Evidence-based Options Research Articles

Evaluation of an online SBIRT training program

ABSTRACT Background: While human ecosystem disruptions have happened in the past, the COVID-19 pandemic is the first situation to warrant such a large, world-wide transition to online education. The pandemic has increased the need for intervention with people in varying stages of substance use disorders. Objectives: In response to the need for more evidence-based, online educational and training options to address this need, this study used pre-posttest evaluations to determine the efficacy of an online training for a specific evidence-based intervention, Screening, Brief Intervention, and Referral to Services (SBIRT). Methods: Social Work students from two universities completed a 4-hour, online training in SBIRT which included a pre/posttest, demographic variables, a satisfaction scale, and a measure of self-efficacy. Mixed Effects Linear regression was used to model the repeated measures of SBIRT knowledge and efficacy, while a linear regression model was used to measure the relationship between satisfaction and participant characteristics. Results: Participants were mostly female (85.9%), mostly White/Caucasian (72.9%), and most already had a bachelor’s degree (50%) or higher (9.6%). Individuals who were White, non-Hispanic/Latinx, or had master’s level or doctoral level mental health training were more likely to have higher SBIRT scores. Those with the highest levels of self-efficacy had the lowest change scores on the knowledge test. Overall, there was an almost threefold increase in SBIRT knowledge posttraining, indicating the viability of this training format, which is similar to findings from studies of in-person trainings of SBIRT which also found increases in SBIRT knowledge. Conclusion: Recommendations based on the results are provided to encourage improved student outcomes from this type of e-learning.

The Black Room

A simple parent request unveiled a startling revelation: The principal of Bridgforth Elementary School segregated students by race. Her attempt to establish a culturally responsive framework was met with an Office of Civil Rights (OCR) complaint of racial discrimination. This case will examine the principal’s rationale for creating the framework, the parental complaint, the school community response, and two evidence-based options for increasing student outcomes for African American students and other ethnic minorities.

Women in Health and their Economic, Equity and Livelihood statuses during Emergency Preparedness and Response (WHEELER) protocol: a mixed methods study in Kenya

IntroductionKenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods...

A Unique Spectrum of Care Tool Provides a Self-Regulated Learning Opportunity and Facilitates Client Communication

Providing only the most state-of-the-art, intensive, and expensive level of treatment available does not meet the needs of every pet owner and pet. To overcome this barrier, veterinarians are working to provide spectrum of care (SOC) options to pet owners. This teaching tip describes the creation of a Spectrum of Care Options Presentation and Explanation (SCOPE), a tool which can serve a variety of educational purposes and improve delivery of care across the spectrum of care. The SCOPE considers andragogy, evidence-based medicine and pet owner preferences related to communication as well as the cost of care. Using a SCOPE during oncology consultations led by an intern on an oncology service rotation demonstrated the utility of the SCOPE to identify evidence-based SOC options for pets with cancer, serve as a self-regulated learning experience for the participating intern and elicit pet owner, and pet contextual issues impacting the care plan. The SCOPE can used to promote the implementation of SOC in veterinary medicine. The SCOPE has flexibility and may be adapted for use in disciplines other than oncology and with a variety of learners such as veterinary students or in early career mentoring programs.

Implementation of an asynchronous general practitioner‑to‑specialist  eConsult service (eConsultant) in Australia

