Evidence-based Treatment Plan Research Articles

The American Headache Society First Contact-Headache in Primary Care program: Current metrics, knowledge assessments, and direction for future initiatives.

This study examines the American Headache Society First Contact-Headache in Primary Care program metrics to date in order to assess the program's reach and provide direction for future initiatives. Approximately 4 million primary care office visits annually are headache-specific encounters. Therefore, it is important that primary care providers are knowledgeable about headache management. Recognizing the need, the American Headache Society First Contact designed the comprehensive First Contact-Headache in Primary Care program with input from an advisory board comprised of a diverse group of physicians and advanced practice providers with backgrounds in family and internal medicine, pediatrics, obstetrics and gynecology, and neurology. This is the first study to assess the reach of the program and critically examine how to best meet the needs of clinicians and patients going forward. We report descriptive statistics for the First Contact website metrics from October 2020 to June 2023 and grand rounds program data from May 2020 to December 2023. We also conducted a cross-sectional analysis of survey data from presentations conducted at two large national family medicine symposia, as well as a thematic analysis of the question: "Please indicate what areas of your practice could be enhanced or improved with additional education?" The First Contact program homepage was the second most visited page on the American Headache Society website (>100,000 views). A total of 20 podcast episodes were created for the program (>3500 plays). The First Contact program held 99 events (72 institutional grand rounds, 22 State-level meetings, and five national meetings), reaching >7000 clinicians. The institutional grand rounds and state-level meetings were held across 27 States and Washington D.C. Only 31.9% (30/94) of First Contact program events (excluding national meetings) occurred in the West census region, which has the fewest headache subspecialists and lowest headache subspecialist density in the United States. When examining survey data of participants who attended the two virtual national family medicine symposia (39.3% response rate, N = 636/1620), 85.7% (544/635) reported being "completely confident" or "veryconfident" in their ability to recognize and accurately diagnose patients presenting with a primary complaint of headache and 81.5% (517/634) reported being "completely confident" or "very confident" in their ability to develop evidence-based treatment plans that are tailored to the needs of individual patients. The use of diagnostic tools to recognize patients with migraine (60.4%, 384/636) and translating standards of care to the practice setting (42.5%, 270/636) were the most reported intended changes by participants. Most participants reported that program content was of clinical relevance and would improve their patients' outcomes (90.5% [571/631] and 90.6% [572/631], respectively). Over three-quarters (77.8%, 495/636) of participants reported areas of their practice that can be improved by additional education specifically regarding workflow, diagnosis, and management. This study evaluates one of the first national initiatives for primary care education. Data from the two First Contact Family Medicine national symposia indicate the program is generally well received with most participants reporting improved confidence and intention to implement key changes in practice to improve care for patients with headache; however, there remain areas of exploration for education that could further enhance participant experience and expand the reach of the initiatives. Areas for future programming include continued education on multifactorial approaches to headache treatment and suggestions for addressing cost, insurance, and time constraints. Also, future work may examine where the First Contact program might focus initiatives based on specific areas of need in headache care, such as geographic "desert" areas, racial and ethnic disparities, and uninsured/underinsured populations.

The sustainability of a community-based learning collaborative to improve the use of trauma-informed evidence-based practices

PurposeMost youth who experience trauma do not receive evidence-based trauma intervention. Efforts to increase use oftrauma-informed evidence-based practices (EBPs) have identified the learning collaborative (LC) as an effective training and implementation model, yet few studies have evaluated sustainability outcomes. This study examined the sustainability of a community-based LC (CBLC) by describing provider, agency, and community-level use of trauma-informed EBPs, an average of 5.3 years after the training. Methods106 participants from 20 agencies completed a follow-up survey after a CBLC training. Participants were trained in Trauma-Focused Cognitive-Behavior Therapy (TF-CBT; clinical track), in Evidence-Based Treatment Planning (EBTP; broker/case manager track), or in strategies to support TF-CBT and EBTP implementation (senior leader track). Clinical and broker track participants reported on their current employment and EBP use within the past three months. Senior leaders for all 20 agencies provided information about the use of trauma-informed EBPs at their agencies. ResultsAt the provider-level, only 36.5 % of the clinical track continued to use TF-CBT and 28.1 % of the broker track continued to use EBTP. Provider promotion to supervisory and leadership positions supported EBP sustainability. Agency-level outcomes indicated that 89 % of clinical agencies and 60% of broker agencies continued to use TF-CBT and EBTP. Although retention of providers within agencies was low, LC trained clinicians and brokers spread to twenty-four new agencies in the community providing psychotherapy and/or case management services to youth. ConclusionsFindings suggest the CBLC model resulted in some sustained community-level changes as agencies continued to use the trauma-informed EBPs and trained providers spread to other agencies within the local community. Provider promotions also increased representation of CBLC trainees in leadership positions. Results suggest that measuring sustainability as a multi-level implementation outcome can lead to a better understanding of implementation success.

