Evidence-based Clinical Interventions Research Articles

Recent trends and disparities in screen-based sedentary behavior and physical activity among U.S. overweight youth, 2018–2022

BackgroundSedentary behavior (SB) and physical activity (PA) are crucial factors influencing health outcomes in overweight children and adolescents. However, recent changes in SB and PA trends among U.S. overweight youth have not been well described, limiting the development of evidence-based clinical and public health interventions. MethodsSerial, cross-sectional analyses were conducted using data from the National Survey of Children's Health (NSCH) on U.S. overweight youth aged 6–17 years, spanning from 2018 to 2022. Linear regression models were employed to analyze time trends, with survey year as the exposure and recreational screen time (ST), adherence to the ≤2 h/day ST guideline, and adherence to the ≥1 h/day PA guideline as the outcomes. Multivariable-adjusted logistic and linear regressions were used to evaluate trends, adjusting for age group, sex, race/ethnicity, household income, and the highest education level of primary caregivers. ResultsData from 11,865 individuals (mean age 12.3 years [SD 2.9]; 6417 [52.3 %] girls) were analyzed. From 2018 to 2022, the average ST duration among overweight youth increased from 3.7 h to 4.1 h per day, a statistically significant increase (p = 0.07). The estimated prevalence of overweight youth meeting the ≤2 h/day ST guideline decreased from 44.6 % to 30.0 % (p = 0.007). Additionally, the prevalence of meeting the ≥1 h/day PA guideline remained low and stable, ranging from 8.4 % to 12.3 % during the analysis period (p = 0.6). DiscussionIn this nationally representative sample of U.S. overweight youth, ST increased by nearly 0.4 h/day over the five-year observation period, while adherence to the ≤2 h/day ST guideline decreased. Adherence to the ≥1 h/day PA guideline remained consistently low. These patterns were consistent across sociodemographic subgroups (age group, sex, ethnicity, and household income). These findings underscore the need for enhanced public health initiatives targeting U.S. youth to reduce recreational screen time and promote a physically active lifestyle.

Process mapping with failure mode and effects analysis to identify determinants of implementation in healthcare settings: a guide.

Generating and analyzing process maps can help identify and prioritize barriers to the implementation of evidence-based practices in healthcare settings. Guidance on how to systematically apply and report these methods in implementation research is scant. We describe a method combining a qualitative approach to developing process maps with a quantitative evaluation of maps drawn from the quality improvement literature called failure mode and effects analysis (FMEA). We provide an outline and guidance for how investigators can use process mapping with FMEA to identify and prioritize barriers when implementing evidence-based clinical interventions. Suggestions for methods and reporting were generated based on established procedures for process mapping with FMEA and through review of original research papers which apply both methods in healthcare settings. We provide case examples to illustrate how this approach can be operationalized in implementation research. The methodology of process mapping with FMEA can be divided into four broad phases: 1) formulating a plan, 2) generating process maps to identify and organize barriers over time, 3) prioritizing barriers through FMEA, and 4) devising an implementation strategy to address priority barriers. We identified 14 steps across the four phases. Two illustrative examples are provided. Case 1 describes the implementation of referrals to chiropractic care for adults with low back pain in primary care clinics. Case 2 describes the implementation of a family navigation intervention for children with autism spectrum disorder seeking care in pediatric clinics. For provisional guidance for reporting, we propose the REporting Process mapping and Analysis for Implementation Research (REPAIR) checklist. Process mapping with FMEA can elucidate barriers and facilitators to successful implementation of evidence-based clinical interventions. This paper provides initial guidance for more systematic applications of this methodology in implementation research. Future research should use a consensus-building approach, such as a multidisciplinary Delphi panel, to further delineate the reporting standards for studies that use process mapping with FMEA.

