Evidence-based Treatment Practices Research Articles

Intra-articular knee injections in patients with primary osteoarthritis in a tertiary clinical setting: a best practice implementation project.

This project aimed to improve physicians' adherence to evidence-based practices regarding the selection and administration of intra-articular knee injections for patients with osteoarthritis. The project also aimed to empower patients by increasing their awareness of these evidence-based practices. In the management of knee osteoarthritis, intra-articular injections are commonly used when initial treatments prove inadequate. However, issues such as patients' demand for rapid relief and variability in physicians' familiarity with optimal practices often lead to suboptimal treatment decisions and potential adverse outcomes. This project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Initially, physicians were surveyed on the topic under consideration, and hospital records were reviewed. Subsequently, targeted interventions were implemented, including briefings and the distribution of informative flyers. The baseline audit indicated low adherence with all audit criteria. Various parameters, such as adherence to best clinical practices, informed decision-making by patients, and the recommendation of alternative treatment modalities, were significantly lacking. Following the interventions, substantial improvements were observed, including higher rates of adherence to best clinical practices by physicians for multiple criteria, such as stepwise referral to conservative therapy options and the content of intra-articular injections. Adherence to best clinical practices can be improved through educational briefings for physicians on the most current evidence-based treatment practices for injectable substances in knee osteoarthritis. The active engagement of patients, facilitated by informative flyers and physician assistance, contributed to better involvement in their treatment choices. However, the participation of health care institutions and providers as well as lifelong education practices may be necessary for more comprehensive and sustainable changes. http://links.lww.com/IJEBH/A277.

Cardiorespiratory fitness and working memory in persons with traumatic brain injury: a cross-sectional analysis

ABSTRACT Introduction Cognitive impairment is a highly impactful consequence of traumatic brain injury (TBI) and there are limited evidence-based treatment practices to combat these impairments. Evidence from other populations suggest that aerobic exercise training (AET) is beneficial for a variety of cognitive deficits, but the research in persons with TBI to date is equivocal. One potential reason is the heterogeneity of exercise prescriptions and outcome measures. This stems from the fact that studies have not been designed based on previous data supporting a specific AET prescription to target a cognitive domain. The primary purpose of this cross-sectional analysis was to examine the relationship between cardiorespiratory fitness (CRF), as a cross-sectional surrogate of AET, and cognition in persons with TBI to inform future research. Methods Cross-sectional analysis was conducted on baseline data of persons with TBI who completed neuropsychological assessments to evaluate several cognitive domains and a cardiopulmonary exercise test (CPET) to measure CRF. Based on the normal distribution of an outcome, Pearson’s r or Spearman’s ρ was calculated to measure the relationship between CRF and cognition. Results Data were analyzed for all participants who demonstrated valid CPETs (n = 21 of 29). Based on the cycle ergometer-based norms of CRF, males in this sample were in the 69th percentile and females in this sample were in the 56th percentile, with high variability across individuals. Higher CRF, as measured by peak power output (Wpeak), was significantly associated with greater working memory (ρ = 0.465, p = 0.017), even after post-hoc corrections. Conclusions These data suggest average and highly variable CRF in persons with TBI of all severity and support cycle ergometry-based CPET testing in this population. Further, these data provide support for future research applying AET to target working memory and possibly other executive functions in persons with TBI. This research is a small step toward large-scale randomized controlled trials that can directly impact clinical care to treat cognitive symptoms post-TBI.

