Evidence-based Interventions Research Articles

Evaluating a peer-support mind-body medicine intervention for healthcare leaders.

Mind-body medicine (MBM) is an evidence-based intervention associated with trauma and stressful events. The MBM intervention alleviates symptoms of work-related stress and builds resilience by utilizing self-care techniques facilitated in small group settings. Healthcare leaders who experienced traumatic stress through the COVID-19 pandemic may benefit from interventions aimed at their needs. We evaluated the effects of a peer support MBM intervention on perceived stress, resilience, well-being, and empathy for nurse leaders and compassionate care leaders. A pre-post intervention was conducted via 7 virtual and 2 on-site groups, recruiting from a large multihospital health system in the United States. Participants engaged in an 8-week program facilitated by a certified faculty group leader from The Center for Mind-Body Medicine and engaged in resilience skills building activities along with facilitated sharing. Validated instruments were used to measure outcomes at pre, post, 1 month, and 6 month follow-up intervals. Surveys included open-ended questions for qualitative feedback related to facilitators, barriers, and group experiences. Seventy-three leaders completed the MBM program, and 22 completed the four research surveys; all qualitative responses were included for feedback. Perceived stress decreased after the intervention (p < .008) and was maintained for 6 months post intervention (p < .005). Resilience increased after the intervention (p < .034) and for 1 month (p < .049) but decreased after 6 months. Qualitative responses showed that time and workload factors were the most significant barrier to participation, while the benefits included protected time with peers, learning well-being skills, and having a safe place to process emotions. Healthcare leaders face unique challenges, including workplace trauma and crises. Interventions that support their stress response, resilience, and overall well-being should take into consideration the nature of their work, the balance of time demands, and the need for peer support to overcome barriers to sustainable interventions.

Communities That HEAL Intervention and Mortality Including Polysubstance Overdose Deaths

The HEALing Communities Study (HCS) evaluated the effectiveness of the Communities That HEAL (CTH) intervention in preventing fatal overdoses amidst the US opioid epidemic. To evaluate the impact of the CTH intervention on total drug overdose deaths and overdose deaths involving combinations of opioids with psychostimulants or benzodiazepines. This randomized clinical trial was a parallel-arm, multisite, community-randomized, open, and waitlisted controlled comparison trial of communities in 4 US states between 2020 and 2023. Eligible communities were those reporting high opioid overdose fatality rates in Kentucky, Massachusetts, New York, and Ohio. Covariate constrained randomization stratified by state allocated communities to the intervention or control group. Trial groups were balanced by urban or rural classification, 2016-2017 fatal opioid overdose rate, and community population. Data analysis was completed by December 2023. Increased overdose education and naloxone distribution, treatment with medications for opioid use disorder, safer opioid prescribing practices, and communication campaigns to mitigate stigma and drive demand for evidence-based interventions. The primary outcome was the number of drug overdose deaths among adults (aged 18 years or older), with secondary outcomes of overdose deaths involving specific opioid-involved drug combinations from death certificates. Rates of overdose deaths per 100 000 adult community residents in intervention and control communities from July 2021 to June 2022 were compared with analyses performed in 2023. In 67 participating communities (34 in the intervention group, 33 in the control group) and including 8 211 506 participants (4 251 903 female [51.8%]; 1 273 394 Black [15.5%], 603 983 Hispanic [7.4%], 5 979 602 White [72.8%], 354 527 other [4.3%]), the average rate of overdose deaths involving all substances was 57.6 per 100 000 population in the intervention group and 61.2 per 100 000 population in the control group. This was not a statistically significant difference (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26). There was a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) in death rates involving an opioid and psychostimulants (other than cocaine), and nonsignificant reductions in overdose deaths for an opioid with cocaine (6%) and an opioid with benzodiazepine (1%). In this clinical trial of the CTH intervention, death rates involving an opioid and noncocaine psychostimulant were reduced; total deaths did not differ statistically. Community-focused data-driven interventions that scale up evidence-based practices with communications campaigns may effectively reduce some opioid-involved polysubstance overdose deaths. ClinicalTrials.gov Identifier: NCT04111939.

