Evidence Based Information Practice Research Articles

The Great Debate: Mesh or No Mesh in Contaminated Hernia Repairs?

Abdominal hernia surgeries are commonly performed with many different approaches, and mesh utilization has become a cornerstone in hernia repair, ensuring durable outcomes with minimal recurrence risk. However, managing contaminated hernia repairs presents unique challenges due to the heightened risks of mesh infection. Recent advancements in lightweight macroporous polypropylene meshes offer promising solutions. Studies have highlighted the superiority of macroporous polypropylene meshes compared to primary suture repair and other mesh types in terms of reduced surgical site infection rates and lower hernia recurrence rates. Moreover, utilizing macroporous polypropylene mesh in the retrorectus plane is associated with a favorable salvage rate, underscoring its efficacy in contaminated hernia repairs. At the same time, contrary evidence suggests higher postoperative complications with mesh use in settings of clean-contaminated or contaminated fields. Most significant complications are increased infection rates and similar recurrence rates compared to mesh-free repairs. New synthetic mesh that is being marketed as having better outcomes than other types of mesh and potentially primary repair need to be carefully assessed as biologic mesh once used to also be touted as the mesh to use in such fields, but more research is showing higher complication rates. The risk of infection and consequent morbidity might outweigh the benefit of less recurrence risk with mesh use. Further research, including prospective studies with long-term follow-up, is warranted to elucidate optimal hernia repair strategies in contaminated fields and inform evidence-based practice guidelines.

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Heart failure (HF) patients frequently present with comorbidities such as atrial fibrillation (AF) or other cardiovascular conditions, elevating their risk of thromboembolic events. Consequently, anticoagulation therapy is often considered for thromboprophylaxis, although its initiation in HF patients is complicated by concomitant bleeding risk factors. This review explores the paradoxical relationship between HF, increased bleeding risk, and the potential benefits of anticoagulation. Through an examination of existing evidence from clinical trials, observational studies, and meta-analyses, we aim to elucidate the role of anticoagulation in HF patients with increased bleeding risk. Despite guidelines recommending anticoagulation for certain HF patients with AF or other thromboembolic risk factors, uncertainty persists regarding the optimal management strategy for those at heightened risk of bleeding. The review discusses the pathophysiological mechanisms linking HF and thrombosis, challenges in bleeding risk assessment, and strategies to minimize bleeding risk while optimizing thromboprophylaxis.Shared decision-making between clinicians and patients is emphasized as essential for individualized treatment plans that balance the potential benefits of anticoagulation against the risk of bleeding complications. Furthermore, it examines emerging anticoagulant agents and their potential role in HF management, highlighting the need for further research to delineate optimal management strategies and inform evidence-based practice. In conclusion, while anticoagulation holds promise for improving outcomes in HF patients, careful consideration of patient-specific factors and ongoing research efforts are essential to optimize therapeutic strategies in this population.

Carrying out research, critical appraisal, ethics and stakeholder involvement

Research skills are a requirement under the Health and Care Professions Council (HCPC) standards for paramedic registration. Paramedics must ‘recognise the value of research to the critical evaluation of practice’. Research in the medical field is important in order to improve the knowledge of clinicians and inform evidence-based practice. The purpose of this article is to demonstrate the key components of the research process, use of a PICO [population, intervention, comparison, outcome] tool to search relevant databases and explain the critical appraisal of research in order to establish if research is valid before implementing results into paramedic practice.

The 2023-2026 Hospice and Palliative Nurses Association Research Agenda.

The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.

Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS)

BackgroundUrologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response.MethodsUCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief.DiscussionEmpirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine.Trial RegistrationClinicaltrials.gov NCT05127616. Registered on 9/19/21.