Revolutionizing Prosthodontics with Artificial Intelligence: A Narrative review

The revolutionary impact of artificial intelligence (Al) on prosthodontics is addressed in this narrative review with focus on how it has changed the way patients are examined. Additionally, machine learning is used which aids in greater accuracy and customization when creating a treatment plan for the patient. Artificial intelligence (AI)-driven technologies are essential in the creation and manufacturing of prostheses and has improved computer-aided design (CAD) systems, making it easier to create customized, anatomically accurate prosthetic limbs. Apart from its practical uses Artificial Intelligence fosters an Ongoing investigation and advancement in the field of prosthodontics, as new materials, techniques, and treatment approaches are developed, Al system continuously incorporate lessons from real patient experiences, pushing the boundaries of what is possible in the field. To address the inherent difficulties in traditional approaches this paper explores a convincing case for using Al in decision making and treatment planning in prosthodontics. Through use of unique patient data to support evidence-based decisions treatment planning can become more precise and personalized by leveraging Al analytical powers. Furthermore, the incorporation of Al-powered technologies including CAD and 3D printing is being investigated as a way to optimize manufacturing process of different of prostheses. Al is playing a crucial role in molding the future of the discipline as highlighted by the ongoing research element. This article highlights the revolutionary potential of artificial intelligence (Al) in prosthodontics, providing a state of and patient-centered approach to dental care.

Urethral multiplicity in boys: systematic review of case reports and case series from the last 15 years.

Urethral multiplicity is a rare congenital anomaly characterized by the presence of two or more urethral channels. It is more common in males and can cause double urinary stream, incontinence, obstruction, and recurrent urinary infections. Diagnosis is difficult due to diverse clinical manifestations. Implementing an evidence-based treatment plan is challenging due to the need for more concise and informative summary publications. Our paper provides a comprehensive review of the management of this pathology and might serve as a valuable resource for pediatric urologists and specialists in the field. A comprehensive search in four electronic databases, PubMed®, PubMed Central® (PMC), Scopus, and Clarivate Analytics's Web of Science (WoS), was conducted to identify case reports and series published between 2008 and 2023 on urethral multiplicities. The quality of the articles was assessed using qualified instruments. Covidence® tool-guided synthesis was followed by individual patient data extraction. Further classifications and analysis were made using Microsoft Excel®. Out of the 90 papers included in the review, 62 were case presentations, and 28 were case series. We found 250 boys with urethral multiplicity. Based on Effman's classification, there were 38 cases of type I (15.3%), 21 type IIA1 (8.4%), 55 type IIA2 (22.1%), 91 type IIA2Y (36.5%), 4 type IIB (1.6%), and 6 type III (2.4%) urethral duplications. There were 19 cases of prepubic sinuses (7.6%), 9 triplications (3.6%), and 6 unknown forms (2.4%). We have provided data for each type, including clinical presentation, investigations, surgical management, and outcomes. Urethral multiplicities are a rare and varied group of malformations that require high-quality imaging examination for successful management. Treatment is specific to each patient and may depend on the surgeon's preference or skill. https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42023471685, identifier (CRD42023471685).

Childhood Apraxia of Speech: A Descriptive and Prescriptive Model of Assessment and Diagnosis.