Background: With the rise in demand for specialist care across Australia, patients are experiencing excessive delays for specialist input, linked with subsequent deterioration in health. eConsultant is an outpatient substitution model which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving GPs remote access to specialist support for patient care within 3-business days. This study, the first to track implementation of an eConsultant service in Australia, identifies barriers and enablers to adoption prior to broader implementation. 
 Method: Our prospective mixed-methods observational study included semi-structured interviews with GPs and stakeholders to understand determinants of implementation. GPs send a Request-for-Advice (RFA) to the specialist and advise patients to schedule a timely follow-up appointment to discuss the eConsultant advice. Adoption (program enrolment/usage by GPs & GP practices) was assessed. 
 Results: The study is underway in 12 rural/remote and 10 urban general practices. To date, RFAs have been generated for 178 patients (mean age 59.5yrs, 63% rural, 37% urban). The GPs mean time to response by the eConsultant was 1.7 (SD 2.3) days and patients mean time to specialist input (initial GP to GP follow-up appointment) was 13.0 (SD 2.7) days (well below average waiting times for OPD appointments). Qualitative interviews conducted with 11 GPs and 4 stakeholders highlight the benefits of eConsultant to providing efficient/timely access to specialist support for GPs and their patients. 
 Conclusion: eConsultant is feasible in Australia with benefits to the health system of timely specialist support for patients without the cost of subsidised patient travel, face-to-face visits, and potentially preventable hospital admissions. eConsultant provides GPs with a reliable, auditable record of advice given by specialists, an opportunity for GP practice capacity building and more direct partnership with specialist colleagues. eConsultant offers a streamlined evidence-based option, implementable state-wide, to support patients and primary care providers.

ADDRESSING BARRIERS TO A FULL RANGE OF EVIDENCE-BASED OBESITY CARE FOR OLDER ADULTS: A GSA ROUNDTABLE DISCUSSION

Abstract Obesity is identified as a chronic disease by the American Medical Association and several professional societies such as the American College of Cardiology, the American Heart Association, The Obesity Society, and the American Gastroenterological Association. These organizations have all established clinical guidelines on caring for individuals with obesity and overweight. However, there is a critical lack of appropriate and individualized treatment strategies for older adults with obesity. To address this issue, in June 2023 The Gerontological Society of America (GSA) convened 15 multidisciplinary leaders in a roundtable discussion on Addressing Barriers to Accessing a Full Range of Evidence-Based Obesity Care Options by Older Adults. Roundtable participants identified how to overcome obesity/overweight perceptions, communicate appropriately with older adults about their body size, address cultural differences in obesity care, provide care in conjunction with common comorbidities that are faced by older adults, collaborate with an interprofessional team to care for older adults with obesity, overcome barriers to implementation of lifestyle changes including diet and exercise, incorporate medical and surgical interventions, and align needs of older adults with community resources. This poster will illustrate key findings from this roundtable discussion.

Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery.

Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.

Vestibular Migraine Pathophysiology and Treatment: a Narrative Review.

To review the diagnosis of vestibular migraine (VM) and update the clinician on the most recent developments in our understanding of its pathophysiology and treatment. Functional imaging studies have identified multiple regions of the brain with abnormal activity and connectivity in VM. There is evidence of abnormal sensory processing and integration in VM patients. Calcitonin gene-related peptide (CGRP) has also been found to play a role in trigeminal and vestibular nucleus pathways. Research into treatment modalities has identified several neuromodulation devices that may be effective in VM. There are a growing number of evidence-based preventive options for VM, including medications that target CGRP. VM is best understood as a sensory processing disorder. CGRP appears to play a role, and further research is needed to fully understand its effects. Treatment options are expanding, but there is still a need for more randomly controlled trials in this area.

The effect of an adapted Mindfulness-Based Stress Reduction program on mental health, maternal bonding and birth outcomes in psychosocially vulnerable pregnant women: a study protocol for a randomized controlled trial in a Danish hospital-based outpatient setting

