Evidence-based Treatment Approaches Research Articles

Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework.

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a 'tailored blueprint' methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

Impact of Evidence-Based Functional Intervention Approach on an Individual with Wernicke’s Aphasia Based on International Classification of Functioning, Disability and Health Framework: A Case Study

Background Severe comprehension impairments in Wernicke’s aphasia (WA) are often seen to be associated with auditory related impairment and phonological processing, including semantic and executive difficulties. This study investigated whether an intensive functional approach regime underpins the improvement in speech, language and cognitive domains in an individual with WA resulting in a positive impact on functional communication skills and quality of life-based on international classification of functioning (ICF), disability and health framework. Aim To study the impact of evidence-based functional treatment approach on the speech, language, cognitive and quality of life (QoL) domains in a patient diagnosed with WA based on ICF Framework. Objective The purpose of this longitudinal case study was to compare before- and after-scores of speech and language abilities, cognitive abilities and QoL in a patient diagnosed with WA after providing an intensive evidence-based functional communication treatment approach. Material and Methods A case aged 60-years-old male with a one-month history of stroke; was diagnosed as WA. The patient received intensive functional treatment approach focusing on language and cognition for one hour continuously per session, for eight sessions, within 2-months which involved different therapy approaches to improve his communication abilities. The measurement of language, cognitive abilities and QoL was assessed using the English adaptation of the Western Aphasia Battery (WAB), Addenbrooke’s Cognitive Examination-Revised (ACE-R) and World Health Organization Quality of Life Instrument, Short Form ((WHOQoLBREF) respectively. The results obtained were analyzed based upon the scores obtained across the domains of WAB, ACE-R, and QoL in two stages i.e. pre- and post-intensive aphasia functional language intervention program. Results The outcome of the current study revealed improved scores in WAB, ACE-R, and WHOQoL which highlighted the fact that aphasia therapy techniques targeting the language and functional goals must be followed and implemented during the therapeutic sessions based on the client’s type of aphasia. Conclusion The findings of the case study suggests that the impact of functional communication approach targeting the maximum participation of the person with aphasia seems to be one of the most effective and efficient way to rehabilitate aphasics to improve their QoL.

Nutrition Concepts for the Treatment of Obesity in Adults.

Obesity caused by a positive energy balance is a serious health burden. Studies have shown that obesity is the major risk factor for many diseases like type 2 diabetes mellitus, coronary heart diseases, or various types of cancer. Therefore, the prevention and treatment of increased body weight are key. Different evidence-based treatment approaches considering weight history, body mass index (BMI) category, and co-morbidities are available: lifestyle intervention, formula diet, drugs, and bariatric surgery. For all treatment approaches, behaviour change techniques, reduction in energy intake, and increasing energy expenditure are required. Self-monitoring of diet and physical activity provides an effective behaviour change technique for weight management. Digital tools increase engagement rates for self-monitoring and have the potential to improve weight management. The objective of this narrative review is to summarize current available treatment approaches for obesity, to provide a selective overview of nutrition trends, and to give a scientific viewpoint for various nutrition concepts for weight loss.

Evaluation of Pharmacogenomics Testing of Cytochrome P450 Enzymes in the Military Health System From 2015 to 2020.

Pharmacogenomics (PGx) plays a fundamental role in personalized medicine, providing an evidence-based treatment approach centered on the relationship between genomic variations and their effect on drug metabolism. Cytochrome P450 (CYP450) enzymes are responsible for the metabolism of most clinically prescribed drugs and a major source of variability in drug pharmacokinetics and pharmacodynamics. To assess the prevalence of PGx testing within the Military Health System (MHS), testing of specific CYP450 enzymes was evaluated. Data were retrospectively obtained from the Military Health System Management Analysis and Reporting Tool (M2) database. Patient demographics were identified for each test, along with TRICARE status, military treatment facility, clinic, and National Provider Identifier. A total of 929 patients received 1,833 PGx tests, predominantly composed of active duty/guard service members (N = 460; 49.5%), with highest testing rates in the army (51.5%). An even distribution in testing was observed among gender, with the highest rates in Caucasians (41.7%). Of the CYP enzymes assessed, CYP2C19 and CYP2D6 accounted for 87.8% of all PGx CYP testing. The majority of patients were tested in psychiatry clinics (N = 496; 53.4%) and primary care clinics (N = 233; 25.1%), accounting for 56.4% and 24.8% of all tests, respectively. Testing was found to be provider driven, suggesting a lack of a standardized approach to PGx and its application in patient care within the MHS. We initially recommend targeted education and revising testing labels to be more uniform and informative. Long-term recommendations include establishing pharmacy-driven protocols and point-of-care PGx testing to optimize patient outcomes.