Childhood apraxia of speech (CAS) represents a significant diagnostic and therapeutic challenge within the field of clinical neuropsychology, characterized by its nuanced presentation and multifactorial nature. The aim of this study was to distil and synthesize the broad spectrum of research into a coherent model for the assessment and diagnosis of CAS. Through a mixed-method design, the quantitative phase analyzed 290 studies, unveiling 10 clusters: developmental apraxia, tabby talk, intellectual disabilities, underlying speech processes, breakpoint localization, speech characteristics, functional characteristics, clinical practice, and treatment outcome. The qualitative phase conducted a thematic analysis on the most cited and recent literature, identifying 10 categories: neurobiological markers, speech motor control, perceptual speech features, auditory processing, prosody and stress patterns, parent- and self-report measures, intervention response, motor learning and generalization, comorbidity analysis, and cultural and linguistic considerations. Integrating these findings, a descriptive and prescriptive model was developed, encapsulating the complexities of CAS and providing a structured approach for clinicians. This model advances the understanding of CAS and supports the development of targeted interventions. This study concludes with a call for evidence-based personalized treatment plans that account for the diverse neurobiological and cultural backgrounds of children with CAS. Its implications for practice include the integration of cutting-edge assessment tools that embrace the heterogeneity of CAS presentations, ensuring that interventions are as unique as the children they aim to support.

Abstract PO4-10-10: NAVYA-AI enabled intervention to increase real-world guideline compliant care: Improving NGS testing in breast cancer

Abstract BACKGROUND: Navya-AI is a validated online cancer informatics solution that combines artificial intelligence based analysis of the guidelines and evidence, along with asynchronous expert review. Navya-AI releases preliminary system-generated opinions for patients whose treatment plans fit high confidence based on NCCN Guidelines and prior expert reviews. Prior research (SABCS 2014-2018 and ASCO 2021 showed: 1) 97% concordance of Navya-AI predictions with an academic medical center in India and in the US 2) 80% of patients implement treatment concordant with Navya-AI recommendations on the ground 3) Navya’s NCCN and evidence-based treatment plans reduce the patient waiting times for an expert opinion by an average by 3.5 days. Next generation sequencing (NGS) is an expensive but necessary method for identifying patients for risk reduction and therapy selection in breast cancer (BC). NGS testing can be over-used or under-used, and compliance with NCCN guidelines on patient selection is especially important in resource-constrained settings and Low Middle Income Countries (LMIC) such as India. The aim of this study is to find the physician compliance to NCCN guidelines on NGS testing in India, and how Navya-AI can identify the opportunity for improved care, and improve compliance with guidelines for optimal care. METHODS: From January 2022 to May 2023, Breast Cancer patients receiving Navya-AI treatment plan (based on guidelines and live expert-review) were analyzed. Patients who could afford NGS testing and targeted therapies, and who met the Enhanced tier of NCCN resource stratified guidelines for their care centers were identified. Their records were screened by Navya-AI to assess if they met NCCN criteria for NGS testing for risk reduction or for treatment selection (young age, positive family history, triple negative breast cancer etc.). Treating physicians were then analyzed if they had ordered NGS appropriately, or had missed an opportunity for NGS (undertreatment), or had over-ordered NGS (overtreatment).RESULTS: 521 BC patients who could afford NGS tests received a Navya-AI plan during this period. Of these, 85% were Indian patients (415/521) and were analyzed. Patients were diverse with respect to age,cancer stage, family history of cancer and histology: Age < 35: 6.7%, 35-50: 33%, 51-65: 43.76%, >65: 16.51%; early stage: 21.5%, locally advanced stage: 29.56%,metastatic stage: 47.79% and benign disease: 1%; positive family history of cancer: 37.35%, triple negative BC: 21.9%. Of 415 indian breast cancer patients who could afford testing, NGS testing was indicated in 69.64% (289/415) as per NCCN guidelines. The treating physician was compliant with NCCN guidelines in only 47.95% (199/415) of the cases: 19.2% (80/415) of the time, NGS was indicated and the treating physician ordered the same; 28.67% (119/415) of the time, NGS was not indicated, and the treating physician did not order NGS. The remaining 52% were not compliant with NCCN. Under-treatment was present in 50.36% (209/415) of cases, and was the vast majority of fallouts. Over-treatment was only present in 1.69% (7/415). In all 50.63% (209/415) cases, where NGS was not ordered by the treating oncologist, but was indicated, and affordable to the patient, Navya requested the patient to discuss the risks/benefits of NGS testing with their treating oncologist. CONCLUSION: NGS testing in BC patients has significant impact on risk-reduction, genetic counseling, choice of surgery, and treatment options for adjuvant therapy. Missed opportunities for NGS testing in more than 50% of the patients who can afford the testing and resultant therapies, points to a signficant area where compliance with guidelines and expert opinions can impact outcomes. A 'Technological Earthshot" that significantly increases adoption of guideline-based care is the first and an easy step towards 'Cancer Moonshots'. Citation Format: RA Badwe, Premal Thaker, Farzana Begum, Mayukh Acherjee, Gitika Srivastava, Naresh Ramarajan, Shona Nag, Sudeep Gupta, Seema Gulia, Jaya Ghosh, Bhawna Sirohi. NAVYA-AI enabled intervention to increase real-world guideline compliant care: Improving NGS testing in breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-10.