Recent trends and disparities in 24-hour movement behaviors among US youth with mental, behavioral and neurodevelopmental conditions

BackgroundMeeting 24-h movement behaviors (24-HMB: physical activity [PA], screen time [ST], and sleep [SL]) recommendations may be associated with positive health outcomes among youth with specific mental, behavioral, and neurodevelopmental (MBD) conditions. However, temporal trends and disparities in meeting 24-HMB guidelines in these higher-risk groups have not been investigated, hampering the development of evidence-based clinical and public health interventions. MethodsSerial, cross-sectional analyses of nationally National Survey of Children's Health (NSCH) data (including U.S. youth aged 6–17 years with MBD conditions) were conducted. The time-trends survey data was conducted between 2016 and 2021.The prevalence of 24-HMB adherence estimates were reported for the overall sample and for various sociodemographic subgroups. The subgroups analyzed included: age group (children[aged 6 to 13 years], adolescents[aged 14 to 17 years]), sex, socioeconomic status, and ethnicity. ResultsData on 52,634 individuals (mean age, 12.0 years [SD,3.5]; 28,829 [58.0 %] boys) were analyzed. From 2016 to 2021 the estimated trend in meeting PA + ST + SL guidelines declined (−0.8 % [95%CI, −1.0 % to −0.5 %], P for trend <0.001), whereas meeting none of 24-HMB guidelines increased (2.2 % [1.8 % to 2.6 %], P for trend <0.001). White participants, children, and boys reported higher estimated prevalence of meeting full integrated (PA + ST + SL) guidelines. DiscussionThe temporal trends observed in this study highlight the importance of consistently monitoring movement behavior among MBD youth and identifying variations by sociodemographic groups in meeting 24-HMB guidelines for health promotion within these vulnerable groups.

Harm Reduction in the Field: First Responders' Perceptions of Opioid Overdose Interventions.

Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

Evaluating generative AI responses to real-world drug-related questions

Generative Artificial Intelligence (AI) systems such as OpenAI's ChatGPT, capable of an unprecedented ability to generate human-like text and converse in real time, hold potential for large-scale deployment in clinical settings such as substance use treatment. Treatment for substance use disorders (SUDs) is particularly high stakes, requiring evidence-based clinical treatment, mental health expertise, and peer support. Thus, promises of AI systems addressing deficient healthcare resources and structural bias are relevant within this domain, especially in an anonymous setting. This study explores the effectiveness of generative AI in answering real-world substance use and recovery questions. We collect questions from online recovery forums, use ChatGPT and Meta's LLaMA-2 for responses, and have SUD clinicians rate these AI responses. While clinicians rated the AI-generated responses as high quality, we discovered instances of dangerous disinformation, including disregard for suicidal ideation, incorrect emergency helplines, and endorsement of home detox. Moreover, the AI systems produced inconsistent advice depending on question phrasing. These findings indicate a risky mix of seemingly high-quality, accurate responses upon initial inspection that contain inaccurate and potentially deadly medical advice. Consequently, while generative AI shows promise, its real-world application in sensitive healthcare domains necessitates further safeguards and clinical validation.

Defining the transition from new to normal: a qualitative investigation of the clinical change process.

Understanding how and when a new evidence-based clinical intervention becomes standard practice is crucial to ensure that healthcare is delivered in alignment with the most up-to-date knowledge. However, rigorous methods are needed to determine when a new clinical practice becomes normalized to the standard of care. To address this gap, this study qualitatively explores how, when, and why a clinical practice change becomes normalized within healthcare organizations. We used purposive sampling to recruit clinical leaders who worked in implementation science across diverse health contexts. Enrolled participants completed semi-structured interviews. Qualitative data analysis was guided by a modified version of the Normalization Process Theory (NPT) framework to identify salient themes. Identified normalization strategies were mapped to the Expert Recommendations for Implementation Change (ERIC) project. A total of 17 individuals were interviewed. Participants described four key signals for identifying when a novel clinical practice becomes the new normal: 1) integration into existing workflows; 2) scaling across the entire organizational unit; 3) staff buy-in and ownership; and 4) sustainment without ongoing monitoring. Participants identified salient strategies to normalize new clinical interventions: 1) taking a patient approach; 2) gaining staff buy-in and ownership; and 3) conducting ongoing measurement of progress towards normalization. The results offer valuable insight into the indicators that signify when a novel clinical practice becomes normalized, and the strategies employed to facilitate this transition. These findings can inform future research to develop instruments that implementation leaders can use to systematically measure the clinical change process.

