Evidence-based Support Research Articles

Innovations to the ECHO model to enhance reach and network-building among addiction clinicians in Western Canada

BackgroundBuilding capacity for evidence-based treatment and support for people with substance use disorders (SUD) is an urgent priority in the context of the toxic drug poisoning crisis. We implemented the first substance use-focused Project Extension for Community Healthcare Outcomes (ECHO) in Western Canada for health care providers, to enhance their clinical addiction skills and knowledge, facilitate practice change, and foster a supportive community of practice. The aims of this article are to describe our innovations to the Project ECHO model in British Columbia (BC) and Yukon, and present key program outcomes.MethodsA pragmatic multi-methods program evaluation employed observational records of BC ECHO on Substance Use session attendance, cross-sectional and longitudinal participant surveys, and qualitative interviews with participants to assess satisfaction, relevance, and preparation to use evidence-based approaches, practice change intentions, and actual behaviours.ResultsThe 52 ECHO sessions (from June 2019 to July 2022) attracted 2134 unique registrants with 5089 attendances (mean 124/session), 2132 newsletter subscribers, and 5842 podcast downloads. The evaluation included 844 post-session survey respondents and 53 interview participants. The program included ECHO sessions with rolling attendance; widely accessed supplemental formats (e.g., newsletter, podcast, clinical tools, archived presentation recordings); variable, regional hub representation; and evidence-based content developed by medical writers. These features contributed to broad geographic and discipline reach, high-quality program content, and high mean session satisfaction ratings (4.2/5). Key qualitative themes emerged, related to knowledge and skill acquisition, gaining confidence in providing SUD care, facilitating shared decision-making, increasing compassion for patients, consolidating learning and applying it to practice, and reducing isolation through expanded networks.ConclusionsThe ECHO model is an effective way to improve capacity in SUD care for physicians and nurse practitioners, while offering benefits for interprofessional attendees. Our findings can inform innovations in other ECHO programs to enhance reach, engagement, and impact.

Self-care among military spouses and partners: Developing the Military and Veteran Spouse Self-Care Inventory (MVSSCI)

LAY SUMMARY When people take care of themselves, it can improve their quality of life. This is especially important for U.S. military and Veteran spouses. The Veteran and military population experiences unique challenges in taking care of themselves while splitting their attention in order to support the military spouse. Although there are ways to measure how well individuals practice self-care, no measure has been created specifically for the military population. The current study created a shortened version of an established self-care inventory (the National Alliance on Mental Illness SCI) while evaluating the Veteran Spouse Resiliency Group (V-SRG), a peer-group-based support program. This group was specifically chosen because it offers evidence-based transition support and a safe space to improve self-care. There were 227 participants who participated in completing surveys and gave feedback on how to improve the military-adapted version of the SCI. Researchers then asked participants to take pre- and post-intervention surveys online and in person to cross-check whether the new military-specific tool was reliable. Researchers did multiple tests to make sure the new measure contained the same concepts as the previously established measure. Military and Veteran partners experience unique stressors, and learning more about their self-care might improve their overall wellness.

Analysis of queries to a Swedish drug information centre identifies scientific knowledge gaps

Drug Information Centres (DICs) are providing clinicians with evidence-based support for rational drug treatment. However, knowledge gaps in the literature may hinder DICs from offering optimal guidance. This study examined the extent and nature of these knowledge gaps and their impact on clinical pharmacological advice, using real-world query data from a Swedish regional DIC. Data from 2022 at the Sahlgrenska University Hospital were analysed, focusing on queries outside off-label prescriptions and pharmaceutical aspects. A qualitative text content analysis identified phrases indicating a lack of evidence. Responses were categorized by the presence of these signalling phrases and the presence or absence of knowledge gaps. Among 209 responses, the majority were patient-specific (79%), posed by physicians (95%), and often related to adverse effects (37%). The analysis revealed that 23% of the responses had scientific knowledge gaps, and in 18% of the responses, no clinical pharmacological advice could be provided. Knowledge gaps were particularly associated with queries on adverse effects, long-term medication safety, specific patient cases and comorbidities, drug comparisons, or patient populations with limited literature coverage. This analysis highlights the potential of DICs to identify unmet clinical needs in drug treatment and to promote research for evidence-based, patient-centred drug treatment.