The AUstralian multidomain Approach to Reduce dementia Risk by prOtecting brain health With lifestyle intervention study (AU-ARROW): A study protocol for a single-blind, multi-site, randomized controlled trial.

The Finnish Geriatric Intervention Study (FINGER) led to the global dementia risk reduction initiative: World-Wide FINGERS (WW-FINGERS). As part of WW-FINGERS, the Australian AU-ARROW study mirrors aspects of FINGER, as well as US-POINTER. AU-ARROW is a randomized, single-blind, multisite, 2-year clinical trial (n = 600; aged 55-79). The multimodal lifestyle intervention group will engage in aerobic exercise, resistance training and stretching, dietary advice to encourage MIND diet adherence, BrainHQ cognitive training, and medical monitoring and health education. The Health Education and Coaching group will receive occasional health education sessions. The primary outcome measure is the change in a global composite cognitive score. Extra value will emanate from blood biomarker analysis, positron emission tomography (PET) imaging, brain magnetic resonance imaging (MRI), and retinal biomarker tests. The finalized AU-ARROW protocol is expected to allow development of an evidence-based innovative treatment plan to reduce cognitive decline and dementia risk, and effective transfer of research outcomes into Australian health policy. Study protocol for a single-blind, randomized controlled trial, the AU-ARROW Study.The AU-ARROW Study is a member of the World-Wide FINGERS (WW-FINGERS) initiative.AU-ARROW's primary outcome measure is change in a global composite cognitive score.Extra significance from amyloid PET imaging, brain MRI, and retinal biomarker tests.Leading to development of an innovative treatment plan to reduce cognitive decline.

Effect of Conventional Physiotherapeutic Techniques on Post-Operative Facial Palsy: A Case Study

This case study highlights the benefits of combining multiple conventional physiotherapeutic methods for post-operative facial palsy with an evidence-based treatment plan using the International Classification of Functioning Disability and Health ICF. A middle-aged female reported with a primary complaint of facial weakness experienced post the surgical removal of parotid gland due to pleomorphic adenomatous growth. Treatment was offered at the out-patient physiotherapy department and each session lasted for 45 minutes with exercises like proprioceptive training facial neuromuscular rehabilitation mime therapy and sensory re-education incorporated as a part of the patients dose-based physical treatment. With outcome measurements Sunnybrook Facial Grading System indicating improvement by 27 points and Facial Disability Index showing improvement by 41 points and a noticeably higher level of confidence the patient demonstrated a considerable reduction in discomfort and improvement of mobility prior to discharge. The case study focuses on how an evidence-based plan of conventional treatment strategies ensures better prognosis for a patient with post-operative facial palsy.

Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience.

Borderline personality disorder (BPD) is a severe mental health condition marked by impairments in self and interpersonal functioning. Stigma from health staff may often result in a reluctance to diagnose, impacting recovery trajectories. Qualitative interviews were conducted with participants (N = 15; M Age = 36.4 years, SD = 7.5; 93.3% female) with lived experience of BPD exploring topics of illness onset, insight, experience of diagnosis and treatment. Qualitative responses were analysed within a co-design framework with a member of the research team who identifies as having a lived experience of BPD. On average, participant symptoms emerged at 12.1years of age (SD = 6.6years, range 1.5-27), but diagnoses of BPD were delayed until 30.2years (SD = 7.8years, range 18-44) resulting in a 'diagnosis gap' of 18.1years (SD = 9.6years, range 3-30). Participant explanations for BPD emergence varied from biological, psychological and social factors. Benefits of diagnosis (e.g., fostering insight, aiding treatment planning and reducing isolation) were contrasted with challenges (e.g., stigma and treatment unavailability). Delay in diagnosis was common, and no participants reported receiving a diagnosis of BPD during their adolescence yet 85% felt they would have benefited from a diagnosis in adolescence. Only a quarter (27%) felt highly supported in the diagnostic process. An ideal four-step diagnosis procedure was outlined based on recommendations from participants with a lived experience; this involved the following: (1) explain the process, (2) assess thoroughly, (3) explore how the features are active in everyday life and (4) link diagnosis to evidence-based treatment planning.