Study of Factors Influencing Early Kinesiophobia in Older Patients after Coronary Artery Bypass Grafting in China

Background: Kinesiophobia is highly prevalent among postoperative cardiac patients. Early identification of kinesiophobia in patients who have undergone coronary artery bypass grafting (CABG) can improve their ability to participate in physical activities. However, there is limited research on the factors influencing kinesiophobia in older patients during the early stages after CABG. To investigate the factors influencing early kinesiophobia in older patients after coronary artery bypass grafting and to examine the correlation between these factors and social support and rehabilitation exercise self-efficacy. Methods: Using convenience sampling, 117 older patients who underwent coronary artery bypass grafting in the cardiac surgery ward of a tertiary grade A hospital in Bengbu City from October 2022 to September 2023 were analyzed. The survey was conducted on-site using a general information questionnaire, the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Cardiac Exercise Self-Efficacy Instrument (CESEI), the Social Support Rating Scale (SSRS), and the pain assessment scale. Single-factor analysis, multifactor regression analysis, and Spearman's correlation analysis were employed. Results: Among the 117 older patients in the early postoperative phase following coronary artery bypass grafting, the incidence of kinesiophobia was 73.5%. Single-factor analysis revealed that education level, medical expense coverage, place of residence, and pain scores were significantly associated with kinesiophobia (p &lt; 0.05). Multifactor regression analysis identified age and monthly income as factors influencing cardiac exercise self-efficacy (p &lt; 0.05). Age, education level, medical expense coverage, and monthly income affected patient social support (p &lt; 0.05). Spearman's correlation analysis revealed significant negative correlations among cardiac exercise self-efficacy, social support, and kinesiophobia level (p &lt; 0.001). Conclusion: The incidence of early kinesiophobia is relatively high among older patients after coronary artery bypass grafting. Educational level, medical expense coverage, place of residence, and postoperative pain were influential factors. Both cardiac exercise self-efficacy and social support have a significant impact on kinesiophobia in patients. Therefore, clinical healthcare professionals should prioritize older patients undergoing postcoronary artery bypass grafting with lower educational levels and monthly incomes. Effective and evidence-based clinical interventions can be tailored based on these influencing factors and their correlations to promote active participation in rehabilitation exercises and improve patient outcomes in the early postoperative phase.

The Relationship between Body Mass Index, Body Dissatisfaction and Mood Symptoms in Pregnant Women.

Background: High body mass and adiposity during pregnancy can contribute to psychological distress, and body dissatisfaction may be a potential underlying mechanism of this association. Objective. This study aimed to evaluate the mediational role of body dissatisfaction in the relationship between body mass index (BMI) and depressive and anxious symptoms, respectively. Methods: Given the cross-sectional design of this study, two alternative models were investigated, positing that BMI was related to depressive (Model 1a) and anxious symptoms (Model 2a), which, in turn, predicted body dissatisfaction. Seventy-two pregnant women in the third trimester of pregnancy completed the Body Image Disturbance Questionnaire, the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, as well as a demographic form assessing their BMI. Results: As hypothesized, body dissatisfaction mediated the relationship between BMI and psychopathological symptoms. Moreover, the alternative models of reverse mediation were also significant, suggesting that psychopathological symptoms mediated the relationship between BMI and body dissatisfaction. Findings from both the hypothesized and alternative models suggested that, on the one hand, higher distress symptoms associated with body dissatisfaction would result from high BMI and, on the other hand, that body dissatisfaction may result from the effect of BMI on distress symptoms. Conclusions: The present study suggests that body image theory and practice should be implemented by the inclusion of evidence-based clinical interventions for promoting psychological well-being during the antenatal period.