Protocol for a prospective observational cohort study of cutaneous leishmaniasis in Ethiopia

Background Cutaneous leishmaniasis (CL) is a skin neglected tropical disease, with an estimated 40,000 new cases each year in Ethiopia. CL causes ulcers, nodules, and plaques on the skin, and in some instances the destruction of the nasopharyngeal mucosa and cartilage. Some CL lesions may heal spontaneously, whilst other lesions may require therapies which are associated with discomfort, adverse effects, prolonged treatment, and a frequent lack of a complete response. Scarring, a sequela of CL, causes permanent disfigurement and is associated with stigma linked with a reduction in health-related quality of life. The choice of treatment for CL is based upon factors including the causative species; the number, extent, size, and location of lesions; and the availability of treatments. The development of robust evidence for CL treatment is hindered by a lack of validated and appropriate outcome measures and few data to support hypothesis-generation and trial design. There is a paucity of prospective data with well-defined treatment outcomes for CL caused by L. aethiopica. Aim The overall aim of this study is to improve the understanding of the health and economic burden of CL. Methods We have designed an observational, multi-centre cohort study to examine treatment outcomes for CL in Ethiopia which includes clinical outcomes, laboratory outcomes, patient reported outcome measures, scar assessments and cost effectiveness. We aim to recruit up to 750 participants across two hospital sites. We present here the protocol for this cohort study with a 12-month follow up period for each participant. Conclusions These data will inform the design of randomized controlled trials to evaluate new treatment strategies, with appropriate economic evaluations. This will help improve evidence-based guidelines and support evidence-led policy decisions, not only in Ethiopia but also globally.

Curricular Self-management for patients on ventricular assist device support decreases depression: A multicenter randomized controlled trial.

Utilization of ventricular assist device (VAD) support in patients with end-stage heart failure is well advanced. Recent studies emphasize the need to develop and evaluate evidence-based psychosocial support interventions for patients following VAD implantation. A national, multi-center study in four established German heart centers was initiated. An evidence-based VAD curriculum was developed; a randomized controlled trial evaluated the impact of the interprofessional intervention over time. Primary combined endpoint was the occurrence of adverse events (thromboembolic events, driveline infections, bleeding, rehospitalization, and death); secondary endpoints were psychosocial outcomes (anxiety, depression [HADS], quality of life [QoLVAD], social support [FSoZu], and self-management [SELMA]). A total of 140 patients were randomized block-wise to intervention (IG n = 70) or control (CG n = 70). Center-effects were considered. Instruments were completed at four time points (T0-T3). At baseline, intervention group (IG) patients were 19% female (control group [CG] 19%; p = 0.982); 58 ± 11 years. (CG 58 ± 11 years.; p = 0.966); 80% were implanted electively (CG 79%; p = 0.968). No significant difference in primary endpoint was found between IG versus CG (p > 0.05). For secondary endpoints, mixed linear regression revealed a significant reduction in depression scores in IG compared to CG (est. 1.18; 95% CI -2.17 to -0.18; p = 0.021). Clinically significant reductions in anxiety were greater in IG patients between T0 and T3 (IG 51.9%; CG 40.7%); increased anxiety was reported in 3.7% IG (11.1% CG). Mixed linear regression analyses favored IG (all >0.05) for QoL, social support, and self-management. A comprehensive curricular VAD intervention has potential to decrease depression levels and improve psychosocial outcomes of patients on VAD support.

Use and Perceptions of Mobile Mental Health Applications Among Healthcare Workers in Saudi Arabia: A Cross-Sectional Study.