The Need of Evidence-Based Treatment of Early-Onset Feeding Tube Dependency: A Pico- Framework Based Analytic Review of Clinical Features and Treatment of Feeding Tube Dependency

Feeding Tube Dependency is a constant increasing perinatal mental health condition, with estimated 350 new cases per year in Germany.The early onset feeding tube dependency is the consequence of a generalized food aversion. To establish an evidence-based nationwide treatment plan, relevant research from the past twenty years were narratively reviewed. Feeding tube dependency is an international increasingmental health condition, with a high symptom persistence and a low spontaneous remission. The generalized food aversion would prevent the transition to oral feeding.The treatment protocols, supported by the German Health System, based on low-frequency individual treatment and intensive inpatient treatments are not supported by the most recent evidence. In treatment outcome research more promising and effective programs can be distinguished from ineffective programs. As a result, treatment which are designed as intensive treatment, home-based or inpatient and are psychodynamicbased are most effective. Day-clinic and behavioral modification programs are not or low in treatment effectiveness.The German Health System approach to assist families with feeding tube dependency is not evidence-based. A new structure of treatment is imperatively required.

Optimizing Mental Health for Women: Recognizing and Treating Mood Disorders Throughout the Lifespan.

Mood disorders can come and go during the reproductive stages of a woman's life and beyond and can include premenstrual-related mood disorders, depression and other psychiatric disorders during pregnancy, postpartum mood disorders, and depression during menopause, as well as comorbid psychiatric conditions. Women may have regular contact with health care providers at these various stages in their lives, providing an opportunity for treatment intervention. However, clinicians struggle to effectively identify and manage these disorders, leaving women's mental health issues unaddressed and causing unnecessary suffering, multiple comorbidities, and unwanted outcomes. Context is essential for diagnoses and treatment, and spending time with patients, taking a full history, and taking the time to understand each patient's perspective during these complex periods lead to more accurate diagnoses, ultimately facilitating more effective treatment plans. An array of options is available for treating women's mental health, including antidepressants, oral contraceptives, hormones and recently approved neurosteroids, and nonpharmacological approaches. Clinicians need to be aware of which treatment options are available and evidence-based, guideline-directed solutions to help women manage their mental health. Creating patient-centered, individualized, evidence-based treatment plans is key to optimizing outcomes for women across their lifespan.

Iatrogenic perforation management using calcium silicate cement: a case report

The world today is literate enough about the basics of oral health conditions and available treatment options. Due to the availability of many resources on different platforms the urge to retain natural teeth rather than have extractions has increased. Dental catastrophes are sometimes unavoidable in everyday dental practice. The prime motive should be patient benefit while the general dental practitioner (GDP) identifies the risks associated with the case, availability of equipment and enhanced operator skill when deciding to the referral of the patient to a specialist. Most failed root canal treatment cases have one or more associated endodontic errors. This case report presents stepwise management of such a case of iatrogenic perforation that occurred during the initial endodontic management. It emphasizes the significance of evidence-based treatment planning, role of magnification, selection of the appropriate armamentarium for performing root canal treatment, use of bioactive materials that collectively demonstrate peri-apical healing following the repair of endodontic mishaps. It also emphasizes on the importance of recall in such cases where adequate healing can be tracked over a period. CPD/Clinical Relevance: Knowledge of management of iatrogenic perforations is useful information for clinicians.