BackgroundStress and mental disorders in pregnancy can adversely affect the developing fetus. Women with a preconception history of mental disorders or of psychosocial vulnerabilities are at increased risk of experiencing perinatal stress or mental health problems. Mindfulness-Based-Stress-Reduction (MBSR) is an acceptable intervention for pregnant women and has a growing evidence-base with meta-analyses consistently pointing to reductions in symptoms of stress, anxiety and depression. This study protocol aim to address the need for a wider array of evidence-based and non-pharmacological options during pregnancy to reduce stress and improve mental health in a psychosocially highly vulnerable group of women.MethodsPregnant women with a preconception history of mental disorders or psychosocial vulnerabilities (n = 240) will be recruited from an obstetric ambulatory clinic at Copenhagen University Hospital, Hvidovre, Denmark. Recruitment for the study began in March 2022 and will continue until the desired number of participants is reached. Consenting pregnant women will be randomized to one of two study arms, an adapted MBSR program as add on to usual care or usual care alone. The primary outcome is mental wellbeing at nine months post-randomization. Secondary and exploratory outcomes include stress, anxiety, depression, and maternal antenatal attachment, experience of childbirth, delivery and mode of delivery. Mindfulness and self-compassion are examined as possible mediators of the effect on outcomes.DiscussionTeaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to improve mental health and wellbeing during pregnancy, reduce stress and support the transition to parenthood. Mindfulness-Based Stress Reduction does not target a particular group, and results from the study is thus of potential relevance for pregnant women in general as a means of reducing stress and improving perinatal mental health and wellbeing.Trial registrationClinicalTrials.gov: NCT05300646. Registered March 29, 2022.

Barriers to accessing pain management services among veterans with bipolar disorder.

To identify barriers veterans with bipolar disorder face to accessing chronic pain management services within a Veterans Affairs (VA) health care system. Veterans (n = 15) with chronic pain and bipolar disorder and providers (n = 15) working within a mid-Atlantic VA health care system. Data were collected from August 2017-June 2018. Veteran interviews focused on their chronic pain experiences and treatment, including barriers that arose when trying to access pain management services. Provider interviews focused on whether they address chronic pain with veteran patients and, if so, what considerations arise when addressing pain in veterans with bipolar disorder and other serious mental illnesses. Veterans were at least 18 years old, had a confirmed bipolar disorder and chronic pain diagnosis, and engaged in outpatient care within the VA health care system. Clinicians provided direct care services to veterans within the same VA. Interviews lasted approximately 60 min and were transcribed and analyzed using a rapid analysis protocol. Four major themes emerged from veteran and provider interviews: siloed care (unintegrated and uncoordinated mental and physical health care), mental health primacy (prioritization of mental health symptoms at expense of physical health symptoms), lagging expectations (unfamiliarity with comprehensive evidence-based pain management options), and provider-patient communication concerns (inefficient communication about pain concerns and treatment options). Veterans with co-occurring pain and bipolar disorder face unique barriers that compromise equitable access to evidence-based pain treatment. Our findings suggest that educating providers about bipolar disorder and other serious mental illnesses and the benefit of effective non-pharmacological pain interventions for this group may improve care coordination and care quality and reduce access disparities.

Promotion of Possible Protective Methods for Farmers During Exposure to Pesticides (Diazinon): A Policy Summary

According to the estimates of the World Health Organization (WHO), more than three million poisonings with organophosphorus derivatives occur every year, and in the meantime, more than 250000 deaths will occur in the future. Globally, 30% of suicide cases occur with the use of organophosphorus derivatives. Organophosphorus toxins are widely used due to their stability and low cumulative effects on the ecosystem. Diazinon, as one of the organophosphates, is widely utilized in agriculture and veterinary medicine. This poison is highly toxic to humans and animals. As stated by various studies, stores of unauthorized supply of poisons and lack of proper monitoring of the permissible limit of poisons, as well as the sale of poisons without a prescription, farmers’ ignorance, and indiscriminate planting of crops that are not based on traditional agriculture, can be caused by various factors related to improper use. In addition, the excessive use of pesticides and agricultural poisons can cause short- and long-term effects on health. Enhancing the antioxidant capacity is an effective solution to weaken the toxic effects of diazinon. Garlic and garlic supplements are used in many countries for their blood lipid-lowering, anti-platelet effects, and beneficial blood circulation. Some garlic products seem to have liver-protective, immune-system-enhancing, and anticancer, chemical-preventive, and antioxidant activities. The anti-inflammatory and antioxidant effects of garlic oil have been shown in different tissues. In today’s world, an effective solution/ decision-making for such problems based on evidence is recommended by compiling a policy brief. Therefore, to demonstrate evidence-based policy options, taking into account the existing obstacles and opportunities, it seems necessary to use intervention strategies and planning to reduce the consumption of pesticides and increase the level of protection for farmers.