The use and perceptions of smartphone-based mental health applications (MH-Apps) in Saudi Arabia require exploration. This study investigated MH-App use among Saudi Arabian healthcare workers (HCWs), including psychiatrists, psychologists, and family medicine physicians. It also assessed HCWs' interest in and willingness to integrate these apps into their practices, as well as their cognitive flexibility and its relationship with their attitudes and app use. This cross-sectional study involved 386 participants recruited using convenience and snowball sampling. The Cognitive Flexibility Scale (CFS) was used to assess cognitive flexibility. The results showed that 33.2% of HCWs downloaded MH-Apps, with 67.9% considering them somewhat beneficial. However, most had not yet tried them. Only 7% of HCWs strongly agreed that these apps are evidence-based. Concerns about using these apps in their practices were reported by 36.5% of HCWs, with the most common concern being the lack of evidence-based support. The primary reason for downloading MH-Apps for personal use was to improve mental well-being, whereas patient-related use was psychoeducation. Furthermore, 27.5% of HCWs recommended MH-Apps to their patients, with old age, women, and psychiatrists/psychologists more likely to recommend them. Higher CFS scores were more strongly associated with older HCWs, those who had ever recommended MH-Apps, and those who used the apps. Saudi Arabian HCWs should be encouraged to use and recommend MH-Apps, with more evidence-based research needed to address concerns. Further research on cognitive flexibility's implications for clinical practice is also warranted.

Finding Solutions to Scaling Parenting Programs That Work: a Systems-Contextual Approach.

Prevention science has now encompassed decades of research exploring risk and protective factors and effective programs for the prevention and treatment of childhood behavioral, emotional, and developmental concerns. This paper shares our experience over the last 40years as program developers and researchers in responding to contemporary needs and finding solutions to barriers preventing access to evidence-based parenting support. We propose a systems-contextual approach to designing and implementing programs that meet families' needs and preferences and promote self-regulatory capacity across the lifespan. Key areas discussed are innovations to improve the reach of evidence-based parenting support (e.g., online program delivery, cultural adaptation, and tailored programs to engage vulnerable children and families), innovations to improve professional training outcomes (e.g., competency-based training, peer supervision and support, implementation support, and workforce development), and innovations to meet future needs (e.g., embracing new technology, standing by science, and considering global issues). It is incumbent on program developers, researchers, and clinicians to continue to evolve our practices and service systems in response to new evidence, societal changes, and technical advances to remain relevant and impactful in shifting prevalence rates of conduct problems and promoting child, family, and community well-being.

ICoaching the coach: building capacity with embedded evidence-based practice implementation support

PurposeThe purpose of this study was to investigate the effectiveness of iCoaching during reading intervention. An interventionist received mentoring support to implement iCoaching. The goal of the study was to increase teacher-delivered, behavior-specific praise (BSP).Design/methodology/approachUsing a single-case multiple-probe design across participants (Gast, 2010; Horner and Baer, 1978), iCoaching was implemented in a two-part package of (1) professional development (PD) and (2) live iCoaching sessions where three teachers received preemptive coaching comments to increase BSP delivery during reading intervention. Visual analysis identified changes in teacher behavior.FindingsFindings demonstrated the iCoaching intervention package increased teacher knowledge and implementation of evidence-based practices (EBPs; i.e. BSP) during tiered reading intervention groups. Most student participants made gains in reading skills (accuracy, words per minute and composite score) across the areas measured.Research limitations/implicationsTeacher absences, observation scheduling, an ongoing global pandemic, IEP meetings during intervention time, and other changes in the schedule were limitations of this study. The first set of earbuds lost the audio signal several times, and researchers lost the ability to hear the instruction occurring in the classroom; the earbuds were replaced by the first intervention phase.Practical implicationsPrevious iCoaching literature demonstrates iCoaching provides implementation support for EBPs learned in PD. Peer coaching can have a positive impact on EBP implementation when iCoaching is non-evaluative, which supports teachers with EBP implementation with minimal disruption to teaching.Originality/valueThis manuscript extends iCoaching research (Randolph et al., 2020, 2021) from small group special education settings to general education intervention groups. Additionally, research shows iCoaching can be extended with mentoring.

Accuracy of Machine Learning in Discriminating Kawasaki Disease and Other Febrile Illnesses: Systematic Review and Meta-Analysis.