293 Risk of Clostridium Difficile Enterocolitis in SJS/TENS Patients Treated with Antibiotics

Abstract Introduction Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are both rare conditions derived from adverse drug reactions. SJS/TENS patients are often treated with antibiotics, both prophylactically and therapeutically, for secondary infections. However, the subsequent development of Clostridium Difficile (C. Difficile) enterocolitis is unknown. Due to the rarity of SJS/TENS, institution trials are limited in their data quantify the additional risk of sequelae such as enterocolitis development after antibiotic administration. Therefore, we used a large commercially available database derived from inpatient hospital coding data to assess the incidence of C. Difficile enterocolitis within 2 weeks of antibiotic administration after development of SJS/TENS. Methods : Our study utilized a large commercially available database. Inclusion criteria identified adult patients ( >18 years old) diagnosed with SJS/TENS between 2002 and 2022, who were treated with antibiotics within 2 weeks of diagnosis, and who subsequently went on to develop Clostridium Difficile enterocolitis within 6 months. We compared our cohort to a control group which did not receive antibiotics and propensity score matched them for age, sex, race, HIV status, cancer, transplant status, and severe sepsis and SIRS and analyzed the risk of developing C. Difficile enterocolitis. Results There were 4,792 SJS/TENS patients who did not receive antibiotics and 5,652 who did. Our matched cohorts contained 4,595 patients. The relative risk of mortality between our cohorts was 4.962 (RR: 2.562, CI 95% 2.125-3.088; p< 0.0001). SJS/TENS who received antibiotics developed C. Difficile 68/4595 vs 30/495 and had a relative risk of 0.827% (RR: 2.267, 1.478-3.476, CI 95%; p< 0.0001). Therefore, an SJS/TENS patient incurred a 2.267 times higher risk of developing C. difficile enterocolitis after receiving antibiotics. Conclusions While causality cannot be affirmed with retrospective data, our findings do suggest that patients with SJS/TENS due to the statistically significant risk of C. Difficile enterocolitis development. However, the overall absolute risk of C. difficile enterocolitis remains disproportionately low in this population that warrants further exploration. Applicability of Research to Practice SJS/TENS patients are difficult to develop evidence-based treatment plans for because of their rarity and the multitude of conflicting small cohort studies available in the literature. Our study utilizes a large database to more robustly suggest that clinicians should be cautious about administering antibiotics to patients diagnosed with SJS/TENS.

Management of Stable Angina: A Treatment Strategy Mnemonic

Nurse practitioners are well-positioned to diagnose and manage stable angina pectoris by implementing guideline-driven medical interventions. This report presents a mnemonic based on current guidelines to support the nurse practitioner by effectively recalling and using evidence-based treatment plans in clinical practice.

Abstract B091: Introduction of Implicit Bias Training to oncology faculty as a means to improve minority participation in cancer clinical trials

Abstract Background: Following George Floyd’s murder in May 2020, conversations about equity and bias became part of our daily national conversation. Simultaneously the COVID-19 outbreak disproportionately affected people of color which further illuminated existing disparities in outcomes. Bias training was introduced in many sectors as a strategy to address inequity. Inclusivity in healthcare is essential to develop evidence-based therapies and treatment plans. Previous studies have demonstrated the consequences when racial and ethnic minorities are excluded from research. (Hamel et al, 2016). Racial and ethnic minorities disproportionately bear adverse outcomes from cancer. Cancer clinical trials would benefit from solutions to promote inclusivity. (Khan et al. 2021) Research Purpose: The purpose of our study was to assess whether Implicit Bias Training can increase minority participation in cancer clinical trials. Methodology: The Office of Diversity, Equity, and Inclusion offered Implicit Bias Training to all clinical oncologists at the Yale Cancer Center (YCC) between May and July 2021. While 109 physicians were eligible to participate, 57 physicians were required by the department to complete this training, and 84% of these physicians completed this opportunity. We analyzed YCC clinical trial enrollment data between two time periods defined as pre-intervention and post-intervention. We selected these periods to investigate not only the efficacy of bias training but specifically bias training as an adjunct to the national conversation during the time of our study. We selected the preintervention period as January 1, 2021, to June 30, 2021. The intervention was designed to be completed by July 1, 2021 therefore the post-intervention period is defined as July 1, 2021 to December 31, 2021. Results/Summary: Our analysis showed an increase of 2.5% in the participation of Black/African American patients. There was a slight (1.5%) decrease in Hispanic patient enrollment during this time. Conclusion: Our analysis suggested that implicit bias training delivered once had only a very modest, if any, improvement in racial minority participation in cancer clinical trials. Our project focused on participation by Black/African American patients. The impediment to Hispanic participation is quite nuanced. Hispanic patients, many of whom are non-English speaking with immigration/insurance issues face additional structural barriers. We think that a different strategy is needed to better serve this patient population. While we had hoped for metrics to demonstrate greater impact from bias training, our next investigation will look at if the intervention is best delivered repeatedly. Future Work: We have not abandoned the strategy of bias training to build trust and increase Black/AA participation. After the intervention, we are interested in whether greater impact is seen over time. We have designed a survey to look at the effects of the intervention after a year. Our next step is to examine whether repeated delivery of this intervention will amplify our results. Citation Format: Renee Taylor, Andrea Silber. Introduction of Implicit Bias Training to oncology faculty as a means to improve minority participation in cancer clinical trials [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B091.