From ‘intuitive’ pragmatic interventions to a systematic approach – Using implementation science to improve childhood cancer survival in low-income settings: The CANCaRe Africa experience

Implementation science is a relatively young field of study and is the science of delivering evidence-based interventions into routine health care. RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) is an evaluation-type implementation science framework. CANCaRe Africa is preparing a project to assess the implementation and effectiveness of a cash incentive intervention to support families with out-of-pocket costs to prevent treatment abandonment and increase childhood cancer survival in sub-Saharan Africa. Our strategy is to enhance the dissemination of our research findings to local policymakers who can support the scale-up of evidence-based clinical interventions and locally effective implementation strategies. It can be done best by embedding implementation science into our clinical research approaches.

Observation of non-recommended (harmful) intrapartum practices among obstetric care providers in public hospitals in southern Ethiopia, 2023.

The majority of developing countries do not follow the WHO's emphasis on replacing harmful and ineffective traditional practices with evidence-based clinical treatment. In these countries, harmful or ineffective practices are routinely used as part of routine care during labor and delivery, while beneficial procedures are not used for the majority of laboring mothers. However, it is critical to use evidence-based practices while giving therapy since they improve care quality, save costs, increase patient and family happiness, and promote professional progress. To assess the magnitude of non-recommended (harmful) intrapartum practices among obstetric care providers in public hospitals in southern Ethiopia, 2023. An institution-based cross-sectional study was conducted from January 30, 2023, to February 30, 2023, in public hospitals in the Gamo and Gofa zones. An observational checklist and a self-administered questionnaire were used to gather data. Using odds ratio of 95% C, bivariate and multivariable logistic regression was used to discover factors related with the outcome variable during data analysis using SPSS version 27. A P-value of less than 0.05 and I were regarded as statistically significant. The magnitude of harmful intrapartum practice was 60.6% (95% CI: 53.25-68.5). Lack of internet access (AOR = 10.1, 95% CI: 4.93-21.1), a few years of work experience (AOR = 6.21, 95% CI: 3.1-12.5), and not being trained on evidence-based intrapartum practices (AOR = 4.01, 95% CI: 1.94-7.95) were statistically significant with harmful intrapartum practices. Evidence-based practice can be improved by promptly providing obstetric care providers with ongoing training and standards for intrapartum care.

Tracking severe acute respiratory syndrome coronavirus 2 transmission and co-infection with other acute respiratory pathogens using a sentinel surveillance system in Rift Valley, Kenya.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been the most significant public health challenge in over a century. SARS-CoV-2 has infected over 765 million people worldwide, resulting in over 6.9 million deaths. This study aimed to detect community transmission of SARS-CoV-2 and monitor the co-circulation of SARS-CoV-2 with other acute respiratory pathogens in Rift Valley, Kenya. We conducted a cross-sectional active sentinel surveillance for the SARS-CoV-2 virus among patients with acute respiratory infections at four sites in Rift Valley from January 2022 to December 2022. One thousand two hundred seventy-one patients aged between 3 years and 98 years presenting with influenza-like illness (ILI) were recruited into the study. Nasopharyngeal swab specimens from all study participants were screened using a reverse transcription-quantitative polymerase chain reaction (RT-qPCR) for SARS-CoV-2, influenza A, influenza B and respiratory syncytial virus (RSV). The samples that tested positive for influenza A (n = 73) and RSV (n = 12) were subtyped, while SARS-CoV-2 (n = 177) positive samples were further screened for 12 viral and seven bacterial respiratory pathogens. We had a prevalence of 13.9% for SARS-CoV-2, 5.7% for influenza A, 2% for influenza B and 1% for RSV. Influenza A-H1pdm09 and RSV B were the most dominant circulating subtypes of influenza A and RSV, respectively. The most common co-infecting pathogens were Streptococcus pneumoniae (n = 29) and Haemophilus influenzae (n = 19), accounting for 16.4% and 10.7% of all the SARS-CoV-2 positive samples. Augmenting syndromic testing in acute respiratory infections (ARIs) surveillance is crucial to inform evidence-based clinical and public health interventions.