Kawasaki disease (KD) is an acute pediatric vasculitis that can lead to coronary artery aneurysms and severe cardiovascular complications, often presenting with obvious fever in the early stages. In current clinical practice, distinguishing KD from other febrile illnesses remains a significant challenge. In recent years, some researchers have explored the potential of machine learning (ML) methods for the differential diagnosis of KD versus other febrile illnesses, as well as for predicting coronary artery lesions (CALs) in people with KD. However, there is still a lack of systematic evidence to validate their effectiveness. Therefore, we have conducted the first systematic review and meta-analysis to evaluate the accuracy of ML in differentiating KD from other febrile illnesses and in predicting CALs in people with KD, so as to provide evidence-based support for the application of ML in the diagnosis and treatment of KD. This study aimed to summarize the accuracy of ML in differentiating KD from other febrile illnesses and predicting CALs in people with KD. PubMed, Cochrane Library, Embase, and Web of Science were systematically searched until September 26, 2023. The risk of bias in the included original studies was appraised using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata (version 15.0; StataCorp) was used for the statistical analysis. A total of 29 studies were incorporated. Of them, 20 used ML to differentiate KD from other febrile illnesses. These studies involved a total of 103,882 participants, including 12,541 people with KD. In the validation set, the pooled concordance index, sensitivity, and specificity were 0.898 (95% CI 0.874-0.922), 0.91 (95% CI 0.83-0.95), and 0.86 (95% CI 0.80-0.90), respectively. Meanwhile, 9 studies used ML for early prediction of the risk of CALs in children with KD. These studies involved a total of 6503 people with KD, of whom 986 had CALs. The pooled concordance index in the validation set was 0.787 (95% CI 0.738-0.835). The diagnostic and predictive factors used in the studies we included were primarily derived from common clinical data. The ML models constructed based on these clinical data demonstrated promising effectiveness in differentiating KD from other febrile illnesses and in predicting coronary artery lesions. Therefore, in future research, we can explore the use of ML methods to identify more efficient predictors and develop tools that can be applied on a broader scale for the differentiation of KD and the prediction of CALs.

Sling Results in Better Sleep Quality and Less Anxiety Early After Arthroscopic Rotator Cuff Repair: A Randomized Single-Blinded Trial.

Sleep disturbance is commonly reported by patients wearing an abduction brace after arthroscopic rotator cuff repair (ARCR). Although a sling has been proven noninferior to an abduction brace for function and repair integrity, there is no evidence-based medical support for the advantage of the sling in improving sleep quality compared with a brace. This study aimed to compare the effects of a sling and an abduction brace on sleep quality and clinical outcomes after ARCR. It was hypothesized that immobilization in a sling would result in better sleep quality while not deteriorating clinical outcomes and bone-tendon healing compared with an abduction brace. Randomized controlled trial; Level of evidence, 1. A total of 142 consecutive patients with rotator cuff tears were randomly assigned to 2 groups: (1) the brace group, receiving abduction brace immobilization for 6 weeks, and (2) the sling group, receiving sling immobilization after ARCR for 6 weeks. The primary outcome was the Pittsburgh Sleep Quality Index at 6 weeks postoperatively. Secondary outcomes-American Shoulder and Elbow Surgeons score, Self-rating Anxiety Scale, pain, satisfaction, and tendon healing (using ultrasonography)-were evaluated until 1 year postoperatively. Complete outcome measurements were obtained for 131 patients. The Pittsburgh Sleep Quality Index at 6 weeks was 11.1 ± 2.7 for the brace group and 9.2 ± 2.3 for the sling group (P < .001), indicating a statistically significant advantage for the sling group. The sling group also reported significantly lower Self-rating Anxiety Scale, lower pain level, and higher satisfaction scores at 6 weeks. No significant difference was observed in outcome measures between groups at 1 year. The tendon healing rates (91% vs 88%, respectively) were comparable between the brace and sling groups within the first 1 year (risk ratio, 1.03 [95% CI, 0.92-1.16]; P = .59). The use of a sling resulted in better sleep quality, less anxiety, and higher satisfaction compared with an abduction brace in the first 6 weeks after ARCR; nevertheless, functional outcomes and repair integrity were similar at 1 year postoperatively between the 2 groups. These findings indicate that a sling is appropriate for the postoperative care of ARCR. However, caution should be used when interpreting these results because the clinical relevance of sling-related benefits warrants further investigation. ChiCTR2200059967 (Chinese Clinical Trial Registry).