The core competency model for corrections: An education program for managing self-directed violence in correctional institutions.

Self-directed violence (SDV), comprising both suicide and self-injury, presents a continued public health challenge for correctional institutions. In fact, correctional settings are one of four primary targets for the reduction of SDV by leading professional organizations. This article presents a public health solution to SDV in correctional settings, namely the Core Competency Model for Corrections (CCM for Corrections), an educational program for correctional mental health providers. Grounded in the general CCM of Suicide Prevention, we proffer an evidence-based sample curriculum covering 10 SDV prevention competencies in correctional settings. These competencies address both clinical care (e.g., enacting evidence-based treatment plans, using best practice documentation standards) and provider-focused (e.g., managing personal attitudes about SDV and incarcerated persons, engaging in self-care and debriefing) skills. We further espouse the underlying social-cognitive theory of CCM for Corrections toward the goal of identifying mechanisms of action for improved SDV prevention skills. Finally, we highlight considerations in the initial design and testing of CCM for Corrections. These recommendations address (a) utilization of a community-academic partnership approach and corrections SDV advisory panel, (b) selection of an in-person or online training modality, and (c) measurement of sample educational program outcomes. The CCM for Corrections represents a promising approach to SDV reduction and management in correctional settings ripe for collaborative pilot testing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Digital health technologies to support medication adherence in chronic kidney disease.

Non-adherence to medications is a critical challenge in the management of people with chronic kidney disease (CKD). This review explores the complexities of adherence in this population, the unique barriers and enablers of good adherence behaviours, and the role of emerging digital health technologies in bridging the gap between evidence-based treatment plans and the real-world standard of care. We present the current evidence supporting the use of digital health interventions among CKD populations, identifying the key research questions that remain unanswered, and providing practical strategies for clinicians to support medication adherence in a digital age.

Potential pitfalls of reproductive direct-to-consumer testing

The availability of direct-to-consumer (DTC) testing has dramatically increased over the past 2 decades, particularly those targeted at reproduction and fertility. Several ethical concerns exist with regard to DTC tests, including the lack of governmental regulation and consumer protection, standardized laboratory methodology, and clinical validity and actionability. Physicians must familiarize themselves with the pitfalls of DTC tests to best aid patients in interpreting DTC test results and guide them toward evidence-based treatment plans.

Commentary on a case report of Dopa-responsive dystonia or Segawa disease in Ghana