The Impact of Testosterone Therapy on Cardiovascular Risk Among Postmenopausal Women.

To summarize the current state of knowledge surrounding the impact of testosterone therapy on cardiovascular risk factors in postmenopausal women. In this scoping review, a comprehensive search of peer-reviewed literature was conducted in adherence to a methodological framework comprising 4 distinct stages: conceptualizing a comprehensive search strategy, screening relevant publications, extracting pertinent data, and organizing and synthesizing the resultant findings. The search used electronic databases, including MEDLINE, Embase, and Google Scholar, to ensure an exhaustive survey of the available literature. The database search yielded 150 articles, including systematic reviews, registered trials, and peer-reviewed studies, of which 48 duplicates were removed. Following the title/abstract screening, 36 publications were included in the full-text review. On completion of the full-text review, using the inclusion/exclusion criteria, 29 articles were excluded and 7 remained for data extraction and qualitative synthesis. Existing research provides promising insights into the benefits of low-dose testosterone therapy, typically combined with estrogen therapy. These benefits may include positive impacts on body composition, functional capacity, insulin sensitivity, inflammatory markers, and cholesterol. However, there remains a substantial lack of knowledge surrounding the effects and mechanisms behind testosterone therapy in postmenopausal women in relation to its impacts on cardiovascular risk. High-quality, evidence-based clinical intervention research is needed to investigate testosterone therapy's potential implication on cardiovascular risk factors in post-menopausal women.

The Modern Regularity of Institutionalized Racism Towards Black Americans

African Americans have faced persistent institutionalized barriers and systemic racism both historically and in the present day. One of the most glaring manifestations of this is the racial disproportionality observed in incarceration rates. This paper delves into specific domains, such as the justice and social welfare systems, where institutional discrimination is evident, contributing to the disenfranchisement of African Americans. It further addresses the gap in literature concerning the impacts of such racial disproportionality in incarceration, especially the systemic challenges faced post-incarceration. The objective of this research is to delineate the facets of institutionalized racism towards African Americans in the context of incarceration and to propose evidence-based clinical interventions for professionals working with this demographic.

Corrigendum to: Healthcare practitioner use of real-time prescription monitoring tools: an online survey.

Objective The aim of this study is to investigate how healthcare practitioners use real-time prescription monitoring tools in clinical practice. Methods An online survey was distributed to Australian prescribers and pharmacists who use a real-time prescription monitoring tool. Data were analysed and descriptive statistics summarised participant characteristics and responses. A Chi-squared test was conducted to test the difference between prescribers and pharmacists. Results The majority of participants agreed that real-time prescription monitoring (RTPM) information is useful (92.2%) and the tool is valuable for informing clinical decisions (90.2%); however, just over half reported that they had changed their prescribing or dispensing practices as a result of RTPM information (51.0%), and they employed evidence-based clinical interventions to varying degrees. No statistically significant differences were detected between pharmacists and prescribers and perceptions on tool use. Conclusions This is the first known study to investigate practitioner use of RTPM tools in Australia, and is a starting point for further research. What constitutes 'success' in the clinical application of RTPM tools is yet to be realised.

Show and Tell: Photography and Storytelling to Better Understand the End-of-Life Experience of Families in the Intensive Care Unit.

End-of-life in the Intensive Care Unit (ICU) is common, costly, and can contribute to negative health outcomes for bereaved family members. Insufficient understanding of the family experience results in poor quality, highly variable care riddled with deficiencies including effective identification and application of evidence-based clinical interventions. Successfully managing the multitude of transitions, for example changes in family role or personal identity requires creative practice guided by theory. This project supports the feasibility of using peri-mortem photographs captured by family members with story-telling and a standardized measurement of grief to explore the family experience of end-of-life in the ICU. Project findings reveal shared experiential themes and emphasize the value of photography and storytelling as meaning-making interventions for families. Further study to generalize findings and develop additional preventative and therapeutic interventions at and beyond end-of-life in the ICU is needed to better meet family needs and improve their health outcomes.