Veterans' perspectives on two transdiagnostic group workshops to improve military to civilian reintegration: A comparative thematic analysis.

Veterans deployed in the post-9/11 wars in Iraq and Afghanistan (Operations Enduring Freedom, Iraqi Freedom, and New Dawn) face a multitude of challenges reintegrating into civilian life after military service. There is a need for evidence-based support programs to address the wide-reaching cognitive, psychological, and physical symptoms that can impede civilian reintegration. The present study incorporates quantitative and qualitative methods to assess veterans' experiences with two reintegration treatments (Short-Term Executive Plus-Home [SH] and Present Centered Group Therapy for Reintegration [PCGT-R]) within the context of a larger randomized clinical trial. A total of 131 veterans ages 24-65 years, drawn from the SH (n = 66) and PCGT-R (n = 65) treatment arms, completed quantitative feedback forms and qualitative interviews. Quantitative surveys indicated SH was more highly rated than PCGT-R in terms of program satisfaction (p < .01), helpfulness (p = .03), and connection to other Veterans Affairs (VA) services (ps < .05). Thematic qualitative analysis indicated that both interventions provided beneficial social support and that both groups appreciated online implementation. They also revealed that SH veterans acquired more emotion regulation and impulse control skills and reported greater willingness to engage in further VA treatments, than PCGT-R veterans. Dropout did not differ significantly between groups, and the most highly cited reasons for dropout among both groups were scheduling conflict and dislike of group formats. Findings emphasize the opportunity for group and skills-based interventions focused on reintegration to increase support and access to VA care among veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceived Effectiveness of Components of Interventions to Support People Bereaved By Suicide.

Background: Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Aims: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Method: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Results: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Limitations: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions' components. Meta-analysis of findings was not possible due to study heterogeneity. Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Application of CAR-T cell therapy in B-cell lymphoma: a meta-analysis of randomized controlled trials.

This study aims to compare the efficacy and safety of chimeric antigen receptor T-cell (CAR-T) immunotherapy with standard treatment for B-cell lymphoma, providing evidence-based support for the more efficient use of CAR-T cell immunotherapy. We conducted a comprehensive literature search of high-quality randomized controlled trials (RCTs) on CAR-T therapy for B-cell lymphoma in the following databases: Wanfang, Web of Science, CNKI, VIP database, and PubMed, up to February 2024. The outcome measures included objective remission rate (ORR), complete remission rate (CRR), and incidence of adverse reactions. Subgroup analysis was performed based on the differences in co-stimulatory domains. Meta-analysis was conducted using Review Manager 5.4 and Stata software. A total of five RCTs involving 1670 patients were included in this meta-analysis. The results showed that the CAR-T treatment group had significantly higher ORR (RR: 1.47, 95% CI 1.23-1.76, I2 = 80%, p < 0.0001), CRR (RR: 2.19, 95% CI 2.16-3.79, I2 = 93%, p = 0.005), cytokine release syndrome (CRS) incidence (RR: 34.51, 95% CI 2.27-523.78, I2 = 98%, p = 0.01), neurotoxicity (NT) incidence (RR: 6.00, 95% CI 1.82-19.75, I2 = 80%, p = 0.003), neutropenia incidence (RR: 1.39, 95% CI 1.02-1.88, I2 = 93%, p = 0.03), leukopenia incidence (RR: 1.39, 95% CI 1.04-1.87, I2 = 61%, p = 0.03), and headache incidence (RR: 1.56, 95% CI 1.25-1.95, I2 = 34%, p < 0.0001) compared to the standard treatment group. Subgroup analysis based on co-stimulatory domains revealed that the 4-1BB subgroup had higher incidences of CRR, CRS, NT and leukopenia than the CD28 subgroup; however, the CD28 subgroup exhibited higher ORR and neutropenia than the 4-1BB subgroup. CAR-T cell immunotherapy demonstrates superior efficacy compared to standard therapy in treating B-cell lymphoma. However, CAR-T treatment can lead to adverse reactions such as CRS and NT. Infusion of an appropriate dose of CAR-T cells (e.g., 100 × 106) may be a strategy to mitigate the risk of CRS and NT.