The case of Dopa-Responsive Dystonia or Segawa Disease reported in this issue brings to the fore the age-old tenets of medicine which is based on the taking of a detailed history, physical examination, and the request of relevant investigations to achieve a diagnosis. This is followed with an evidence-based treatment planning. This maxim remains important especially in resource poor environments where sometimes one must depend on the history and physical examination findings alone to make a diagnosis and commence treatment. The patient under review had had her condition progressively worsening for two years and had been managed as a case of cerebral palsy.The initial consideration of a possible dyskinetic cerebral palsy from bilirubin encephalopathy which the author indicated was common is understandable as this is one of the commonest causes of such presentation in the setting. However, having a more detailed history and having other differentials in mind such as childhood Dopa-Responsive Dystonia, as was the case presented, helped in identifying subtle differences in presentation that influenced the ultimate diagnosis. In this case, a later onset of symptoms (dystonia), with the symptoms being minimal after sleep and becoming more severe late afternoon having helped to clinch the diagnosis. Considering each patient one sees as eligible for a possible case report allows one to update his or her knowledge on the condition, identify peculiar features and directs the request of relevant investigations. The use of telemedicine is yet to be widespread in the developing world even though telecommunication infrastructure is improving in these regions. This case had the diagnosis essentially made by contacting a paediatric neurologist by telephone. Such specialist consultations need to be encouraged as there are very few specialists across the globe and less still in the developing economies.Governments and Medical Associations may have to lead in creating these platforms to assist in this direction to improve the overall access to specialist care and reviews in less endowed regions. In the case presented, the diagnosis of Dopa-Responsive Dystonia was confirmed after a demonstration of a marked and sustained response to low dose L-dopa without motor fluctuations or dyskinesias. We applaud the author for the diagnosis having been made by essentially a detailed history and physical examination and response to L-dopa. It was however indicated that there are recent developments that involve analysis of cerebrospinal fluid for neurotransmitters that demonstrate low concentrations of biopterin and neopterin with DNA sequencing demonstrating mutation of the GTP cyclohydrolase-1 gene in up to 80% of cases in gene studies. These diagnostic tests hinge on the finding of an autosomal dominant heterozygous mutation in the GTPcyclohydrolase-I gene that results in biopterin deficiency, a cofactor for tyrosine hydroxylase and dopamine deficiency and considered the most classic molecular pathophysiology of this condition [1]. These additional tests were not done bringing to the fore the limited access to investigative tools in some developing economies. While National Reference Laboratories are in existence in some countries, regional efforts could be made to set up reference laboratories that serve entire region to allow for pooling of infrequently performed laboratory tests for analysis. This will make such infrequently encountered medical conditions be accurately diagnosed and treated. Of concern is how to achieve an un-interrupted supply of L-Dopa as the child returns to the village. This should engage the attention of all involved in her treatment as they follow the patient up.To conclude, the suggestion by the author that the diagnosis of Dopa-Responsive Dystopia or Segawa disease must be considered in all cases of dystonia including cases of apparent dystonic cerebral palsy and especially where there is no history of birth asphyxia need being emphasized.

Predicting the Unpredictable in Psoriasis Treatment

Psoriasis is an autoimmune skin inflammation disease that causes silvery and erythematous scaly plaques. Moderate to severe psoriasis is treated using biologics to antagonize inflammatory cytokines and inhibit inflammatory responses in the skin and joints. However, primary treatment of psoriasis as administered in accordance with treatment guidelines fails for some patients. In these cases, the physician will attempt treatment with another biologic. However, changing treatments has adverse consequences such as physical and psychological burdens on patients as well as wasted health care resources. Even after treatment changes, however, the new biologic may be ineffective. Our goal was to investigate methods of selecting the most effective biologics for different patients with psoriasis. We created an innovative platform by using streptococcus induction and patients’ peripheral blood mononuclear cells to screen biologics, including anti-TNF-α, anti-IL-12/23, anti-IL-17, and anti-IL-23 biologics, for their effectiveness as measured by cytokine and chemokine expression. IL-4, IL-13 and interferon-r (IFN-r) were crucial markers for biologic efficacy in different individuals. By using this platform to prescreen the effectiveness of biologics on individual patients, physicians can devise evidence-based treatment plans, improving patient outcomes. The three benefits of using this platform to inform treatment plans are improved patient outcomes, reduced risk for doctors, and reduced economic burden on the health care system. The model and strategy for selecting biologics for psoriasis treatment proposed in this study enables precise treatment of individuals. Funding Statement: Research/Educational Grants from Taiwan (CMRC-CENTER-0) and Ministry of Science and Technology in Taiwan (MOST 109-2320-B-39-044). Declaration of Interests: All authors have completed the International Committee of Medical Journal Editors uniform disclosure form available at www.icmje.org/coi_disclosure.pdf , and declare that Dr. Hsieh and Dr. Yu have no conflicts of interest to declare. Dr. Yen participated as a speaker for AbbVie, Novartis Pharmaceuticals Corporation, Eli-Lilly, Janssen-Cilag Pharmaceutical, Leo Pharma and Sanofi Pfizer Limited. Dr. Lai participated as speaker for AbbVie, Novartis, Eli-Lilly and Janssen- Cilag Pharmaceuticals Corporations Dr. Yen has a pending patent on markers IFN-r, IFN-r/IL13, and IFN-r/IL4. Ethics Approval Statement: All participants provided written informed consent, and the study protocol was approved by the Institutional Review Board of Taichung Veterans General Hospital (TCVGH-CE16265B).