Evaluation of the quality of guidelines for sublingual immunotherapy of allergic rhinitis.

Guidelines are intended to facilitate evidence-based clinical decision-making and knowledge translation; however, the quality and rigor of the guidelines are different. This study was conducted to assess the quality of sublingual immunotherapy guidelines for allergic rhinitis, in order to provide a reference for evidence-based clinical treatment and management of sublingual immunotherapy. Using both Chinese and English search methods, articles were obtained from PubMed, Cochrane, Web of Science, CNKI, CBM, WanFang Data, VIP, and other databases from the construction of the database to September 2020. The AGREE II instrument was used by two researchers to independently evaluate the quality of the extracted articles, and the consistency of the researchers was evaluated using the inter-group correlation coefficient. Ten articles were included in this study, of which two articles ranked A level, six articles ranked B level, and two articles ranked C level. The six sections of AGREE II included scope and aim, clarity, participant, applicability, rigor, and editorial independence, with standardized scores of 78.06%, 45.83%, 42.81%, 77.50%, 50.42%, and 46.25%, respectively. The quality of the current guidelines for sublingual immunotherapy is average. The formulation methodology and reporting standards of these guidelines must be developed. By standardizing the treatment of sublingual immunotherapy properly, it is recommended that guideline makers refer to the AGREE II to formulate high-quality guidelines and promote their wide application.

Are Abnormal Muscle Biomechanics and Patient-reported Outcomes Associated in Patients With Hip Dysplasia?

Developmental dysplasia of the hip (DDH) is a major risk factor for the early development of hip osteoarthritis. Recent studies have demonstrated how DDH alters hip muscle moment arms and elevates muscle-induced biomechanical variables such as joint reaction forces and acetabular edge loads. Understanding the link between abnormal biomechanics and patient-reported outcome measures (PROMs) is important for evidence-based clinical interventions that improve patient symptoms and functional outcomes. To our knowledge, there are no reports of the relationships between muscle-induced biomechanics and PROMs. (1) Are there associations between PROMs and muscle-induced hip biomechanics during gait for patients with DDH and controls? (2) Are there associations among PROMs and separately among biomechanical variables? Participants in this prospective cross-sectional comparative study included 20 female patients with DDH who had no prior surgery or osteoarthritis and 15 female individuals with no evidence of hip pathology (controls) (age: median 23 years [range 16 to 39 years]; BMI: median 22 kg/m 2 [range 17 to 27 kg/m 2 ]). Muscle-induced biomechanical variables for this cohort were reported and had been calculated from patient-specific musculoskeletal models, motion data, and MRI. Biomechanical variables included joint reaction forces, acetabular edge loads, hip center lateralization, and gluteus medius muscle moment arm lengths. PROMs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the WOMAC, International Hip Outcome Tool-12, National Institutes of Health Patient-Reported Outcome Measure Information System (PROMIS) Pain Interference and Physical Function subscales, and University of California Los Angeles activity scale. Associations between PROMs and biomechanical variables were tested using Spearman rank-order correlations and corrected for multiple comparisons using the Benjamini-Yekutieli method. For this study, associations between variables were considered to exist when correlations were statistically significant (p < 0.05) and were either strong (ρ ≥ 0.60) or moderate (ρ = 0.40 to 0.59). Acetabular edge load impulses (the cumulative acetabular edge load across the gait cycle), medially directed joint reaction forces, and hip center lateralization most commonly demonstrated moderate or strong associations with PROMs. The strongest associations were a negative correlation between acetabular edge load impulse on the superior acetabulum and the HOOS function in daily living subscale (ρ = -0.63; p = 0.001), followed by a negative correlation between hip center lateralization and the HOOS pain subscale (ρ = -0.6; p = 0.003), and a positive correlation between hip center lateralization and the PROMIS pain subscale (ρ = 0.62; p = 0.002). The University of California Los Angeles activity scale was the only PROM that did not demonstrate associations with any biomechanical variable. All PROMs, aside from the University of California Los Angeles activity scale, were associated with one another. Although most of the biomechanical variables were associated with one another, these relationships were not as consistent as those among PROMs. The associations with PROMs detected in the current study suggest that muscle-induced biomechanics may have wide-reaching effects not only on loads within the hip, but also on patients' perceptions of their health and function. As the treatment of DDH evolves, patient-specific joint preservation strategies may benefit from targeting the underlying causes of biomechanical outcomes associated with PROMs. Level III, prognostic study.