Effect of evidence-based information management and practice training on librarians’ critical thinking: A randomized educational trial

Critical thinking is one of the most important elements in making the right decision in every profession. Evidence based practice shows potential to empower the critical thinking skills of practitioners. The aim of this study was to determine the effect of evidence-based information management and practice (EBIMP) training course on the promotion of medical librarians’ critical thinking. This study is a randomized double-blind educational trial in the form of a parallel trial. A sample of 60 librarians were recruited nationwide in the study through the volunteer enrollment to the evidence-based information management and practice training course. Intervention group received a 10-module virtual course focusing on evidence-based information management. But the control group received a basic course of evidence-based medicine. The courses were delivered through virtual learning system and data was collected through California Standard Critical Thinking Skills Questionnaire Form B (CCTST). Data were analyzed with Covariance Analysis (ANCOVA), Chi-square (χ²), Kolmogorov-Smirnov and Levin tests, and t-test, using SPSS 25. The findings showed that the critical thinking skills of participants after training of the information management and evidence-based practice (EBIMP) had significant improvement in the intervention group compared with the control group regarding the “inference” (4.86 ± 1.94 vs 4.20 ± 1.32), “assessment” (7.90 ± 1.77 vs 5.90 ± 1.70), “Inductive reasoning” (8.67 ± 2.32 vs 6.37 ± 1.87), “deductive reasoning” (6.47 ± 2.04 vs 5.77 ± 1.97) subskills. Education of evidence-based information practice could be effective in promotion of critical thinking skills of medical librarians. This study suggests evidence-based information practice to be added to the curriculum of medical library and information science fields. Trial registration: This study was registered with number 9000.1v1 in Registry of Efficacy and Effectiveness Studies (REES).

Life Course Investments at the Maternal and Child Health Bureau.

Life Course Investments at the Maternal and Child Health Bureau.

Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy management in upper gastrointestinal (GI) surgery

Objective This scoping review will identify and synthesise the available evidence for post-operative physiotherapy following upper GI surgery, in order to identify gaps in the literature, inform evidence-based practice and contribute towards guidelines and/or policy development. Introduction Physiotherapy management following thoracic, cardiac and upper gastrointestinal surgery has been identified as one of the five key priorities for review by the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) editorial board. Previously, systematic reviews have been published with a focus on one type of physiotherapy treatment. The aim of this scoping review was to identify all types of post-operative physiotherapy following upper GI surgery research to provide a comprehensive review of available evidence. Inclusion criteria Studies with adult patients undergoing upper GI surgery and published between 2015 and 2020 were included. The surgical procedure included required post-operative physiotherapy intervention as part of the recovery process. The context was in-patient, hospital-based surgery. Physiotherapy intervention prior to admission (such as pre-habilitation), and intervention after hospital discharge, for example, out-patient follow up were excluded. Research from any country of origin and any type of healthcare system was included. Methods The search strategy was agreed by the scoping team and searches were undertaken of PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Exclusion criteria included any articles not written in English. All identified citations were uploaded into web-based Endnote. Articles were screened against title and abstract by one reviewer, and full text articles were appraised by two reviewers. Data extraction included the aim of the study, design/methodology, sample details (number of participants, mean age, gender ratio), comparison group details, outcome measures, and key findings relevant to the scoping review questions. Quality was assessed using the relevant Critical Appraisal Skills Programme (CASP) or Joanna Briggs Institute (JBI) tools dependent on study methodology. Results Eleven studies were identified for inclusion of which there were three randomised control trials (RCT), four cohort studies, one systematic review, one cross sectional study, one narrative review and one survey. No qualitative studies were found. Four studies considered the role of adjuncts (incentive spirometry and inspiratory muscle training). Five studies investigated ambulation or early mobilisation post-surgery, one study looked at the role of pre-operative education and one study looked at current practise. 57 physiotherapists were surveyed, 1,384 participants were included in studies and 37 papers were included in reviews. The studies found that early and intensive mobilisation as part of an ERAS programme showed a statistically significant reduction in length of stay (LOS) and post-operative pulmonary complications (PPCs). Reported physiotherapy interventions are in line with current best practice guidelines. IMT and IS continue to show positive results in the literature in particular in the older and high-risk patient. Pre-operative assessment and education should be considered in patients undergoing upper abdominal GI surgery however screening tools for prioritisation are not yet established. The quality of the research was generally good; however, sample sizes were small and often underpowered. Conclusions This scoping review has demonstrated that current evidence supports post-operative physiotherapy intervention in people who undergo upper GI surgery. Future research should aim to determine the role of pre-operative physiotherapy, clarify the impact of breathing exercise protocols and expand the diversity of methodologies to include more qualitative research.