Treatment selection and influencing factors for chronic lymphocytic leukemia: a physician survey in Japan.

Chronic lymphocytic leukemia (CLL) is a rare form of lymphoma in Japan. This study aimed to explore hematologists' motivations and considerations in making treatment decisions for CLL. Responses from hematologists treating CLL, obtained through an online survey, were descriptively analyzed. Subgroup analyses by preferred first-line (1L) treatment, years of clinical experience, and level of interest in CLL were conducted. Out of 107 hematologists surveyed, 82.2% identified Bruton tyrosine kinase inhibitors (BTKi) as their primary choice for 1L treatment; the reasons included established clinical evidence (61.4%) and oral administration convenience (56.8%). Key factors influencing 1L treatment selection among those favoring BTKi included the presence of 17p deletion, TP53 mutation, and patient's fitness status. BTKi was favored by 92.6% of hematologists with < 10 years of clinical experience and by 78.8% with more experience. The main reasons for choosing BTKi included safety (50.0%) and tolerance (46.7%) among hematologists who stated they had a specific interest in CLL and the oral administration route (62.1%) among hematologists with lower interest. When BTKi was used as 1L therapy, venetoclax-based regimens were preferred for second-line treatment. The most common concern about BTKi was substantial out-of-pocket costs. Although many Japanese hematologists select their treatment based on clinical evidence, variations exist in treatment strategies, possibly associated with hematologists' experience and interest in CLL. These findings underscore the importance of further promoting evidence-based treatments to ensure that all physicians can make informed decisions. Future research should explore additional factors that influence CLL treatment decisions.

The role of eco-anxiety in the presentation of bulimia nervosa: a case report

BackgroundDespite a growing literature demonstrating the significant impacts of climate change on mental health, research is urgently needed to investigate how climate change-related concerns may contribute to the development, exacerbation, or re-emergence of eating disorders, as well as affect the effectiveness of existing interventions. This case report contributes to this scant knowledge base by offering empirical evidence for how responses to climate change can influence eating disorder symptoms and, importantly, limit the effectiveness of evidence-based treatments such as Cognitive Behavior Therapy-Enhanced (CBT-E).Case presentationA 24-year-old female graduate student studying environmental science presented to a specialized eating disorder clinic with worsening bulimia nervosa. Her symptoms initially improved with CBT-E; however, after three months, concerns about food waste significantly impeded further progress. The therapist, identifying symptoms of eco-anxiety, adapted standard CBT-E strategies to include psychoeducation about eco-anxiety, cognitive restructuring of beliefs about food waste and other eating-related eco-concerns, relevant exposures related to such concerns, and problem-solving to increase social support. These adaptations led to resumed progress, with the patient achieving nutritional adequacy by treatment end (38 sessions) and maintaining treatment gains through one year follow-up.ConclusionsTo our awareness, this is the first case report on the co-occurrence of eco-anxiety and eating disorders. This case underscores the importance of screening for concurrent eco-anxiety, suggests ways in which eating disorders and eco-anxiety can influence one another longitudinally, describes how coexisting eco-anxiety can limit standard CBT-E’s effectiveness, and provides examples of successful treatment adaptations tailored to address eco-anxiety-related concerns.

Implementing a Positive Behavior Support Program for Young Children with Autism in Public Agencies: A Social Validity Evaluation from Parents, Practitioners, and Administrators.