Communication, Socialization, and Literacy for Adults With Developmental Disabilities: An Interview Study of Parents' Perspectives and Experiences.

The study highlights the significance of continuous support and services in communication, socialization, and literacy skills for adults with developmental disabilities (DDs). The aim of the study was to gather in-depth information on the individualized needs, lived experiences, and expectations of adults with DD by interviewing their parents. A total of 14 parents of adults with DD participated in one-on-one semistructured interviews. During the interviews, parents were asked to describe (a) their children's current communication, socialization, reading and writing skills; (b) the types of communication, socialization, and literacy support their children were receiving; and (c) the types of support that their children needed. Interviews were video- and audio-recorded, transcribed, and analyzed qualitatively using thematic analysis. Thematic analysis revealed three main themes and eight subthemes: (1) insufficient support and services for adults with DD (i.e., lack of competent professionals and lack of literacy support), (2) approaches that the parents attempted for their children with DD (i.e., parents' responsibilities, technologies, and pseudoscience), and (3) recommendations for ongoing support and services (i.e., novel technologies, social media, and motivation). The study highlights crucial gaps between the participating parents' desire for individualized, consistent, and innovative support and services for their adult children with DD and scarcity of resources in communication, socialization, and literacy. The dearth of evidence-based support and resources leads to easy access to pseudoscience. Future research is warranted to develop innovative, customized, and highly motivating programs in communication, socialization, and literacy for adults with DD. https://doi.org/10.23641/asha.27214407.

Three-dimensional conformal radiation therapy with concurrent chemotherapy for stage III non-small cell lung cancer: protocol for a systematic review and meta-analysis

IntroductionLung cancer continues to be a common form of cancer worldwide and a primary contributor to cancer-related fatalities. Non-small cell lung cancer (NSCLC) is the most prevalent form, making up...

The Use of Snoezelen to Support People With Profound Intellectual and Multiple Disabilities: An International Survey Describing the Perspectives of Support Persons.

Snoezelen is often used for people with profound intellectual and multiple disabilities, but scarcely evaluated. This study aimed to provide insight into the application and perceived effects of snoezelen from the perspective of support persons. We conducted an international survey with professionals (n = 130) and relatives (n = 8) supporting people with profound intellectual and multiple disabilities. Information regarding the application and perceived effects was gathered. Content and descriptive analysis were used. Despite variation, common characteristics were identified regarding purpose, approach and context. Perceived positive effects mostly concerned improved mental health of the person receiving snoezelen (n = 88). A person-centred approach was reported as important element for positive effects. This study describes the use of snoezelen for people with profound intellectual and multiple disabilities. These insights can be used for future research into working elements and effects of snoezelen and facilitate evidence-based support.

Evidence-Based Implementation Support: Considering Motivation and Capacity Within the Ecosystem of Training and Technical Assistance.

This invited commentary reflects on Wandersman and Scheier's (2024) call for a more evidence-based model of training and technical assistance (i.e. TTA or implementation support). Their clarion call prompts us to consider what steps need to be taken to refine and scale a solution that genuinely enhances the effectiveness of TTA through a re-imagined model of implementation support. We highlight eight priorities to re-imagine a more effective and efficient model of TTA that reflects best practice and simultaneously contributes to continuous, collective evidence-building. The eight priorities include: (1) an ecosystem of TTA connecting TTA research and practice; (2) TTA capacity building; (3) health equity, and equitable partnerships; (4) trust and relationships; (5) TTA evaluation; (6) continuous quality improvement; (7) implementation support mechanisms; and (8) cost-effective solutions. We advocate for an international, cross-disciplinary, applied agenda aimed at establishing a robust empirical foundation for TTA to foster a culture of continuous quality improvement and knowledge generation across government agencies and philanthropies that fund TTA Centers. We describe a potential scenario for how funders can initiate and support evidence-based TTA.