Practitioner, Coach, and Athlete Perceptions of Evidence-Based Practice in Professional Sport in Australia.

To examine practitioners', coaches', and athletes' perceptions of evidence-based practice (EBP) in professional sport in Australia. One hundred thirty-eight participants (practitioners n = 67, coaches n = 39, and athletes n = 32) in various professional sports in Australia each completed a group-specific online questionnaire. Questions focused on perceptions of research, the contribution of participants' own experience in implementing knowledge to practice, sources, and barriers for accessing and implementing EBP, preferred methods of feedback, and the required qualities of practitioners. All practitioners reported using EBP, while most coaches and athletes believed that EBP contributes to individual performance and preparation (>85%). Practitioners' preferred EBP information sources were "peer-reviewed journals" and "other practitioners within their sport," while athlete sources were "practitioners within their sport" and "other athletes within their sport." As primary barriers to accessing and implementing research, practitioners highlighted "time constraints," "poor research translation," and "nonapplicable research." Practitioners ranked "informal conversation" as their most valued method of providing feedback; however, coaches prefer feedback from "scheduled meetings," "online reports," or "shared database." Both athletes and coaches value "excellent knowledge of the sport," "experience," and "communication skills" in practitioners disseminating EBP. Practitioners, coaches, and athletes believe in the importance of EBP to their profession, although practitioners reported several barriers to accessing and implementing research as part of EBP. Athletes place a high value on experienced practitioners who have excellent knowledge of the sport and communication skills. Collectively, these findings can be used to further stakeholder understanding regarding EBP and the role of research to positively influence athlete health.

Cannabinoids in the Treatment of Insomnia Disorder: A Systematic Review and Meta-Analysis.

Insomnia is associated with significant comorbidity, disability and impact on quality of life and, despite advances in pharmacotherapy and psychotherapy, remains a significant burden to society. Cannabinoids are gaining acceptance for use as medicines in the treatment of insomnia disorder. We conducted a systematic review and meta-analysis to evaluate the efficacy of cannabinoids in the treatment of insomnia disorder. We performed a systematic review of the PubMed, Cochrane Library, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature Complete databases from inception to 5 December 2019, and again prior to data abstraction, for studies of cannabis-based products for the treatment of insomnia disorder in adults. Inclusion criteria were (1) clinical studies, (2) participants aged ≥18years, (3) insomnia disorder either formally diagnosed against contemporaneous diagnostic criteria or quantified with validated instruments and (4) compared cannabis-based products with the standard of care, placebo or a sedative. No language restrictions were imposed. Non-primary research, animal studies and studies of cannabis-induced insomnia were excluded. Risk of bias was assessed using the RoB 2 tool for randomised controlled trials (RCTs) and Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized trials. Heterogeneity was assessed with the I2 statistic. A total of five studies (two RCTs and three non-randomised studies) with 219 study participants were included, of which three could be combined. The three non-randomised studies contributed data on the Pittsburgh Sleep Quality Index Questionnaire score, showing a favourable effect of cannabinoids at ≤4weeks of follow-up (mean difference -1.89 [95% confidence interval {CI} -2.68 to -1.10]; n=176) and at 8 weeks of follow-up (mean difference -2.41 [95% CI -3.36 to -1.46]; n=166). One double-blind crossover RCT (n=32) reported that, compared with amitriptyline, nabilone-a synthetic analogue to tetrahydrocannabinol (THC)-improved Insomnia Severity Index scores after 2 weeks of treatment (adjusted difference -3.25 [95% CI -5.26 to -1.24]) and resulted in a more restful sleep as a sub-measure of the Leeds Sleep Evaluation Questionnaire (LSEQ) (difference 0.48 [95% CI 0.01-0.95]) but with no effect on overall sleep quality as measured by the LSEQ. In a single ascending-dose RCT (n=9), THC reduced sleep-onset latency compared with placebo at 10mg, 20mg and 30mg doses (mean difference -43.00min [95% CI -82.76 to -3.24], -62.00 [95% CI -103.60 to -20.40] and -54.00 [95% CI -103.93 to -4.07], respectively). All the included studies were assessed as poor quality, mainly due to small sample sizes, short treatment periods, uncertain clinical significance and high risk of bias. Few studies have examined the efficacy of cannabinoids in the treatment of insomnia disorder. Despite some possible signals for efficacy, the heterogeneity of participants, interventions, efficacy outcomes and results, and the high risk of bias across included trials, do not reliably inform evidence-based practice. This review highlights shortcomings in the existing literature, including lack of diagnostic clarity, poorly defined participant groups, non-standardised interventions and studies of inappropriate design, duration and power to detect clinically meaningful outcomes. Further research in the form of high-quality RCTs are required before drawing any conclusions about the efficacy of cannabinoids in the treatment of insomnia disorder. PROSPERO registration number, CRD42020161043.