Voluntary Neonatal Medication Incident Reporting—A Single Centre Retrospective Analysis

Background: Medication errors in neonatal intensive care units (NICUs) are prevalent, with dosage and prescription errors being the most common. Aims: To identify the common medication errors reported over twelve years using a voluntary, nonanonymous incident reporting system (RiskMan clinical incident reporting information system) at an Australian tertiary NICU. Methods: This was a single-centre cohort study conducted at a tertiary NICU. All medication-related incidents (errors) reported prospectively through the RiskMan online voluntary reporting database from January 2010 to December 2021 were included. The medication incidents were grouped into administration, prescription, pharmacy-related, and others, which included the remaining uncommon incidents. Results: Over the study period, 583 medication errors were reported, including administration-related (41.3%), prescription-related (24.5%), pharmacy-related (10.1%), and other errors (24%). Most incidents were reported by nursing and midwifery staff (77%) and pharmacists (17.5%). Most outcomes were minor or insignificant (98%), with only a few resulting in major or significant harm. There was one extreme incident that may have contributed to the death of a neonate and nine moderate incidents. Conclusions: Our results demonstrate that medication errors are common and highlight the need to support improvement initiatives and implement existing evidence-based interventions in routine practice to minimise medication errors in the NICU.

Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review.

Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary. To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy. PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science. We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis. Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups). We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.

Survive or suffer: sustainability of addiction care curriculum/training in South African Universities

ABSTRACT South Africa is grappling with a significant challenge of high harmful substance use rates, a shortage of addiction care professionals, and an expanding treatment gap. In response, the Department of the Premier initiated a project in 2010 to revamp its approach to substance use treatment in the Western Cape. This endeavor led to the establishment of a postgraduate diploma in addictions (PGDIP) in collaboration with the Universities of Cape Town and Stellenbosch. The PGDIP aimed to enhance the expertise of healthcare professionals in evidence-based practices for substance use prevention and treatment. Despite the initial success of the program in upskilling professionals and improving addiction care quality, financial constraints threaten its continuity, hindering the upskilling of the addiction treatment workforce. The cessation of bursaries and the self-funding requirements pose challenges to training professionals in evidence-based approaches. The growing prevalence of substance use disorders in South Africa underscores the urgency of investing in addiction specialists to address the escalating demand for treatment services and the complex needs of individuals struggling with addiction. To avert a potential public health crisis, it is imperative for the country to prioritize the training of addiction practitioners and ensure standardized academic training to professionalize the addiction workforce.

Case report on Bipolar Affective Disorder with Manic Episodes and Chronic Myeloid Leukemia

Bipolar affective disorder (bipolar disorder) is a complex illness characterized by periods of severe mood disruption, including manic episodes. Treatment typically involves a combination of medications tailored to the individual's symptoms and needs. Here, we present the case report of a 45-year-old male farmer with bipolar affective disorder and comorbidities, including diabetes mellitus and chronic myeloid leukemia. The patient exhibited symptoms of mania, including irritability, decreased sleep, over talkativeness, delusions of grandiosity and perception, and psychomotor agitation. Treatment with Risperidone, Sodium Valproate, Haloperidol, Promethazine, and Lorazepam resulted in a 25% improvement in symptoms. Despite challenges posed by comorbid illness and past experiences, the patient showed improvement with adherence to medication. This case underscores the importance of tailored treatment approaches in managing bipolar affective disorder and highlights the need for further research to bridge the gap between evidence-based treatment and clinical practice.

The American Society of Addiction Medicine Clinical Practice Guideline Development Methodology.

The American Society of Addiction Medicine (ASAM) has published clinical practice guidelines (CPGs) since 2015. As ASAM's CPG work continues to develop, it maintains an organizational priority to establish rigorous standards for the trustworthy production of these important documents. In keeping with ASAM's mission to define and promote evidence-based best practices in addiction prevention, treatment, and recovery, ASAM has rigorously updated its CPG methodology to be in line with evolving international standards. The CPG Methodology and Oversight Subcommittee was formed to establish and publish a methodology for the development of ASAM CPGs and to develop an ASAM CPG strategic plan. This article provides a focused overview of the ASAM CPG methodology.

Trauma-Informed Research With Emerging Adult Survivors of Sexual Violence.

Health researchers have had increasing calls to include vulnerable populations in research to tailor inclusive evidence-based practice interventions. The inclusion of vulnerable populations in research is sensitive and complex. Sensitive topics such as dating and sexual violence are especially complex, with emerging adults the highest risk group for all forms of sexual violence and an especially hard-to-reach population for inclusion in research. Impacts of trauma, including physiological and psychological, complex needs of survivors, and potential for revictimization during interactions when participating in research must be considered. Researchers must be equipped with specialized, trauma-informed skills to safely and ethically conduct all aspects of research. Using the trauma-informed framework, the purpose of this paper is to discuss the complexities of conducting research with emerging adult survivors of sexual violence and to explore evidence-based approaches that can safely include this vulnerable population through the application of trauma-informed approaches. The use of evidence-based, trauma-informed research approaches tailored to engage this population in research can further help to develop effective interventions that are context-sensitive to emerging adults.

Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report

BackgroundSeveral studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting.MethodsReported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12–25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy.ResultsImplementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%).ConclusionsResults indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science.

Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study

BackgroundSustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada.MethodsFirst, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings.ResultsWe identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability.ConclusionThis research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.

Evidence-based Practice Interventions for Reducing Postoperative Pulmonary Complications: A Narrative Review.

Specific surgical procedures, such as upper abdominal and thoracic surgery, are connected to an increased predisposition of postoperative pulmonary complications (PPCs). The incidence of PPCs could vary approximately between 20-90% with upper abdominal surgery, which can be minimized by using treatment procedures that increase lung capacity and encourage inspiration. This review aims to examine the effectiveness of already existing evidence-based interventions that promote lung expansion, thereby preventing PPCs. We mainly focused on the existing evidence of preoperative education on the incentive spirometer, early mobilization, directed coughing, deep breathing exercises, chest physiotherapy, and inspiratory muscle training (IMT) to prevent PPCs. The literature search was limited to experimental, observational studies, systemic reviews, and articles published in the last 15 years, January 2007- Dec. 2022, in PubMed and Google Scholar. This initial search yielded a total of 5301 articles. All articles with titles not related to the topic were eliminated. 1050 records were screened, and the final review was conducted with 22 articles, including 13 randomized controlled trials (RCTs), four systemic reviews, one retrospective review, three observational studies, and one non-experimental study. Our review reveals mixed evidence for individual interventions, including but not limited to incentive spirometry, inspiratory muscle training, early mobilization, cough, deep breathing, etc. Some studies maintain that intervention is effective; others imply there is no substantial difference in the choice of intervention. The literature review concluded that patients who received multiple interventions showed significant improvement in pulmonary function postoperatively. However, definitive studies need to be conducted to solidify this conclusion.

Transdisciplinary assessment frame as leverage for integrated care

In patients with severe, complex, and long-lasting psychiatric problems, psychopathology becomes intrinsically intertwined with personality, biological, social, and existential well-being. Consequently, the share of experience of general well-being becomes more critical. Therefore, apart from standard evidence-based treatment, added guidelines and good practices concerning suicidality, lifestyle, family impact and resource, human custodial measures, collaboration with patients and their expertise, and spiritual and existential guidance, complement standard guidelines. Unfortunately, these extra guidelines are used only as an add-on with traditional treatments or separated in a recovery approach where treatment would no longer be the focus. Because of the lasting need for integrated and precision care in these patients, UPC Duffel Belgium started an integrated plan for precision care. The first step in this plan was the development of a three-level assessment frame, a 'general treatment' backbone as leverage for uniting the different specializations, and a frame in which all interdisciplinary and transdisciplinary activities find their place. The next step is the collaborative use of the system and implementation of the associated skills and attitudes for all participants.
 The first person-centered level is the individual psychotherapeutic level at which criteria for treatment indication are evaluated in an overview that prioritizes with the patients’ different problems, systematically organized in four axes. Axis I, of distant fixed factors of nature and nurture is associated with the latent intrapersonal or permanent contextual or cultural factors (Axis II). The outcome behavior Axis III shows problem behaviors as a flip side of their associated therapeutic goals, followed by Axis IV with direct behavior-triggering and factual temporary, environmental, and relational/contextual factors. This case conceptualization is feasibly visualized and translated into a short explanation and hope inspiring narrative with the patient. 
 The second interdisciplinary level is the team level, at which treatment criteria are evaluated in the context of the treatment history. The staff and the patient check ten points: identification of the patient, triggering events for admission, previous treatments with successes and failures, important influences of personality, contextual or cultural factors as far as conditional for the present treatment, preferences of the patient, short term risks, long term risks, treatment priorities, ultimate goal and deselected treatment targets, criteria for dismission and contextual points of attention. Experience experts coach patients, using these points as a guide, to emancipate these patients to equality and to informed negotiator in their treatment, thus obliging the teams to prepare for a transparent discussion. 
 The third transdisciplinary level is the hospital level which automatically and repeatedly evaluates the stay's effect by Routine Outcome Monitoring in all domains of functioning as in the International Classification of Functioning model (ICF). This model provides an overview of functioning, activity, and participation problems and resources and indicates the right places for engaging in transdisciplinary actions and collaboration beyond the restricted cure field of psychiatry. The functioning chart is a hinge that connects the psychopathology frame and the complementary positive health domains as both map on the same ICF scheme.

Evidence-based Practice Interventions for Reducing Postoperative Pulmonary Complications: A Narrative Review

Background: Specific surgical procedures, such as upper abdominal and thoracic surgery, are connected to an increased predisposition of postoperative pulmonary complications (PPCs). The incidence of PPCs could vary approximately between 20-90% with upper abdominal surgery, which can be minimized by using treatment procedures that increase lung capacity and encourage inspiration. This review aims to examine the effectiveness of already existing evidence-based interventions that promote lung expansion, thereby preventing PPCs. Method: We mainly focused on the existing evidence of preoperative education on the incentive spirometer, early mobilization, directed coughing, deep breathing exercises, chest physiotherapy, and inspiratory muscle training (IMT) to prevent PPCs. The literature search was limited to experimental, observational studies, systemic reviews, and articles published in the last 15 years, January 2007- Dec. 2022, in PubMed and Google Scholar. Result: This initial search yielded a total of 5301 articles. All articles with titles not related to the topic were eliminated. 1050 records were screened, and the final review was conducted with 22 articles, including 13 randomized controlled trials (RCTs), four systemic reviews, one retrospective review, three observational studies, and one non-experimental study. Our review reveals mixed evidence for individual interventions, including but not limited to incentive spirometry, inspiratory muscle training, early mobilization, cough, deep breathing, etc. Some studies maintain that intervention is effective; others imply there is no substantial difference in the choice of intervention. Conclusion: The literature review concluded that patients who received multiple interventions showed significant improvement in pulmonary function postoperatively. However, definitive studies need to be conducted to solidify this conclusion.

Randomized Controlled Trial of Clinical Guidelines Versus Interactive Decision-Support for Improving Medical Trainees' Confidence with Latent Tuberculosis Care.

In order to eliminate tuberculosis (TB) in the USA, primary care providers must take on an expanded role in the diagnosis and management of latent tuberculosis infection (LTBI). Clinical practice guidelines and recommendations exist for LTBI management, but there is a need for innovative tools to improve medical students' and residents' knowledge of evidence-based practices for LTBI testing and treatment. To assess the impact of LTBI-ASSIST, a free online decision support aid, as a novel educational tool and mechanism of delivering clinical practice guidelines for medical trainees. A single site, randomized controlled trial of trainees delivered by electronic survey. Medical students and Internal Medicine residents at the Johns Hopkins University School of Medicine. Participants were randomized in 1:1 ratio to receive the US clinical practice guidelines and recommendations for Latent TB management (control arm) or the guidelines plus an introduction to LTBI-ASSIST (LTBI-ASSIST arm) as they completed a case-based knowledge assessment and reported confidence with domains of LTBI care. (1) Proportion of questions answered correctly on a case-based knowledge assessment; (2) change in reported confidence with domains of LTBI care. One hundred and thirty participants completed the knowledge assessment. Those randomized to receive the LTBI-ASSIST Tool performed better on the case-based knowledge assessment with a mean score of 75.9% (95% CI: 70.6-81.1), compared to 57.4% (52.8-62.0) in the group that received the guidelines only (p <0.001). Similarly, the LTBI-ASSIST group reported a higher change in confidence (measured as post-assessment confidence minus pre-assessment confidence), compared to the control group, in six of the seven domains of LTBI care. LTBI-ASSIST can be an effective supplement to existing guidelines in educating medical trainees and helping providers find evidence-based, guideline-supported answers for questions encountered in clinical practice. NIH Clinical Trial Registry No. NCT05772065.

Barriers and facilitators to outcome measurement and treatment practices in aphasia rehabilitation in the USA: a mixed methods approach using the Theoretical Domains Framework

Purpose To identify clinician-perceived barriers and facilitators to the delivery of outcome measurement and evidence-based treatment practices and integration of these practices in aphasia rehabilitation. Materials and methods Using a convergent mixed methods design, aphasia clinicians (n = 87) across care settings in the United States completed an online survey designed within the Theoretical Domains Framework (TDF). Participants responded to open-ended questions and rated Likert scale statements. Qualitative data were analyzed using content analysis and quantitative data were summarized using descriptive statistics. Results Factors related to the TDF domain of “environmental context and resources” (priority and productivity demands; characteristics of resources) were cited as primary barriers in 70% of qualitative responses for both outcome and treatment practices and were consistent with Likert rating statements. Facilitators were associated with TDF domains of “memory, attention, decision-making” (decision-making processes), “knowledge” (awareness of evidence) and “social influences” (client and caregiver preferences). Conclusions Organizational-level factors and the misalignment of the research evidence with clinical needs are barriers to delivering evidence-based care in aphasia rehabilitation. Theoretically informed strategies such as establishing organizational infrastructure for practice change, developing clinically relevant evidence through research-practice partnerships, and implementing algorithms to support clinical decision-making can address barriers and leverage facilitators.

A qualitative study on the implementation of a transdiagnostic cognitive behavioral therapy for children in a child welfare residential treatment program

BackgroundYouth with severe emotional or behavioral issues who are involved with child welfare authorities are sometimes placed in intensive care services in a residential treatment program. Evidence-based psychotherapies are often used in residential treatments, but there is very little research on how to adapt psychotherapy for residential treatment. ObjectiveTo describe the implementation of a transdiagnostic cognitive behavioral therapy (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children) in a residential treatment program for children. Participants and settingStaff (n = 20) at a residential facility in Calgary, Canada. MethodsA combination of qualitative interviews and focus groups were conducted before and after therapy to identify barriers and facilitators to implementation. Data were analyzed and reported using the Consolidated Framework for Implementation Research and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies. ResultsModifications were made to the program including creating inclusive language, integrating relevant content targeting pediatric irritability, delivering sessions online for caregivers, and using additional staff to support youth to learn and practice the application of the content and behavioral interventions. Key barriers to implementation of the Unified Protocol included staff turnover and the difficulty of sustaining a critical mass of knowledge surrounding the Unified Protocol. The major facilitators to implementation were the perceived quality of the program and advantages of the program to children and their caregivers. ConclusionsThis study supports the feasibility and acceptability of providing transdiagnostic cognitive behavioral therapies for children in residential treatment and provides a template for how to implement evidence-based practice in residential treatment.

Implementation of Substance Use Services to Justice-Involved Youth: Examining Barriers, Facilitators, and Best Practices.

Justice-involved youth are known to be at elevated risk of substance use disorder (SUD). This review examines literature published over a 10-year period and summarizes evidence-based practices for screening, treatment, and linkage to care for justice-involved youth as well as barriers and facilitators that may arise during implementation. Strategies to incorporate a health equity lens and trauma-informed approaches are discussed. Despite high prevalence of substance use and research showing that treatment reduces recidivism, few juvenile justice systems universally screen and treat youth with SUD. There is limited developmentally appropriate guidance available for those seeking to better address substance use in juvenile justice settings. This review highlights gaps in the literature, which must be addressed to increase access to treatment and improve outcomes for this vulnerable youth population.

Treatment Patterns and Outcomes in U.S. Military Veterans Diagnosed With Chronic Lymphocytic Leukemia (CLL)

IntroductionU.S. veterans in the Veterans Affairs (VA) Healthcare System are managed in a national single-payer system with access to FDA-approved therapies. Prescribing patterns and outcomes of patients with CLL manage in the VA system are described. Patients and MethodsThis is a retrospective analysis of adult patients diagnosed with CLL managed in the VA from January 1999 through December 2020. First line treatment patterns are trended over 20 years. Factors associated with survival were analyzed in both untreated and treated patients. ResultsIn the final analysis, 16,331 patients with CLL were included. The median overall survival (OS) for the whole cohort was 8.7 years (95% confidence interval [CI], 8.6-8.9). The median OS from diagnosis was 8.9 years (95% CI, 8.6-9.2 in untreated patients with CLL. In treated patients, the median time to first line treatment was 1.9 years (range, 0-21 years), and the median OS from initiation of treatment was 5.0 years (95% CI, 4.8-5.2). First line treatments varied over time, consistent with FDA approval of targeted therapies. Exposure to targeted therapies as either first line or in subsequent lines of therapy was associated longer survival: median OS of 8.5 years (95% CI, 8.0-9.1) compared to 3.5 years (95% CI, 3.5-3.9) in patients who never received targeted therapy (P < .0001). ConclusionPatients treated in the VA have received therapies in line with current evidence-based treatment practices over the past 20 years. Treatment with targeted therapies is associated with longer median OS both in the first line and relapsed/refractory setting.

A Meta-Analysis of the Efficacy of Trigger Warnings, Content Warnings, and Content Notes

Trigger warnings, content warnings, or content notes are alerts about upcoming content that may contain themes related to past negative experiences. Advocates claim that warnings help people to emotionally prepare for or completely avoid distressing material. Critics argue that warnings both contribute to a culture of avoidance at odds with evidence-based treatment practices and instill fear about upcoming content. A body of psychological research has recently begun to empirically investigate these claims. We present the results of a meta-analysis of all empirical studies on the effects of these warnings. Overall, we found that warnings had no effect on affective responses to negative material or on educational outcomes. However, warnings reliably increased anticipatory affect. Findings on avoidance were mixed, suggesting either that warnings have no effect on engagement with material or that they increased engagement with negative material under specific circumstances. Limitations and implications for policy and therapeutic practice are discussed.

Social Work Students’ Knowledge and Attitudes Towards Therapeutic Yoga

Body-based interventions such as yoga are becoming increasingly common as evidence-based practices in social work and therapeutic treatment. However, yoga is rarely taught as a therapeutic practice in social work educational programs. This study examined social work students’ knowledge and interest in yoga as both a physical exercise and therapeutic approach. 213 social work students from two mid- to large- sized universities in a Midwest state completed a survey. The survey results showed that students are interested in participating in yoga as well as learning yoga as a therapeutic approach for their clinical practice. A few students noted concerns about cultural appropriation and using interventions to fit the individual client. Training in yoga as a therapeutic intervention could be added into existing social work programs to increase the ability of future social workers to provide this intervention to their clients.