Machine Learning Applied to Cholesterol-Lowering Pharmacotherapy: Proof-of-Concept in High-Risk Patients Treated in Primary Care.

Objectives: Machine learning has potential to improve the management of lipid disorders. We explored the utility of machine learning in high-risk patients in primary care receiving cholesterol-lowering medications. Methods: Machine learning algorithms were created based on lipid management guidelines for England [National Institute for Health and Care Excellence (NICE) CG181] to reproduce the guidance with >95% accuracy. Natural language processing and therapy identification algorithms were applied to anonymized electronic records from six South London primary care general practices to extract medication information from free text fields. Results: Among a total of 48,226 adult patients, a subset of 5630 (mean ± standard deviation, age = 67 ± 13 years; male:female = 55:45) with a history of lipid-lowering therapy were identified. Additional major cardiometabolic comorbidities included type 2 diabetes in 13% (n = 724) and hypertension in 32% (n = 1791); all three risk factors were present in a further 28% (n = 1552). Of the 5630 patients, 4290 (76%) and 1349 (24%) were in primary and secondary cardiovascular disease prevention cohorts, respectively. Statin monotherapy was the most common current medication (82%, n = 4632). For patients receiving statin monotherapy, 71% (n = 3269) were on high-intensity therapy aligned with NICE guidance with rates being similar for the primary and secondary prevention cohorts. In the combined cohort, only 46% of patients who had been prescribed lipid-lowering therapy in the previous 12 months achieved the NICE treatment goal of >40% reduction in non-high-density lipoprotein cholesterol from baseline pretreatment levels. Based on the most recent data entry for patients not at goal the neural network recommended either increasing the dose of statin, adding complementary cholesterol-lowering medication, or obtaining an expert lipid opinion. Conclusions: Machine learning can be of value in (a) quantifying suboptimal lipid-lowering prescribing patterns, (b) identifying high-risk patients who could benefit from more intensive therapy, and (c) suggesting evidence-based therapeutic options.

Exploring Patients' Perspectives on Late Complications after Colorectal and Anal Cancer Treatment: A Qualitative Study.

Patients often experience late complications following treatment for colorectal and anal cancer. Although several measurement tools exist to classify the severity of these symptoms, little is known about how patients personally experience and adapt to these complications. This study aimed to investigate patients' experiences and coping strategies in relation to these symptoms. We conducted an explorative qualitative interview study to gather data. Our findings revealed two main categories: How patients react after treatment for colorectal and anal cancer, and Experienced symptoms. Additionally, we identified four sub-categories: the period after discharge, coping strategies, stool symptoms, and other symptoms. Patients commonly feel abandoned once their surgical and oncological treatments are completed. It is typical for patients to turn to the internet for guidance on managing late complications, despite being aware that evidence-based options are limited. Stool-related issues significantly impact patients' personal and professional lives, requiring constant preparedness for accidents, the use of diapers, and the need for extra clothing at all times. Furthermore, patients experience additional troublesome symptoms such as urinary incontinence, fatigue, pain, and sexual dysfunction, which further affect their daily lives. Patients experience multiple problems after colorectal cancer surgery, and this warrants more focused attention.

Managing side effects of contraception

All contraceptive methods can cause side effects, some of which may be beneficial. Women often discontinue or change their contraception due to recognised or perceived side effects of the method. Good contraceptive counselling should include discussion of side effects, and prepare women for what to expect. Many initial side effects may with lessen with time. Explanation and understanding of this can discourage early discontinuation of methods. The Faculty of Sexual and Reproductive Healthcare offers practical and evidence-based options for management of method side effects. Using proven management strategies, in a partnership with the woman, may increase acceptability of the method and reduce early discontinuation.

