implications and future directions are discussed.

Using Physiological Signals and Machine Learning Algorithms to Measure Attentiveness During Robot-Assisted Social Skills Intervention: A Case Study of Two Children with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) often face barriers in accessing opportunities across a range of educational, employment, and social contexts. One of these barriers is the development of effective communication skills sufficient for navigating the social demands of everyday environments. Fortunately, researchers have established evidence-based practices (EBP) for teaching critical communication skills to individuals with ASD [1]. One EBP that has received a great deal of attention over the last few decades is technology-aided instruction and intervention (TAII) [1], [2]. TAII is an instructional practice in which technology is an essential component and is used to facilitate behavior change. Further, it encompasses a wide range of applications including computer-assisted instruction, virtual and augmented reality, augmentative and alternative communication, and robot-assisted intervention [2].

Occupational Therapy for Poststroke Anxiety and Depressive Symptoms in Inpatient Rehabilitation.

Poststroke anxiety and depressive symptoms (P-SADS) affect one in three people and are associated with decreased participation in activities of daily living. This study sought to characterize occupational therapy (OT) P-SADS care practices and identify factors influencing P-SADS care provision in one U.S. inpatient rehabilitation (IRF) facility. An explanatory sequential mixed-methods study design was used by gathering data from electronic health records (from January 1, 2019 to December 31, 2019) as well as semi-structured interviews with OT practitioners in the IRF. No objective P-SADS screens were documented nor were any P-SADS-focused goals written. Minimal evidence-based P-SADS interventions were identified. Practitioners reported multi-level barriers to OT P-SADS care including limited time, pressure to prioritize physical recovery, and inadequate resources to guide practice. OT practitioner P-SADS care was inconsistent with established evidence-based practice. This research identifies gaps in comprehensive stroke recovery and informs implementation efforts to support evidence-based P-SADS care in IRFs.

Comparison of the Effects of Two Oral Care Methods: A Pilot Study

Background: Scrubbing with toothbrush and gargling with chlorhexidine has been shown to be effective in reducing bacteria and preventing ventilator-associated pneumonia (VAP) in patients in the intensive care unit (ICU). However, we still lack established evidencebased practice for oral care specific to ICUs.Objective: To evaluate effect of two oral care practices in two different ICUs as measured by the previously developed Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS).Methods: This experimental pilot study was conducted with seven experiment group and seven control group of patients in the ICU setting.Data were collected using a patient information form, Richmond Sedation-Agitation Scale, Glasgow Coma Scale, pain score and ICOCFAS score. The research population consisted of inpatients in the ICU of a training and research hospital in Sakarya, Turkey.Results: After the application of two different oral care practices for seven days, there was no statistically significant difference between the groupsin before and after average total ICOCFAS scores, F(0.214, 14.570) =2.010 (p>0.05). However, when the group effect was kept constant, there was a significant difference between the measurements taken at the end of the seventh day,F(1.214, 14.570) =5.520 (p<0.05).Conclusion: Chlorhexidine combined with toothbrush scrubbing can reduce the incidence of ventilator-associated pneumonia (VAP). However, further studies are needed withlarger sample sizes and additional oral care plans for ICU patients on mechanical ventilation.ICU nurses should be continuously instructed on the importance of adequate dental biofilm removal, chlorhexidine solutions and toothbrush use. The ICOCFAS should be used to evaluate the oral care of patients in ICUs.International Journal of Human and Health Sciences Vol. 06 No. 04 Oct’22 Page: 412-419

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sleep-Wake Disturbances: Common Side Effect.

For sleep-wake disturbances, standards of care are based on established evidence-based practice. Sleep-wake disturbances are defined as ongoing issues with sleep or daytime sleepiness (e.g., circadian rhythm disorder, hypersomnia, insomnia, narcolepsy, sleep apnea). Sleep-wake disturbances are estimated to occur in 35%-75% of patients with cancer.

Lymphedema: Common Side Effect.

For lymphedema, standards of care are based on established evidence-based practice. Lymphedema is the accumulation of lymph fluid that obstructs the flow of the lymphatic system, causing persistent swelling of the affected body part. Lymphedema is most commonly seen after lymph node dissection or radiation therapy. It occurs in 10%-40% of patients with breast cancer and 80% of patients with lymph node dissection in the groin.

Genitourinary Distress: Common Side Effect.

For genitourinary distress, standards of care are based on established evidence-based practice. Genitourinary distress is accidental urine leakage that can dampen underwear or saturate clothes. It is a sense of urgency, frequent urination, and/or pain or discomfort when urinating. Genitourinary distress is found in 35%-75% of patients with prostate cancer.

Cognitive Dysfunction: Common Side Effect.

For cognitive dysfunction, standards of care are based on established evidence-based practice. Cognitive dysfunction is the decline in function in one or more cognitive domains, including attention and concentration, executive function, information processing speed, language, visuospatial skill, psychomotor ability, and/or learning and memory. Cognitive dysfunction occurs in 80% of patients with brain tumors, 40% of patients with acute myeloid leukemia, and as many as 75% of patients with breast cancer.

Hot Flashes: Common Side Effect.

For hot flashes, standards of care are based on established evidence-based practice. Hot flashes are a sensation of heat that can be accompanied by facial flushing, perspiration, chills, heart palpitations, night sweats, and anxiety. Hot flashes occur in 51%-82% or women treated for breast cancer and 80% of men treated for prostate cancer with surgical or chemical castration.

Fatigue/Lack of Endurance: Common Side Effect.