Prevalence of nosocomial infections and their influencing factors in a tertiary general hospital in Qingdao.

The goals of this study were to analyze the situation and dynamic change trend of the prevalence of nosocomial infections among inpatients, to investigate the use of antibiotics, and to provide evidence-based support for the development of targeted prevention and control measures for nosocomial infections and rational use of antibiotics. The nosocomial infection surveillance system was utilized to conduct a cross-sectional survey of nosocomial infections of all inpatients, followed by a statistical evaluation of the 5-year survey results. The average prevalence of nosocomial infections over the 5-year period (2017 to 2021) was 2.28%, and the incidence rate per case was 2.42%. The lower respiratory tract was the primary site of infection, followed by the urinary tract. The most prevalent pathogens of nosocomial infections were Gram-negative bacteria (GNB), including Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli; and the main strains of Gram-positive bacteria (GPB) included Staphylococcus aureus and Enterococcus faecium. The use of antibiotics accounted for 41.31% on average; and the proportion of antibiotics used for treatment was 84.99% on average. The average rate of pathogen examination was 51.09%, indicating an increasing trend (χ2 = 44.196, p < 0.001). The average prevalence of nosocomial infections over the past five years was 2.28% in this tertiary general hospital. Although the prevalence rate of nosocomial infections in the hospital was relatively low, it is necessary to strengthen the measures for prevention and control of infections of the lower respiratory tract, urinary tract, and surgical incision.

A year of rapid reviews: evidence-based decision support for Austrian social insurances &amp; hospitals

Abstract Background The Austrian Institute for Health Technology Assessment (AIHTA) has supported the decisions of Austrian social insurance funds and hospital providers with rapid reviews since 2023. This summary of rapid reviews aims to provide insights on findings, as well as experiences and challenges of conducting the rapid reviews after one year. Methods We included all rapid reviews that were requested to the AIHTA team in 2023. For research questions that were withdrawn, the reasoning was documented. The completed rapid reviews were grouped into medical specialties, depending on the intervention analysed. The conclusions of the rapid reviews were presented in tabular form, with the strength of the available evidence classified as high, moderate, low or insufficient. Results The rapid reviews on interventions (n = 9) cover a variety of medical specialties (orthopaedics, gynaecology, neurology, physical medicine, ophthalmology, vascular surgery and dermatology). In three rapid reviews, the analysed evidence on the intervention was insufficient for benefit (compared to standard of care). In four rapid reviews, the evidence indicated a potential benefit with some limitations (e.g. indication-specific results, or minimal clinically important difference not clearly achieved). In two rapid reviews, the evidence indicated a potential benefit. For three topics, no rapid review was conducted (topic scope too broad for rapid review, change in prioritisation). Challenges include time constraints, as well as narrowing the research questions to be suitable for rapid reviews. Conclusions The overview of rapid reviews highlights evidence-based findings on medical interventions. Further steps include collecting feedback from inquirers, on the extent to which the evidence from rapid reviews was used to support the decision-making. Rapid reviews are a feasible tool but require continuous evaluation and further adaptation of methods. Key messages • The rapid reviews to inform decision-making processes for Austrian social insurance funds and hospitals spanned multiple specialties and revealed varying levels of evidence. • To improve the implementation of rapid reviews, and to overcome challenges of time constraints and narrowing down research questions, feedback from stakeholders should be collected.

Implementing a Hospital-Wide Programme Using iPARiHS to Prevent and Manage Incontinence-Associated Dermatitis and Improve Hospital-Acquired Pressure Injuries.

To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries. This is an empirical research study using mixed methods. The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys. Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success. This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks. Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care. No patient or public involvement. To describe the implementation study, we referred to the StaRI Guideline. This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved.