ABSTRACT Purpose Community-based organizations (CBOs) are increasingly providing violence prevention programming and services. However, researchers have found that many of these organizations struggle to implement evidence-based practices or face administrative burdens of managing the grants that fund the organization. The current study sought to further explore facilitators and barriers of CBOs receiving state funding. Materials and Methods Participants included 29 individuals who led grant writing or implementation efforts at a CBO receiving at least one violence prevention grant from a large state agency. Online focus groups were held, and reflexive thematic analysis was conducted. Results We divided the major themes into two categories: facilitators and barriers. Facilitators included: 1) these grants were a financial lifeline for organizations providing violence prevention services, helping expand organizations’ capacity; and 2) grantees expressed satisfaction with the funder when there was clear and regular communication. Barriers included: 1) rigid application, reporting and budgeting requirements; 2) delays in reimbursement that hindered grants administration; and 3) an under-resourced state agency impacting the overall grant process. Grantees discussed the importance of and recommended fostering community and collaboration among violence prevention organizations. Discussion These results have implications for funders to consider when administering funds, supporting organizations, building community, and reporting requirements for violence prevention efforts. Recommendations for funders are provided, including streamlining budget requirements, providing training and technical assistance, and creating more opportunities for collaboration. Conclusion As more community-based organizations are funded to implement violence prevention services, funders need to review procedures to ensure equity throughout grant applications and implementation.

Navigating Ethical Disparities between Evidence-Based Practice and Advocacy Regarding Pediatric Gender Dysphoria Treatment.

To assess whether large language models (LLMs) with advanced reasoning and live web search (LWS) provide recommendations concordant with evidence-based clinical practice guidelines (CPGs) developed by the American Academy of Orthopaedic Surgeons (AAOS) for anterior cruciate ligament (ACL) and rotator cuff (RC) injury management. Recommendations from CPGs were extracted and developed into a total of 46 questions (n = 15 for ACL, n = 31 for RC). Four configurations were evaluated: GPT-5 Thinking, GPT-5 Thinking Deep Research, Gemini 2.5 Pro, Gemini 2.5 Pro Deep Research. Concordance with CPGs, the primary endpoint, was independently evaluated by two orthopaedic surgeons. Citation integrity, the secondary endpoint, was evaluated against four criteria: 1-relevance, ensuring the citation was congruent with the response; 2-accuracy, confirming the citation metadata were correct; 3-existence, to rule out hallucinations; and 4-source quality, ensuring the cited source is from a peer-reviewed journal. Blinding was performed by a third investigator, by anonymously randomising the order of LLM-generated responses for each CPG recommendation. All LLMs answered ACL questions concordantly (100% [15/15]; 95% confidence interval [CI]: 78.2%-100%). For RC questions, GPT-5 Thinking and Gemini 2.5 Pro Deep Research each had one discordant answer (96.8% [30/31]; 95% CI: 83.3%-99.9%), whereas the other two configurations were fully concordant (100% [31/31]; 95% CI: 88.7%-100%). GPT-5 Thinking achieved 96.8% (231/239; 95% CI: 93.6%-98.6%) citation integrity, improving to 100% (176/176; 95% CI: 97.9%-100%) with Deep Research. Gemini 2.5 Pro showed substantially lower baseline performance (64.6% [173/268]; 95% CI: 58.5%-70.3%) but improved to 98.6% (274/278; 95% CI: 96.4%-99.6%) with Deep Research. Inter-rater agreement was perfect (κ = 1.0) across all domains, except for citation relevance, which maintained strong agreement (κ = 0.88). Contemporary LLMs with agentic capabilities can deliver clinically aligned answers concordant with CPGs on ACL and RC injuries, recovering from previous hallucinations. Built-in LWS functions are particularly helpful in ensuring citation reliability. Although expert oversight remains imperative, Deep Research allows LLMs to be considered as a first-pass clinical reasoning companion. NA.

Small-intestinal bacterial overgrowth (SIBO) is defined by an excessive microbial presence in the small intestine and is associated with a range of gastrointestinal symptoms. Its management remains complex due to diagnostic limitations and high recurrence rates following treatment. A narrative review was conducted using MEDLINE (PubMed) and Cochrane databases to identify relevant studies published between 1984 and 2024. Search terms included small intestinal bacterial overgrowth SIBO, FODMAP, probiotics, prebiotics, synbiotics, and low-carbohydrate diets. Reference lists were also screened for additional studies. Antibiotics, particularly rifaximin, are commonly used for SIBO treatment but recurrence is frequent. Dietary strategies, such as low-FODMAP and low-carbohydrate diets, may help reduce symptoms, especially in patients with complications like D-lactic acidosis. Evidence for biotic agents (probiotics, prebiotics, synbiotics) is mixed, with limited high-quality studies and inconsistent outcomes. Some probiotic strains show symptom improvement, but effects on breath-test results are variable. A tailored, multidisciplinary approach combining dietary and medical therapies may offer optimal symptom control in SIBO. However, heterogeneity in study designs and limited evidence highlight the need for further research to inform standardised, evidence-based clinical practice.

Clinical champions are often engaged to implement new evidence-based practices in health care settings. Previous research suggests that the mere presence of a champion does not guarantee successful implementation; therefore, we aimed to identify specific champion attributes and site-level factors that contribute to evidence-based practice adoption. During a Department of Veterans Affairs (VA) quality improvement program, we engaged site champions to implement an advance care planning evidence-based practice with seriously ill Veterans in VA home based primary care (HBPC) and community nursing homes (CNHs). We conducted interviews (N = 99) with champions and leadership at 11 HBPC programs and 6 VA CNH programs. Guided by the Tailored Implementation in Chronic Diseases (TICD) framework and Shea's conceptual model of champion impact, we analyzed interview data to examine champion characteristics and site factors associated with successful adoption of the evidence-based practice. Additionally, we categorized sites as successful or not successful in terms of adopting the evidence-based practice and compared champion characteristics and site factors between these sites using a Matrixed Multiple Case Study approach. Eight HBPC programs (73%) and four CNH programs (67%) were successful. Champions at successful sites believed in the importance of eliciting and documenting Veterans goals of care, were motivated and committed to participating in the project, and were dedicated to serving as champions. Successful sites had champions who engaged in champion activities beyond attending coaching calls, including supporting and educating peers. The degree of leadership support, as well as the relative priority of the project varied; unsuccessful sites mentioned competing priorities and lower levels of leadership engagement. Results suggest that champion belief in the importance of the evidence-based practice, commitment to the program, motivation to serve as a champion, and engagement with peers are characteristics common among champions at sites that successfully adopted the evidence-based practice. At the site-level, the degree of leadership engagement and the priority of implementing the evidence-based practice emerged as factors influencing success. These findings can assist future healthcare interventions and programs in identifying clinical champions for implementing evidence-based practices.

Depressive and anxiety disorders often co-occur with insomnia, creating complex treatment challenges. Although clinical guidelines recommend psychotherapy as first-line treatment for these comorbid conditions, limited access to psychological services in primary healthcare facilities in China often leads to heavy reliance on pharmacological therapy. To the appropriateness of psychotropic medications for patients with insomnia comorbid with depressive or anxiety disorders at primary healthcare facilities in China. This cross-sectional study included patients with documented diagnoses of insomnia comorbid depressive or anxiety disorders in 2022 at all 67 primary healthcare facilities in Dongcheng District, Beijing, China. The primary outcome was the prescribing rate of guideline-recommended psychotropic medications. Among 842 patients with insomnia and depressive disorders and 1014 patients with insomnia and anxiety disorders, over 90% received psychotropic medications. Benzodiazepines were the most frequently prescribed classes (55.9 and 69.6%), followed by non-benzodiazepine hypnotics (42.5 and 42.4%), whereas medications recommended by the guideline, including antidepressants with sedative effects, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, were used infrequently. Only 29.9% of patients with insomnia and depressive disorders and 11.5% of those with insomnia and anxiety disorders received guideline-recommended pharmacotherapy, with lower concordance among older adults. Guideline-recommended pharmacotherapy for insomnia comorbid with depressive or anxiety disorders was rarely implemented at primary care in China. This highlights the need to facilitate evidence-based practices and improve management of comorbid mental health conditions, particularly for older adults.

The study examined the moderating effect of reflective action team learning practices on the association between team psychological safety and knowledge acquisition and creation in teaching hospitals. The study population comprised trainees and health professional staff teams. Using a cross-sectional survey design and sampling frame of teaching hospitals, a sample of 132 respondents was selected. Statistical Package for Social Scientists (SPSS) with a PROCESS macro procedure by Hayes was used for data analysis. Results indicated that reflective action team learning moderates the relationship between team psychological safety and knowledge acquisition. There was a statistically significant regression of team psychological safety and knowledge creation. The interaction effect between team psychological safety and reflective action team learning was significant. Thus, nurturing reflection-in-action team learning practice has high ramifications for knowledge acquisition and creation, which are prerequisites for clinical evidence-based practices

Optimizing bridging radiotherapy prior to CAR-T cell therapy: An evidence-based approach.

Doctorally prepared nurses bring different experiences and expertise depending on whether they have a PhD or DNP. The Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health called for greater collaboration between the two. This article describes a collaborative effort using DNP and PhD nurse leaders at a comprehensive cancer center. The organization intentionally combined leaders from two strong departments-research and evidence-based practice-to support a professional governance council. With this change in structure, DNP and PhD professionals were able to collaboratively conduct a research study, drawing on their respective areas of expertise. The collaboration between the DNP and PhD professionals enhanced the knowledge and understanding of the research and evidence-based practice processes in the professional governance council.

Ankylosing spondylitis (AS) is a progressive form of spondyloarthritis involving inflammation of the spine, accompanied by deficits in occupational performance. Although occupational therapy (OT) for AS is not as widely documented as in other professions, studies have examined the benefits of OT on pain, function, and disability among AS patients. This review explored assessments and interventions used by OT practitioners working with AS clients, impairments addressed, and settings of practice. Eight databases and gray literature were searched in April 2024. A total of 17 records were included. The only standardized assessment tool implemented was the Canadian Occupational Performance Measure (COPM). The most common interventions were joint or spinal protection strategies and adaptive equipment training, followed by ADL or functional training. Although findings suggest that OT practitioners support people with AS in many health care settings, there is still limited research, and additional studies are needed to best guide evidence-based practice.

Introduction Type 2 diabetes mellitus (T2DM) represents a global public health problem. In Ecuador, it is the second leading cause of death among women and the third among men. Digital health technologies, including mobile applications, messaging platforms, and web-based tools, have emerged as promising interventions for managing this condition, although a gap remains between their theoretical potential and their effective implementation in clinical practice. Objective To explore and synthesize the available evidence on the experiences, perceptions, barriers, and facilitators reported by adult users with type 2 diabetes mellitus regarding the use of digital health technologies for managing their disease in community or outpatient settings. Methodology An integrative systematic review of literature published between 2015 and 2025 was conducted in PubMed, Scopus, and Google Scholar. Qualitative, quantitative, and mixed-methods studies in English and Spanish involving adults using mobile applications for T2DM were included. Methodological quality was assessed using the Johns Hopkins Evidence-Based Practice model. Results A total of 66 studies were analyzed, with qualitative designs predominating (n=28), followed by randomized clinical trials (n=13) and experimental studies (n=14). Most studies were rated as high (n=35) or good quality (n=28). Experiences were grouped into three categories: positive (usefulness, satisfaction, empowerment, educational support), conditioning factors (individual, contextual, and design-related), and barriers (technological, usability, personal). Perceptions focused on usefulness, usability, and impact on self-care. Facilitators included simple design, personalization, professional support, cultural adequacy, and motivation. Conclusions Digital health technologies promote self-management and glycemic control, although barriers persist that limit their sustained adoption. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251241989.

Heparin has been the preferred locking solution for many organizations for totally implanted vascular access devices (TIVADs). Published data are limited on the use of normal saline alone as a locking solution for TIVAD 90-day maintenance flushing. The purpose of this evidence-based practice initiative was to determine whether locking TIVADs with normal saline alone during a 90-day maintenance flushing protocol resulted in an increase in partial occlusions. A clinical team monitored alteplase administration to measure partial occlusions. Prior to heparin deimplementation, nurses maintained TIVADs using 500 units of heparin upon de-access. Infusion nurses received education about published data, pulsatile flushing, and clamping sequences prior to device deimplementation. Encounters (N = 2,908) during six months of heparin locking were compared to encounters (N = 3,239) during six months of normal saline locking. Data demonstrated minimal variance between locking with normal saline compared to heparin.

Hyponatraemia remains the most prevalent electrolyte disturbance in heart failure, complicating clinical management and correlating with adverse outcomes. While traditionally viewed as a biomarker of disease severity, mounting evidence suggests that hyponatraemia reflects specific pathophysiological mechanisms that demand targeted intervention alongside standard decongestion strategies. This mini review synthesises contemporary evidence to provide clinicians with an updated, mechanistically grounded approach to hyponatraemia in heart failure. We emphasise the critical distinction between dilutional hypervolaemic states driven by arginine vasopressin dysregulation and depletional hypovolaemic states arising from aggressive diuresis or sodium losses. Recent trials challenge longstanding practices: fluid restriction in stable chronic heart failure shows no quality-of-life benefit despite guideline recommendations, whilst emerging biomarkers such as early urine chloride offer promise in identifying diuretic resistance. We critically appraise the role of vasopressin antagonists, which correct sodium biochemically but lack mortality benefit, and explore oral urea as a pragmatic alternative supported by recent observational data. For acute severe presentations, we detail hypertonic saline protocols with strict correction limits and discuss proactive desmopressin strategies to prevent osmotic demyelination. Important knowledge gaps persist, including optimal diagnostic algorithms in diuretic-exposed patients, patient-centred outcome data for sodium-correcting therapies, and validation of safe-correction protocols. Overall, this review equips clinicians to integrate mechanistic understanding with evidence-based practice whilst identifying priorities for future investigation.

Background/Aims Research can enable understanding birthing people's health and wellbeing. When research findings are translated into practice, they can reduce maternal and neonatal morbidity and mortality. Midwives can play a critical role in using and adding to the evidence base; thus, midwifery education should support students in developing research skills they can use in the future. This literature review aimed to explore students’ engagement with research and evidence-based practice. Methods Nine databases were searched to find evidence applicable to the review's aim. The identified relevant literature, published between 2009 and 2024, was synthesised into relevant themes. Results Learning about research using pedagogical approaches resulted in students planning to engage with research and practice in an evidence-based way in the future. However, barriers affected students’ ability to apply research and evidence-based practice knowledge to their clinical practice. Conclusions Learning about research/evidence-based practice results in planned future engagement with these elements. However, educational, clinical and psychological barriers create a practice–theory gap, hindering students from applying their knowledge to their practice. Implications for practice To enhance students’ engagement with evidence-based and research-informed learning, clinical and academic educators should systematically address educational, clinical and psychological barriers, thereby reducing the practice–theory gap that inhibits the effective translation of research evidence into clinical practice.

The Red Carpet Entry (RCE) program is an evidence-informed structural intervention to improve linkage to HIV care within 72h of diagnosis. In this paper, we review a rigorous, novel approach for evaluating an implementation toolkit to support adoption and effective implementation of RCE. We fielded and evaluated an RCE implementation toolkit at two clinic sites over an 8-month period. We evaluated the toolkit by assessing implementation processes, contexts, and outcomes at each clinic site, and by surveying and interviewing key implementation staff (n = 9) to solicit their feedback on the toolkit routinely throughout program implementation. This study offers preliminary evidence that the toolkit can support effective implementation of RCE and bolsters evidence regarding the impact of RCE on linkage to care. Both clinics used the toolkit to implement the RCE program with a high degree of fidelity-clients received 85-100% of intended RCE services at the clinic sites. Moreover, as a result of implementing RCE, one site saw an improvement in linkage to care from 68% at baseline to 77% during the implementation period. Staff reported that toolkit components were well-designed for communicating key information but needed to be more succinct and easier to navigate to increase their utility for busy clinic staff. We refined the toolkit to incorporate key lessons learned from our evaluation. Toolkits, especially those that have been tested with program implementers and are informed by evidence regarding implementation and client outcomes, are a critical tool for supporting the integration of evidence-based practices into routine healthcare.

Clinical champions are a known strategy for implementing evidence-based practices; however, their application in de-implementing potentially inappropriate medications (PIMs) among persons with dementia is underexplored. We conducted a pragmatic cluster-randomized clinical trial of a champion-led deprescribing intervention in accountable care organization (ACO) primary care settings. To (1) understand clinical champions' perspectives of their deprescribing projects and (2) identify key contextual factors that influenced champions' deprescribing PIMs for persons with dementia within ACO primary care. A qualitative study guided by the de-implementation outcomes framework. Clinician champions who engaged in deprescribing projects. Data sources included transcripts from monthly learning calls and semi-structured interviews. All champions were invited to participate in learning calls and semi-structured interviews. The 30- to 60-min interviews were conducted using a semi-structured guide. We coded transcripts and performed thematic analysis to identify overarching themes. Eleven champions participated. Feasibility and fidelity of deprescribing were commonly undermined by external and organizational disruptions. Five contextual factors influenced champions' experiences: limited organizational readiness, lack of information technology infrastructure to support data access and patient identification, the importance of relationship-building and care coordination, the dyadic nature of deprescribing involving care partners, and the pharmacist's role as a multidisciplinary liaison. Champions employed adaptive, communication- and relationship-centered strategies to support deprescribing efforts. Champion-led deprescribing for persons with dementia is shaped by key contextual factors within ACO primary care settings. Dementia-specific training helped clinicians tailor deprescribing to local needs, but sustained efforts require supportive organizational structures, including ongoing education, accessible clinical data, and multidisciplinary collaboration. Primary care clinicians are uniquely positioned to lead personalized deprescribing conversations while pharmacists serve as liaisons with providers, patients, and care partners to coordinate deprescribing. Interventions that align with value-based care principles may strengthen system-level coordination and promote safer medication management in dementia care. ClinicalTrials.gov ID: NCT05359679.

Although research and evidence-based practice are widely regarded as foundational to high quality patient care, little is known about the evidence-based practice and research competencies of ambulatory care nurses. The aim of this study was to measure the self-perceived evidence-based practice and research competencies and learning needs of ambulatory care nurses. In 2024, a national sample of 2790 ambulatory care nurses participated in an online cross-sectional structured survey measuring evidence-based practice and research competencies. Respondents rated their competency using the EBP Capability Beliefs Scale and the Application of Knowledge and Skills subscale from the Research Competencies Assessment Instrument for Nurses (RCAIN). Results were compared across practice settings, job roles, and subspecialties. Higher education levels correlated with higher scores in both evidence-based practice and research competencies. After controlling for education level, nurses from specialty or procedural areas scored higher in evidence-based practice competencies than nurses from all other work environments. Direct care nurses scored lower than nurses in all other roles in research competencies. Statistically significant correlations were also found between evidence-based practice competencies and the type of organization where a nurse worked. Findings indicate EBP and research competencies must be increased among ambulatory care nurses. Leadership support and resource allocation are critical for EBP development. Among ambulatory care nurses, those in direct care roles may have the greatest opportunities to develop EBP and research competencies. Nurses with limited exposure to EBP and research should be encouraged to engage in professional development activities on these topics. Education and EBP mentorship for ambulatory care nurses should be tailored to the ambulatory care environment where possible, to make it relatable to learners.

Healthcare facility volume and evidence-based practice implementation in surgical care of patients with common cancers.

Nurse educators are critical in advancing evidence-based practice (EBP) in academic and clinical settings. However, limited research exists on how doctoral education influences their EBP beliefs and implementation behaviors. This study evaluated changes in EBP beliefs and implementation among Doctor of Nursing Education (DNE) students over time. Using a pre/post single-group design, surveys were administered during the first-year EBP course and again during the second-year Capstone course. Instruments included the EBP Beliefs and EBP Implementation Scales for Educators. Thirteen DNE students participated; 11 completed both surveys. Belief scores significantly improved ( M 83.5-97.5; P =.004; g =1.6), as did implementation scores ( M 17.5-42.4; P =.004; g =1.7). The findings of this study suggest that the DNE curriculum effectively strengthens educators' EBP beliefs and implementation. The longitudinal assessment demonstrated meaningful gains in applying evidence-based teaching strategies.

Evidence-based practice (EBP) is widely endorsed as a cornerstone for high-quality, patient-centered care. However, its integration into daily clinical routines remains inconsistent, particularly in settings where cultural, educational, and organizational challenges persist. Reliable, contextually adapted tools are essential to measure EBP implementation and guide improvement efforts. This study aimed to validate the Italian versions of the EBP Implementation Scale and its short-form (3-item) version. A cross-sectional survey design was adopted. Both versions of the EBP Implementation Scale were translated and culturally adapted in accordance with internationally recognized guidelines. Data were gathered from a national sample of 405 nurses through a combination of convenience and snowball sampling. Psychometric assessment encompassed confirmatory and Bayesian factor analyses, evaluation of internal consistency and test-retest reliability, and measurement invariance testing. All analyses were performed in R Studio. Confirmatory factor analyses confirmed that both versions (long and short) of the scale measure a single underlying construct. The instruments demonstrated high reliability (ω = 0.96 and 0.87 respectively). Measurement invariance across educational groups was partially established, as the partial scalar invariance model demonstrated acceptable fit (CFI = 0.991, RMSEA = 0.045), suggesting consistent interpretation of the scale across different levels of EBP training. Latent profile analysis revealed distinct subgroups of EBP implementers, with notable differences in latent means (p < 0.001) associated with previous education in evidence-based practice. The Italian EBP Implementation Scales are valid and reliable tools for assessing EBP implementation behaviors. They can support education planning, monitor practice changes over time, and inform interventions aimed at enhancing evidence-based care.