A self-guided Internet-based intervention for individuals with chronic pain and depressive symptoms: study protocol of a randomized controlled trial

BackgroundDespite the existence of evidence-based therapy options for the treatment of chronic pain and comorbid depressive symptoms (e.g., CBT), many individuals remain untreated. Treatment gaps result from a lack of specialists, patient fear of stigmatization, or patient immobility. Internet-based self-help interventions could serve as an anonymous and flexible alternative treatment option. In a pilot study, chronic pain patients with comorbid depressive symptoms who used a generic Internet-based depression program showed a significant reduction in depressive symptoms (but not pain symptoms) compared to a waitlist control group. Based on these findings, we developed the low-threshold, anonymous, and cost-free Internet-based self-help intervention Lenio that is tailored to the specific needs of chronic pain patients with comorbid depressive symptoms. Lenio is accompanied by the smartphone application (app) COGITO designed to increase therapeutic success. With Lenio and COGITO addressing both chronic pain and depressive symptoms, the trial aims to increase treatment effects of online interventions for chronic pain patients by reducing both depressive symptoms and pain.MethodsThe effectiveness of the Internet-based self-help intervention and accompanying smartphone app will be evaluated in a randomized controlled trial (RCT). A total of 300 participants will be randomized into an intervention group (Lenio/COGITO), an active control group (depression-focused smartphone app), or a waitlist control group. Assessments will be done at baseline, after an 8-week intervention period (post), and after 16 weeks (follow-up). The primary outcome is the post-assessment reduction in “pain impairment” (mean value of impairment in daily life, free time, and work) as assessed by the DSF (German pain questionnaire). Secondary outcomes will include the reduction in depressive symptoms as well as in the severity of pain. DiscussionLenio is one of the first Internet-based interventions to reduce chronic pain and depression that will be empirically evaluated. Internet-based interventions could offer a promising alternative to conventional face-to-face psychotherapy in the treatment of chronic pain patients. The primary objective of the current study is to add essential insight into the feasibility, effectiveness, and acceptance of Internet-based interventions for people with chronic pain and depressive symptoms. Trial registrationDRKS-ID DRKS00026722, Registered on October 6th, 2021.

Empowering Patients One App at a Time: An Introduction to Digital Therapeutics

The growth of digital health has led to more app-based solutions entering the market which aim to provide therapeutic outcomes for a variety of diseases. This column explores the emerging field of digital therapeutics (DTx) as evidence-based and FDA-cleared digital interventions – setting them apart from the majority of commercially available solutions. In an effort to identify high quality and evidence-based options, medical and health science librarians can benefit from recognizing the qualifications of DTx, types of available DTx, and use cases for their patrons.

Acupuncture Methods for Piriformis Syndrome: A Protocol for Systematic Review and Network Meta-Analysis.

Piriformis syndrome (PS) is a common disease that is difficult to clinically treat, which seriously affects people's health and living quality. Multiple clinical studies have demonstrated that acupuncture therapy is an effective treatment for PS, but the optimal method of various acupuncture methods has remained unknown. The aim of this study protocol is to compare the efficacy and the safety of different acupuncture methods for PS. We will search seven electronic bibliographic databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chongqing VIP Database) from inception to June 2023. Randomized controlled trials (RCTs) will be selected for assessing the effectiveness of acupuncture therapy on PS. Primary outcome measure for this study is pain intensity, and the secondary outcomes are clinical symptoms and signs, physical activity, effective rate, and adverse events. Study selection, data extraction, and risk of bias assessment will be independently completed by at least two reviewers. Then, standard pairwise meta-analysis and network meta-analysis will be conducted using Revman 5.3, Stata V.15.1 and OpenBUGS V.3.2.3. The heterogeneity will be explored by subgroup, meta-regression, and sensitivity analysis, if applicable. Finally, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) pro system will be used to evaluate the quality of evidence. Our systematic review and network meta-analysis will identify the best acupuncture treatment method for PS patients. The results of our review will help decision-makers make educated choices regarding evidence-based acupuncture management options for PS. No. CRD42022335028.