Transformation of Cognitive Behavior Therapy as a Psychotherapeutic Intervention in Contemporary Health Care: A Review

Cognitive behavior therapy (CBT) is an evidence-based intervention in contemporary clinical health care services. CBT was developed as a psychotherapy to overcome the deficits of psychoanalysis and behaviorism by Aron T. Beck. However, after 63 years, CBT has transformed from its early framework. In comparison to other psychotherapies, cognitive behavior therapy has rapidly changed and developed as an evidence-based clinical intervention. Therefore, this study explored the evolution of cognitive behavior therapy by focusing on its origin, development, limitations, clinical application, third waves, and future directions. Early CBT therapeutic framework has developed as a cognitive model of depression and developed as an intervention to address the negative core belief of individuals and rationalize maladaptive behaviors, thoughts, and emotions. However, clinicians have experienced several limitations and scholars have recognized theoretical limitations in CBT. Later, scholars on CBT have overcome these deficits and developed disorder-specific CBT therapies. Then, clinicians empirically evaluate those therapeutic frameworks and transform CBT into an evidence-based clinical intervention. Further, CBT has strength in integrating third-wave therapies. In the future, CBT will therapeutically further transform with technology, integrating advanced theories of pathology, and clinical demand of the present health care services. Therefore, as a psychotherapeutic intervention, cognitive behavior therapy has transformed from its early framework, and at present, it has developed empirically. Further, in the future, it will transform into a more effective psychotherapeutic intervention.

Healthcare practitioner use of real-time prescription monitoring tools: an online survey.

Objective The aim of this study is to investigate how healthcare practitioners use real-time prescription monitoring tools in clinical practice. Methods An online survey was distributed to Australian prescribers and pharmacists who use a real-time prescription monitoring tool. Data were analysed and descriptive statistics summarised participant characteristics and responses. A Chi-squared test was conducted to test the difference between prescribers and pharmacists. Results The majority of participants agreed that real-time prescription monitoring (RTPM) information is useful (92.2%) and the tool is valuable for informing clinical decisions (90.2%); however, just over half reported that they had changed their prescribing or dispensing practices as a result of RTPM information (51.0%), and they employed evidence-based clinical interventions to varying degrees. No statistically significant differences were detected between pharmacists and prescribers and perceptions on tool use. Conclusions This is the first known study to investigate practitioner use of RTPM tools in Australia, and is a starting point for further research. What constitutes 'success' in the clinical application of RTPM tools is yet to be realised.

CLINICAL TOOLS TO ADDRESS BRAIN HEALTH CONCERNS IN THE CONTEXT OF LATER-LIFE DEPRESSION

Abstract GSA’s revised KAER Toolkit for Primary Care Teams (Fall, 2021) is an important resource, yet the complexities of depressive and cognitive symptoms in aging individuals create particular challenges for generalist behavioral health providers. Mental health practitioners and their patients can benefit from evidence-based clinical intervention materials that address the intersection of depression and brain health concerns. This presentation highlights treatment strategies and clinical tools from the new Brain Health module of the revised 2021 client workbook Treating Later-Life Depression: A Cognitive Behavioral Therapy Approach from Oxford University Press. Examples will be presented of large print within-session “Learn pages” that inform both providers and patients about normative cognitive aging and ways in which cognitive functioning can be affected by depression. Between-session “Practice forms” will also be demonstrated that address lifestyle factors to promote brain health, consideration of whether to complete a cognitive evaluation, and strategies to manage brain health changes.