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder Objectives: Although dissociative phenomena belong to the diagnostic criteria of borderline personality disorder (BPD) and are of high clinical relevance, their predictive significance with regard to the treatment outcome has hardly been investigated. Because some therapeutic and experimental studies suggest that dissociation can impede emotional learning and thus adversely affect the response to psychotherapy, we examined this issue in patients with BPD. Methods: In this naturalistic psychotherapy study we assessed 342 patients with BPD at the beginning and end of inpatient dialectical behavioural therapy (DBT) with self-report measures for dissociation (Questionnaire on dissociative symptoms, FDS, as German version of the Dissociative Experiences Scale, DES) as well as general and borderline specific pathology (Brief Symptom Inventory, BSI; Borderline Symptom List, BSL) and quality of life (SF-12). Results: Both the general mental distress (BSI) and the borderline-specific pathology (BSL) as well as the psychosocial quality of life improved less in patients with initially severe dissociative symptoms than in those with less pronounced symptoms; this effect was mainly driven by the subscale derealisation of the Dissociative Experience Scale (DES), and was found particularly in women. Conclusion: Consistent with earlier findings, dissociative phenomena proved to be negative predictors of the therapeutic outcome in BPD women completing inpatient DBT. Whether this also applies to outpatient and other evidence-based treatment approaches for BPD remains to be clarified. Our results indicate the necessity to identify and treat dissociative symptoms as early as possible for a successful psychotherapy.

Changing the Paradigm of School-Based Physical Therapist Service Delivery: Using Evidence to Support Intensive Intervention.

The purpose of this article is to highlight the paradigm shift away from the typical model of direct service delivery of consistent frequency and duration in the school setting to accommodate an intensive progressive resistive exercise intervention. School-based physical therapists describe how they applied an evidence-based intensive intervention with multiple students in an urban public school district. The school-based physical therapists had to modify the typical service delivery model and overcome other challenges to implement this intensive intervention approach. Substantial improvements in strength and functional activities were observed in multiple students and measured across several months. An intensive intervention model appears effective and feasible in the school setting. Evidence-based intervention approaches should be considered when the student could benefit. For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A339.

Prevention Adaptation of an Evidence-Based Treatment for Parents Involved With Child Welfare Who Use Substances.

Background: Parental substance use, especially opioid misuse and/or methamphetamine use, is a key driver for recent increases in family involvement with child welfare and foster care placements in the United States. There is an urgent need for programs that prevent parental substance use disorders, yet few prevention programs exist that target parents’ unique needs and strengths. Adapting evidence-based treatment approaches for prevention might be an efficient, effective way to address this gap. The current study informed the rigorous adaptation of an evidence-based treatment that supports families involved with child welfare due to substance use, Families Actively Improving Relationships (FAIR), to a prevention-oriented intervention: “PRE-FAIR.” FAIR entails four treatment domains: substance use, parenting, mental health, and ancillary services (e.g., housing, medical care, and food). FAIR significantly improved parenting and reduced parental substance use in three rigorous treatment trials, but FAIR’s effectiveness in preventing the initiation or escalation of opioid misuse and/or methamphetamine use is untested. To inform adaptation, particular attention was paid to operationalizing strategies underlying a key hypothesized mediator of successful parent outcomes—engagement.Methods: Graduated FAIR parents (n = 9) and FAIR administrators, clinical supervisors, and clinicians (n = 11) participated in semi-structured interviews. Content analysis was used to identify key variables driving FAIR engagement and parent outcomes. Causal loop diagramming, a qualitative systems science method, was employed to operationalize emergent themes, and describe how causal links between key variables interrelated dynamically over time.Results: Themes reinforced the value of FAIR’s treatment domains for supporting parent’s sobriety and parenting skills within a prevention orientation. Ancillary supports and strong relationships were particularly crucial for helping parents cope with stressors leading to substance use. Five engagement strategies were identified as essential to parent success: 24/7 clinician availability, in-person clinician advocacy, in-home delivery, strengths-based interactions, and urinalysis. Implications for PRE-FAIR engagement strategies and dosage were identified.Discussion: Traditional qualitative analyses and qualitative analyses based in systems science can inform rigorous adaptations of evidence-based treatment programs for prevention. Future research will explore additional required, fidelity-consistent prevention adaptations to FAIR, and the impact of PRE-FAIR on parental substance use and child welfare case outcomes.