Policy options to facilitate cancer genomic variant data sharing: outcomes of a modified policy Delphi.

Sharing cancer gene variant and relevant clinical data could accelerate progress in cancer genomics. However, data sharing is currently impeded by issues related to financial sustainability, equity, incentives, privacy and security, and data quality. Evidence-based policy options to facilitate data sharing in these domains, and ultimately improve interpretation of cancer-associated genomic variants, are therefore needed. We conducted a modified policy Delphi with expert stakeholders that involved generating, evaluating, and ranking potential policy options to address these issues, with a focus on the US context. We found policy options in the financial sustainability domain were highly ranked, particularly stable funding for trusted entities. However, some Delphi panelists noted that the culture of public research funding has favored short-term grants. Panelists favored policy options focused on action by funders, which had the highest overall total scores that combined effectiveness and feasibility ratings and priority ranking within domains. Panelists also endorsed some policy options connected to actors such as journals, but they were more skeptical of policy options connected to legislative actors and data resources. These findings are critical inputs for policy makers as they consider policies to enable sharing of cancer gene variant data to improve health.

From "surviving to thriving": Mood Lifters - a wellness program for parents of medically complex children.

Parents of medically complex children juggle unique demands associated with caring for chronically ill children, many of which negatively impact their mental wellbeing. Despite this, parents of medically complex children often forgo mental health support due to concerns with costs, time, stigma, and accessibility. There is limited research on evidence-based interventions addressing such barriers for these caregivers. We piloted an adapted version of Mood Lifters, a peer-led wellness program, to equip parents of medically complex children with evidence-based strategies to manage their mental health while also reducing barriers to support. We hypothesized parents would find Mood Lifters to be feasible and acceptable. Further, parents would experience improvements in mental wellbeing upon program completion. We conducted a single-arm prospective pilot study to assess Mood Lifters for parents of medically complex children. Participants included 51 parents in the U.S. recruited from a local pediatric hospital providing care for their children. Caregiver mental wellbeing was assessed through validated questionnaires pre-intervention (T1) and post-intervention (T2). Repeated-measures analysis of variance was conducted to evaluate change between T1 and T2. Analyses from T1 and T2 (n=18) revealed improvements in parents' depression (F(1,17) =7.691, p=0.013) and anxiety (F(1,17)=6.431, p=0.021) after program completion. Improvements in perceived stress and positive and negative emotion were significant at p<0.0083. Parents of medically complex children experienced improved mental health upon participating in Mood Lifters. Results offer preliminary support for the feasibility and acceptability of Mood Lifters as an evidence-based care option that may also alleviate common barriers to care.

History of Cannabis Regulation and Medicinal Therapeutics: It's Complicated

The genus Cannabis has a complex history, with great variations in the genus itself, as well as in its current uses worldwide. Today, it is the most commonly used psychoactive substance, with 209 million users in 2020. The legalization of cannabis for medicinal or adult use is complex. From its origins as a therapeutic agent in 2800 bc China, to the current knowledge on cannabinoids and the cannabinoid system, to the complex status of cannabis regulation across continents—knowledge gained from the history of cannabis use can inform research on cannabis-based treatments for patients with medical conditions that remain challenging in 21st century medicine, warranting research and evidence-based policy options. Changes in cannabis-related policymaking, scientific advances, and perceptions may result in increasing patient inquiries about its medicinal usage, regardless of personal opinions, thus meriting education and training of clinicians. This commentary outlines the long history of cannabis use, its current therapeutic potential from a regulatory research perspective, and the continued challenges in research and regulation in the ever-changing era of modern cannabis use. It is crucial to understand the history and complexity of cannabis use as medicine to better understand its potential for clinical therapeutics and the effects of modern-day legalization on other health- and society-related issues.