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

<strong>Context:</strong> The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. <strong>Objectives:</strong> The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. <strong>Methods:</strong> Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. <strong>Findings:</strong> The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. <strong>Implications:</strong> This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.

Generating real-world evidence: Using automated data extraction to replace manual chart review.

e18096 Background: Real world evidence is a valuable resource to help guide clinical care beyond evidence generated from clinical trials, for example safety and effectiveness of novel treatments in special populations. Administrative databases often lack sufficient clinical detail to address gaps in the improvement of patient management and quality of care. Detailed clinical data collection and curation are resource intensive, limiting the ability to generate and maintain large informative cancer databases. Darwen, novel technology developed by Pentavere, enables the automation of data abstraction from unstructured hospital electronic medical records and may eliminate the need for manual chart review. Methods: Health records were identified through an institutional cancer registry from patients with stage IIIB/IV lung cancer (NSCLC or SCLC) diagnosed and treated at the Princess Margaret Cancer Centre between 01/01/2015 and 31/12/2017. Cases underwent automated data extraction including demographics, comorbidities, treatment, concurrent medications and outcomes until 30/06/2018. Agreement with data fields extracted using manual data collection in an external validation set of patients is planned. Results: Of 1210 patients identified, 538 were eligible for analysis. From automated data abstraction, 9.9% were reported to have SCLC, 67.5% adenocarcinoma, 11.2% squamous carcinoma, 28% EGFR mutations, 5.8% ALK fusions and 9.3% tumour PDL1 &gt; = 50%. Of the 304 (56.5%) that received systemic therapy, initial treatment was chemotherapy for 55.6%, targeted therapy in 34.2% and immunotherapy in 10.2%. Additional outcome data and agreement with manually curated data fields will be presented. Conclusions: Automated software to extract clinical data is a powerful new tool to generate and maintain databases that yield high quality real world clinical evidence. This is a critical next step to improve clinical decision making, inform evidence-based practice and improve quality of cancer care.

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence-Based Practice.

Determining possible associated factors and the influencing pathways to hemoglobin A1C (HbA1C) levels and quality of life (QoL) will facilitate the development of effective interventions to improve the physical and psychosocial health of patients with type 2 diabetes mellitus (T2DM). To test a hypothesized model that addressed the pathways among personal characteristics, social support, diabetes distress, and self-care behaviors to HbA1C and QoL. A total of 382 adults with T2DM were recruited. Self-reported questionnaires and medical records were used to collect data regarding personal characteristics, diabetes distress, and social support at baseline. The self-care behaviors characters were collected 6 months later, as well as QoL and HbA1C levels 1 year later. The 12-month QoL directly affected 12-month HbA1C levels. The 6-month self-care behaviors directly affected 12-month QoL, and indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline diabetes distress directly affected 12-month QoL. Moreover, baseline diabetes distress indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline social support directly affected baseline diabetes distress and 6-month self-care behaviors. In addition, baseline social support indirectly affected 12-month QoL through baseline diabetes distress. Baseline social support also indirectly affected 12-month QoL through 6-month self-care behaviors. Enhancing QoL is important to improve HbA1C levels. Enhancing self-care behaviors is essential to improve subsequent HbA1C control and QoL. Reducing diabetes distress is crucial to improve subsequent QoL. Improving social support is suggested a favorable strategy to reduce diabetes distress and enhance subsequent self-care behaviors in patients with T2DM.