Management of Steroid-Refractory Graft-Versus-Host Disease - a Survey By the Transplant Complications Working Party of the EBMT

Management of Steroid-Refractory Graft-Versus-Host Disease - a Survey By the Transplant Complications Working Party of the EBMT

ADDRESSING CHILDHOOD MALTREATMENT: A PRACTICAL APPROACH FOR THE CHILD PSYCHIATRIST IN A CHANGING HEALTHCARE SYSTEM

Objectives: Childhood maltreatment is a pervasive problem with long-lasting and intergenerational consequences for both mental and physical health. Child and adolescent psychiatrists frequently evaluate youth who are experiencing the lasting effects of maltreatment and should be well-versed in the current recommendations for the assessment, evaluation, and treatment of maltreated children. Methods: Four presentations will examine various aspects of the medical and mental health evaluation of maltreated children and adolescents, evidence-based treatment approaches, and mechanisms of intergenerational transmission. Special consideration will be given to how COVID-19 has affected the experience of maltreated youth and how technology may support or create barriers in the evaluation and treatment of maltreated children and adolescents. Results: The first presentation will focus on approaches to the assessment and evaluation of child maltreatment. The second presentation will address the scope of practice of child abuse pediatrics, including the medical evaluation of suspected abuse, commonly observed injuries, and changes in reporting, prevalence, and evaluation methods that occurred thus far during the COVID-19 pandemic. The third presentation will discuss the evidence base and trauma-informed approaches for the application of psychotherapeutic and psychopharmacologic treatments in survivors of maltreatment. The final presentation will explore the role of the intergenerational transmission of childhood maltreatment on child behavioral and mental health outcomes and will discuss additional therapeutic interventions. Conclusions: Child abuse is a pervasive problem with significant physical and mental health morbidity. Despite the growing recognition of the lasting and intergenerational effects of childhood maltreatment, it is still underrecognized and underreported. The COVID-19 pandemic has influenced both the assessment and treatment of childhood maltreatment as encounters have shifted to virtual settings. It is vital for child and adolescent mental health providers to stay informed of structural changes and evidence-based advances in the diagnosis, protection, evaluation, and treatment of maltreated children. TRA, CAN, EBP

Epidemiology of cardiovascular disease in Europe.

This Review presents data describing the health burden of cardiovascular disease (CVD) within and across the WHO European Region. CVD remains the most common cause of death in the region. Deaths from CVD in those aged <70years, commonly referred to as premature, are a particular concern, with >60 million potential years of life lost to CVD in Europe annually. Although more women than men die from CVD, age-standardized rates of both morbidity and death are higher in men, and these differences in rates are greatest in individuals aged <70 years. Large inequalities in all measures of morbidity, treatment and mortality can be found between countries across the continent and must be a focus for improving health. Large differences also exist in the data available between countries. The development and implementation of evidence-based preventive and treatment approaches must be supported in all countries by consistent surveillance and monitoring, such that we can quantify the health burden of CVD as well as target interventions and provide impetus for action across Europe.

Paediatric oral sensorimotor interventions for chewing dysfunction: A scoping review.

Chewing dysfunction can have adverse effects on growth, development and quality of life. There is a lack of evidence-based consensus guidelines for sensorimotor intervention. To address this, we need to understand the current state of the science in clinical sensorimotor interventions for paediatric chewing dysfunction and systematically plan a research agenda and priorities for the field. The purpose of this scoping review was to examine the extent, range and nature of evidence for oral sensorimotor interventions for paediatric chewing dysfunction. This scoping review entailed five phases that included: identification of the research question; identification of relevant studies; study selection; data charting; and collation, summarization and report of the results. Treatment studies that were peer-reviewed and written in English were included. All studies involved a paediatric population and included an oral sensorimotor and/or chewing intervention. Information regarding study design, population, intervention, comparator, outcome measures and findings were extracted. Of the 21 studies included in this scoping review, 53% were specific to children with cerebral palsy. All interventions were multi-component in nature and the treatment studies included a range of study designs, but few were controlled trials with comparators. A wide variety of outcomes measures were used within and across studies to determine treatment effectiveness. The findings suggest that in a small number of studies, sensorimotor interventions provide preliminary evidence for effectiveness in specific populations. These and other treatment protocols must be trialled in additional clinical populations and settings to improve the evidence base for sensorimotor treatment of paediatric chewing dysfunction. This review also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment. What is already known on the subject Paediatric feeding disorders are highly prevalent and children often have chewing dysfunction that results in significant negative consequences. We lack evidence-based sensorimotor treatment approaches for chewing dysfunction, which directly impacts the care clinicians can provide children. What this study adds to existing knowledge This scoping review is the first step in examining the literature to understand the current state of the science for oral sensorimotor interventions for paediatric chewing dysfunction. Few randomized controlled studies were identified and a majority included children with cerebral palsy. Most of the interventions were multi-component and included a variety of treatment approaches. What are the potential or actual clinical implications of this work? The results of this scoping review can be used as an initial reference for clinicians selecting treatment approaches for chewing dysfunction. It also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment.

Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions

Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.

Approach to Resistant Hypertension from Cardiology and Nephrology Standpoints

Resistant hypertension is commonly encountered in primary care, cardiology, and nephrology clinics. In patients presenting for the evaluation of resistant hypertension, taking a thoughtful approach to excluding pseudoresistant hypertension or a secondary cause of hypertension is important. When a patient is deemed to have true resistant hypertension, following an evidence-based treatment approach while considering patient-specific comorbidities results not only in better blood pressure control but also better patient long-term adherence to lifestyle and pharmacologic interventions. This article details an approach to the diagnosis and treatment of resistant hypertension with special consideration for patients with preexisting renal and/or cardiovascular disease.

Tactile Play and Oral Acceptance of Wet Food Items

Abstract Date Presented 04/23/21 Limited evidence-based intervention approaches are available to treat sensory-based feeding problems in children. This study explored the effects of tactile play on the oral acceptance of wet food items using the sequential-oral-sensory approach. After 6 weeks, all three subjects increased acceptance of the nonpreferred food. This research emphasizes the effectiveness of tactile play in nonfood items, group treatment, and exposure to aversive food while including caregivers in treatment. Primary Author and Speaker: Julia M. Hawkins Additional Authors and Speakers: Claudia List Hilton, Alex Casteel, Ickpyo Hong, and Yung-Chi Sung

Unprovoked Versus Provoked Venous Thromboembolism in Pediatric Patients: Comparison of Characteristics and Outcomes

Background: The incidence of Venous thromboembolism (VTE) is increasing in the pediatric population which has led to a significant impact on morbidity, mortality and health care costs. The majority of VTE episodes diagnosed in children are considered provoked events secondary to an identifiable risk factor. In contrast, truly unprovoked VTE events are rare in children and there is limited data describing clinical course and outcomes in this population. The aim of this study is to highlight important differences in characteristics and outcomes of unprovoked VTE compared to provoked VTE in pediatric patients.Method: We performed a retrospective analysis of a prospectively maintained institutional thrombosis database. We identified all patients with an objectively confirmed VTE at our institution over a 5-year period from 2011 to 2016. Patients were managed according to standardized institutional protocols based on published guidelines. We compared patients with unprovoked VTE to those with provoked VTE with regards to demographics, prevalence of high risk thrombophilia (defined as inherited deficiency of antithrombin, protein C, or protein S, or antiphospholipid antibody syndrome), frequency of extensive VTE (defined as completely occlusive thrombosis involving >1 venous segment), frequency of pulmonary embolism (PE), frequency of recurrent VTE and frequency of post-thrombotic syndrome (PTS) assessed using the Manco-Johnson instrument in evaluable patients with history of VTE involving extremity veins, inferior vena cava, and/or superior vena cava. Data was compared using the Mann-Whitney U test or Fisher exact test as appropriate. Two-tailed p value less than 0.05 was considered statistically significant.Results: See Table 1 for a summary of the results. A total of 313 patients developed 336 VTE events at our institution during the study period. Of 336 VTE events, 24 (7%) were unprovoked events affecting 19 patients. Patients with unprovoked VTE were significantly older compared to patients with provoked VTE while gender distribution was similar between the 2 groups. The prevalence of high risk thrombophilia was significantly higher in patients with unprovoked VTE. Similarly, the frequencies of extensive VTE, PE and recurrent VTE were significantly higher in patients with unprovoked VTE. The frequency of physically and functionally significant PTS was not significantly different between the two groups. However, the frequency of PTS of any severity was significantly higher in patients with unprovoked VTE.Conclusion: Our study indicates that pediatric patients with unprovoked VTE represent a distinct patient population that appears to be at high risk for poor outcomes. Multicenter, prospective studies are needed to confirm our results and for developing optimal evidence-based risk stratified treatment approaches. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Creating Virtual Reality Based Interventions for Older Adults Impacted by Substance Misuse: Safety and Design Considerations