For fatigue/lack of endurance, standards of care are based on established evidence-based practice. Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to the activity and interferes with usual function. Lack of endurance refers to limited physical capability to sustain an exercise or activity for an extended period of time. From 80% to 100% of patients with cancer report experiencing fatigue. It can be isolated or occur within a symptom cluster with pain, depression, dyspnea, anorexia, and sleep disturbance.

Skin Toxicities: Common Side Effect.

For skin toxicities, standards of care are based on established evidence-based practice. Cancer treatment-related skin toxicities are a frequent and distressing side effect of antineoplastic therapies, particularly chemotherapy and targeted therapies. Toxicities associated can appear as rashes, hand-foot skin reaction, hand-foot syndrome, and hair loss. As many as 90% of patients will experience some skin toxicity at some point in their therapy.

Constipation: Common Side Effect.

For constipation, standards of care are based on established evidence-based practice. Constipation is the decreased passage of stool characterized by infrequent bowel movements, hard stool, a sensation of abdominal bloating or cramping, straining with bowel movements, and the feeling of incomplete evacuation. Constipation occurs in 43%-58% of people with a diagnosis of cancer.

Distress: Common Side Effect.

For distress, standards of care are based on established evidence-based practice. Distress is a multifactorial and unpleasant emotional experience of a psychological (e.g., cognitive, behavioral, emotional), social, and/or spiritual nature that can interfere with the ability to effectively cope with a cancer diagnosis, physical symptoms and treatment, and long-term consequences of treatment. All patients are expected to experience some level of distress at some point in the cancer trajectory.

Peripheral Neuropathy: Common Side Effect.

For peripheral neuropathy, standards of care are based on established evidence-based practice. Peripheral neuropathy is disease or dysfunction of one or more peripheral nerves (i.e., motor, sensory, or autonomic), resulting in numbness or weakness. Peripheral neuropathy occurs outside of the brain and spinal cord and is caused by cancer, treatment, or both. Chemotherapeutic agents that can cause peripheral neuropathy include epothilones, platinum analogs, taxanes, and vinca alkaloids, as well as immunomodulating drugs and proteasome inhibitors.

Pain: Common Side Effect.

For pain, standards of care are based on established evidence-based practice. Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain can be acute or chronic. Syndromes include neuropathic pain, chronic pain syndromes, arthralgias, skeletal pain, and gastrointestinal, genitourinary, and pelvic pain. Pain occurs in 59% of patients undergoing treatment and almost 100% of those with advanced disease.

School-Based Supports and Interventions to Improve Social and Behavioral Outcomes with Racially and Ethnically Minoritized Youth: A Review of Recent Quantitative Research

School discipline disproportionality has long been documented in educational research, primarily impacting Black/African American and non-White Hispanic/Latinx students. In response, federal policymakers have encouraged educators to change their disciplinary practice, emphasizing that more proactive support is critical to promoting students’ social and behavioral outcomes in school. Results from a literature review conducted nearly a decade ago indicated that there was, at that point, a paucity of empirical research related to considering students’ culture (e.g., race, ethnicity) and supporting school behavior. The purpose of this study is to replicate and expand the previous review to summarize the characteristics of the most recent school-based quantitative research addressing interventions to promote social and behavioral outcomes for racially and ethnically minoritized youth. We screened 1687 articles for inclusion in the review. Upon coding 32 eligible research studies, we found that intervention and implementer characteristics within these studies varied, but noted strong intervention effects in studies that included established evidence-based practices, adapted interventions, as well as new practices piloted with student participants. Results inform recommendations to continue to study interventions that promote positive social and behavioral outcomes for racially and ethnically minoritized students to disrupt a long history of subjection to exclusionary discipline disproportionately.

Predictive Factors for Awake-Prone Manoeuvre Failure and Outcomes of Prone Positioning in Non-Intubated Patients with Acute Respiratory Failure Due to COVID-19

Background: Prone positioning is an established evidence-based practice for acute respiratory distress syndrome (ARDS) patients undergoing invasive mechanical ventilation (IMV), but evidence is limited in non-ventilated, awake patients. This study investigated the predictors of successful awake prone positioning and the association with mortality.Methods: We prospectively studied 59 patients with COVID-19 and moderate ARDS admitted to the ICU for a high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIV), a reservoir mask or a nasal cannula who underwent awake prone manoeuvres from 1 March 2020 to 30 August 2020. Age, sex, comorbidities, Simplified Acute Physiology Score 3 (SAPS 3), and body mass index (BMI) were recorded at admission. Multivariate Poisson regression was used to control for confounders.Findings: Fifty-nine patients (54.1±12.9 years) were enrolled. The mean BMI was 31.3±7.0. Thirty-two (54.2%) patients used reservoir masks, 21 (35.6%) used HFNCs, 3 (5.1%) received NIV, 3 (5.1%) used a nasal cannula during awake prone ventilation, and 26 (44.1%) needed IMV. The successful group had a higher survival rate (87.9%) than the failure group (38.5%). Additionally, 30 (90.9%) and 12 (46.2%) patients in the successful and failure groups, respectively, were discharged from the ICU, with 25 (75.8%) and 13 (50%) discharged after 28 days. The successful group had shorter ICU (4.5 (3-8.8) days) and hospital (11 (7.3-16.8) days) stays. Pre-manoeuvre partial oxygen saturation (SpO2) (p = 0.013) was associated with increased mortality.Interpretation: Manoeuvre failure was associated with pre-manoeuvre SpO2. Responders had better survival and shorter durations of IMV, ICU stays and hospitalization.Funding: No fundingDeclaration of Interests: The authors have no conflicts of interest to declare.Ethics Approval Statement: This study received Ethics Committee approval (CAAE 61274316.1.0000.5327).