Emergency residential care settings: A model for service assessment and design

There have been calls for uncovering the “black box” of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care.

How academic librarians experience evidence-based practice: A grounded theory model

This study explored academic librarians’ experience of evidence-based practice. A better understanding of evidence-based practice from an empirical basis can help fulfill the aims of evidence-based library and information practice to continuously improve practice and make effective, value-adding decisions about library and information services for their clients and communities. This research uses a constructivist grounded theory approach to investigate the question: How do academic librarians experience evidence-based practice? Thirteen Australian academic librarians participated in semi-structured interviews. The study used the methods of constant comparison to create codes and categories towards constructing a new theoretical model of experiencing evidence-based practice in the academic library context. The model consists of six categories of experiences: empowering, intuiting, affirming, connecting, noticing and impacting. This model can provide a platform for developing support for academic librarians andtheir educators by increasing awareness of various mindsets and actions experienced in the workplace context towards facilitating evidence-based information practice.

Body composition during fetal development and infancy through the age of 5 years.

Fetal body composition is an important determinant of body composition at birth, and it is likely to be an important determinant at later stages in life. The purpose of this work is to provide a comprehensive overview by presenting data from previously published studies that report on body composition during fetal development in newborns and the infant/child through 5 years of age. Understanding the changes in body composition that occur both in utero and during infancy and childhood, and how they may be related, may help inform evidence-based practice during pregnancy and childhood. We describe body composition measurement techniques from the in utero period to 5 years of age, and identify gaps in knowledge to direct future research efforts. Available literature on chemical and cadaver analyses of fetal studies during gestation is presented to show the timing and accretion rates of adipose and lean tissues. Quantitative and qualitative aspects of fetal lean and fat mass accretion could be especially useful in the clinical setting for diagnostic purposes. The practicality of different pediatric body composition measurement methods in the clinical setting is discussed by presenting the assumptions and limitations associated with each method that may assist the clinician in characterizing the health and nutritional status of the fetus, infant and child. It is our hope that this review will help guide future research efforts directed at increasing the understanding of how body composition in early development may be associated with chronic diseases in later life.

Research–Practice Integration in Real Practice Settings

At the National Bridging the Research and Practice Gap Symposium to discuss evidence-based practice (EBP) in social work, 150 participants attended five breakout groups to address real practice setting applications. These participants from social work academia and practice communities addressed issues and looked for solutions to promote research–practice integration. Their discussions of EBP implementation issues identified five areas of focus, including the urgent need to (1) provide training, (2) design interventions based on developmental and cultural competence, (3) plan research-informed strategies with an effective infrastructure, (4) initiate research–practice integration in the process of developing social work interventions, and (5) prepare future practitioners and educators to begin collaborative work. Their recommendations focused on people-oriented, skills-based preparations, such as the provision of consumer-oriented EBP information, intervention applications and observations, development of formal training programs to connect academia to field practice, and a planning process to develop competence-based EBP curricula and practice bases.

Evidence-based practice and web usability assessment

Purpose – Issues related to usability and creating effective and engaging user experiences on the internet continue to vex libraries and information agencies. Many organizations still do not have an on-going, sustainable usability assessment program in place. This should be a cause for concern because usability programs serve as a quality-control check on our ability to provide quality information. This is why evidence-based information practice is so important as a fundamental building block of a usability assessment plan. This paper aims to address these issues. Design/methodology/approach – Through a review of the basic principles of evidence-based practice, the author puts into context how a web assessment methodology could be put in place at a library or information organization. Findings – Using the principles of evidence-based practice, as well as a user-centered design perspective, can greatly enhance the ability of libraries and information organizations to develop effective web usability assessment programs. Originality/value – While there has been a significant body of work in library and information science related to implementing evidence-based practice (EBP), there has been little specifically written about applying EBP to web usability assessment. This article fills that gap in the literature.