Virtual reality (VR) is an emerging evidence-based intervention approach that has been successfully used to address substance use disorders (SUDs) and manage chronic pain in young and middle age adults. However, the safe and effective use of VR-based interventions with older adults living with SUDs has not been established. This article outlines considerations for researchers wishing to develop and test VR-based intervention approaches for older adults impacted by substance misuse. An overview of older adult substance misuse and treatment needs will be provided, followed by a review of ethics and general safety related considerations for using VR based intervention approaches with an older adult population.

Overview of Non-Alcoholic Fatty Liver Disease (NAFLD) and the Role of Sugary Food Consumption and Other Dietary Components in Its Development.

NAFLD is the world’s most common chronic liver disease, and its increasing prevalence parallels the global rise in diabetes and obesity. It is characterised by fat accumulation in the liver evolving to non-alcoholic steatohepatitis (NASH), an inflammatory subtype that can lead to liver fibrosis and cirrhosis. Currently, there is no effective pharmacotherapeutic treatment for NAFLD. Treatment is therefore based on lifestyle modifications including changes to diet and exercise, although it is unclear what the most effective form of intervention is. The aim of this review, then, is to discuss the role of specific nutrients and the effects of different dietary interventions on NAFLD. It is well established that an unhealthy diet rich in calories, sugars, and saturated fats and low in polyunsaturated fatty acids, fibre, and micronutrients plays a critical role in the development and progression of this disease. However, few clinical trials have evaluated the effects of nutrition interventions on NAFLD. We, therefore, summarise what is currently known about the effects of macronutrients, foods, and dietary patterns on NAFLD prevention and treatment. Most current guidelines recommend low-calorie, plant-based diets, such as the Mediterranean diet, as the most effective dietary pattern to treat NAFLD. More clinical trials are required, however, to identify the best evidence-based dietary treatment approach.

Comorbid Bipolar and Alcohol Use Disorder—A Therapeutic Challenge

Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40–70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.

The Intersection of Education and Healthcare: Supporting Children with Chronic Health Conditions

Objective: Chronic health conditions in childhood have been negatively associated with linguistic, academic, and occupational outcomes. Traditionally, categorical diagnostic approaches relying on exclusionary criteria are used in healthcare services. Methods: This literature review examines research from various fields to evaluate the effects of chronic illness in cognitive-linguistic development in children. We explore the implications for different conceptualizations of the term “chronic illness.” We compare categorical and non-categorical diagnostic approaches, specifically in relation to children’s academic performance. Results: We provide recommendations for bridging the gap between healthcare and education to provide children with chronic conditions the best chance of thriving medically and academically. Definitions of chronic illness that rely on inclusive criteria and acknowledge individual variability seem best suited for clinical practice and research. Conclusions: Effective supports for children with chronic illness require evidence-based treatment approaches that are tailored to the unique needs of each individual child. Educators, healthcare providers, families, and related service providers must have open lines of communication to serve children with chronic health conditions. Early identification and intervention is crucial.

Iran Obesity and Metabolic Surgery (IOMS) Cohort Study: Rationale and Design

Obesity is a major global public health problem with a rapidly increasing prevalence. Bariatric surgery is the most effective treatment for morbid obesity and comorbidities that provides continuing weight loss for patients with severe obesity. The purpose of this cohort study is to create a suitable platform for developing evidence and assessing the health status of obese patients that can eventually promote the provision of health care and educational services to obese patients throughout the country. Iran Obesity and Metabolic Surgery is a prospective cohort study that started in 2008 and is ongoing. Laboratory tests and doctors’ visits are performed by a multidisciplinary team of experts in preoperative and postoperative follow-up at least up to 10 years post operation. A total of 19,730 patients entered the study from November 2008 to March 2018. Of these, 7922 patients were treated through surgery. Of those who underwent surgery, 80% were women and 36.2% were 30–40 years old. This cohort study responds to questions about the factors affecting the prognosis of patients, the survival of patients, the selection of an appropriate type of surgery for each case, the potential complications, the best follow-up times for the patients, and improvements in comorbidities. This study also seeks to create and expand collaboration through data linkage with other cohorts and registration centers and increase the use of the data existing in the databases. Based on the research findings, it is recommended to modify the bariatric surgery guidelines toward an evidence-based treatment approach for obesity.