The Irritable Bowel Syndrome Outcome Study (IBSOS): Rationale and design of a randomized, placebo-controlled trial with 12 month follow up of self- versus clinician-administered CBT for moderate to severe irritable bowel syndrome

Irritable bowel syndrome is a common, oftentimes disabling, gastrointestinal disorder whose full range of symptoms has no satisfactory medical or dietary treatment. One of the few empirically validated treatments includes a specific psychological therapy called cognitive behavior therapy which, if available, is typically administered over several months by trained practitioners in tertiary care settings. There is an urgent need to develop more efficient versions of CBT that require minimal professional assistance but retain the efficacy profile of clinic based CBT. The Irritable Bowel Syndrome Outcome Study (IBSOS) is a multicenter, placebo-controlled randomized trial to evaluate whether a self-administered version of CBT is, at least as efficacious as standard CBT and more efficacious than an attention control in reducing core GI symptoms of IBS and its burden (e.g. distress, quality of life impairment, etc.) in moderately to severely affected IBS patients. Additional goals are to assess, at quarterly intervals, the durability of treatment response over a 12month period; to identify clinically useful patient characteristics associated with outcome as a way of gaining an understanding of subgroups of participants for whom CBT is most beneficial; to identify theory-based change mechanisms (active ingredients) that explain how and why CBT works; and evaluate the economic costs and benefits of CBT. Between August 2010 when IBSOS began recruiting subjects and February 2012, the IBSOS randomized 171 of 480 patients. Findings have the potential to improve the health of IBS patients, reduce its social and economic costs, conserve scarce health care resources, and inform evidence-based practice guidelines.

Leading the Nation in Women’s Health: The Important Role of Research

Article history: Received 20 April 2011; Accepted 20 April 2011 Over the past two decades, the Veterans Health Administration (VHA) has supported numerous initiatives to remedy gaps in services available to women veterans. Finding deficits in the VHA’ sw omen’s health care delivery in the early 1990s, reports from the U.S. Government Accounting Office spurred the initial move to upgrade the care provided to women veterans. Unfortunately, much of the country continued to marginalize women’s services in VHA, providing only a “pap” clinic and part-time (and often “collateral duty”) Women Veteran Coordinators to meet all of the needs of women veterans. Nonetheless, there were pockets of true excellence, facilities that engaged in a process of intensive development of comprehensive women’ sh ealth centers (BeanMayberry et al., 2007; Yano, Goldzeig, 2006). In 2008, my office, which oversees delivery of VA health care to women veterans nationally, launched an initiative to take this early work to the next level, transforming VA’s women’s health delivery system into an ational leader in women’s health. Our goal is to provide “the best care anywhere” for women veterans (Longman, 2005). A solid foundation of research is essential to this vision. The U.S. Department of Veterans Affairs has already produced an impressive body of work that has helped to guide changes in strategies for the provision of care for women veterans (BeanMayberry, et al., 2010; Goldzweig, Balekian, Rolon, Tano, & Shekelle, 2006). However, still more research is needed; this current Special Issue of Women’s Health Issues takes another important step forward in filling remaining gaps, while also identifying new areas of research needing attention. As more and more women are entering and serving in military roles, many of which of which expose them to combat, we are challenged to understand and treat the effects of military service on women’s lives. Examining all of the possible effects of military service includes, of course, not only careful assessment of negative effects and vulnerabilities, but also of positive outcomes based on hard-won opportunities to serve their country, strengths, and resilience, and other factors that may have had less attention overall. Nationally, our population of women veterans is rapidly expanding, from the group of pioneering womenwho comprised only 3.5% of the military during World War II, to 4% during the Vietnam Era, and to approximately 11% in 1991, during Gulf War I. Today, women comprise 15% of active duty military and 17% of the National Guard and Reserve forces (Women’s Research and Education Institute, 2008). Thus, we need to plan for the many women “in the pipeline” who will be seeking health care from the VA in the next few years and beyond. The characteristics of the women veteran population and subpopulations (e.g., by period of service or era, among racial-ethnic minorities, education, marital status) are changing as well, requiring ongoing research to support our strategic planning and readiness in the face of their long-term preventive, reproductive, chronic