Challenging behaviors in young children with autism and intellectual disabilities pose significant barriers to learning and inclusion. The Prevent-Teach-Reinforce for Young Children (PTR-YC) program is an evidence-based intervention that addresses these behaviors according to Positive Behavior Intervention Support principles. It is essential to assess the social validity of an intervention, when implemented into a public service system, to ensure sustainability and relevance to stakeholders. The present study aimed to document the social validity of PTR-YC from the point of view of three key informants: parents, practitioners, and administrators. Sixty-one participants were interviewed about their experience with PTR-YC (9 administrators, 31 practitioners, and 20 families). Semi-structured interviews assessed three fundamental components of social validity (Wolf, 1978): (a) social relevance of intervention goals, (b) social appropriateness of intervention procedures, and (c) social importance of intervention effects. Participants' responses were subjected to thematic analysis. Intervention goals, namely family participation in the clinical process, strategies that focuses on prevention, and teaching alternative adaptive behaviors, were identified as relevant. Participants appreciated the program's clear, structured, and turnkey clinical process, its parent-practitioner collaboration, and its consistency with practices already in place in the field. Positive instrumental outcomes (e.g., knowledge, competencies, self-efficacy) and ultimate outcomes (e.g., decrease in challenging behavior) of the intervention were reported on children, families, and practitioners. This study represents the first in-depth evaluation of the social validity of PTR-YC in specialized public services for autism and demonstrates its appropriateness for universal implementation in this sector.

Cultivating a Culture of Patient Safety in Healthcare Settings: A Systematic Review of Evidence-Based Interventions

Background and purpose: Establishing a robust culture of safety is essential for enhancing health outcomes and minimizing risks to patients. This systematic review aims to synthesize interventions designed to enhance safety culture in healthcare settings. Methods: A comprehensive literature search was performed across multiple databases, including PubMed, CINAHL, and Scopus. The initial search yielded a total of 250 articles. After applying inclusion and exclusion criteria, which considered study design, population, and intervention type, 35 articles were shortlisted for full-text review. Ultimately, 21 studies met the final inclusion criteria, focusing on various interventions aimed at promoting safety culture. Results: The analysis revealed notable variation in the types of safety culture interventions implemented across the studies, with educational programs emerging as the most frequently adopted approach. The effectiveness of these interventions was found to be significantly influenced by both individual and systemic factors, highlighting the importance of contextual elements in promoting safety culture. Additionally, many interventions faced challenges related to sustainability and maintaining long-term impact, suggesting that ongoing support and resources are necessary for success. The review also indicated that the participation of nursing professionals in safety culture initiatives was often limited, despite their critical role in patient care, underscoring the need for strategies that engage this key group more effectively. Conclusion: The review underscores the necessity for targeted strategies that actively engage nursing professionals in safety culture initiatives to foster a safer healthcare environment. The findings serve as a valuable resource for policymakers and healthcare managers aiming to implement best practices for enhancing safety culture.

Charting Progress in the Science of Technical Assistance for Implementation of Evidence-Based Interventions.

Technical assistance (TA) has long been a strategy utilized to support implementation of a range of different evidence-based interventions within clinical, community and other service settings. Great progress has come in extending the evidence base to support TA's use across multiple contexts, the result of more extensive categorizing of implementation strategies to support systematic studies of their effectiveness in facilitating successful implementation. This commentary builds on that progress to suggest several opportunities for future investigation and collaborative activity among researchers, practitioners, policymakers and other key decision-makers in hopes of continuing to build the success highlighted in this special issue and elsewhere. Authors call for increased attention to operationalization and tailoring of TA, considering how TA services can be sustained over time and how to consider externally-provided TA versus that housed within an organization. In addition, the commentary suggests a few key areas for capacity-building that can increase the quality, reach, and impact of TA for the future.

An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework.

Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. The overall framework of this study was informed by the initial phase of the Medical Research Council's complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms.

The impact of austerity on the delivery of an NHS mentalisation-based therapy service

Historically, a group of people experiencing distress were largely viewed by health services as untreatable, because of a chronic sense of mistrust and difficulties in being cared for. This group of people have attracted labels such as ‘Emotionally Unstable Personality Disorder’ and ‘Complex Emotional Needs’. However, the recent developments in so-called evidenced-based psychological treatments offer hope that these patients can ‘recover’, or what one therapy has called ‘a life worth living’. It follows that these newer psychological treatments hold the promise of keeping hope alive, that even the most traumatised and disturbed people may be coached into functioning, and, perhaps more cynically, to reduce their burden on already-stretched health services. This cultural shift towards optimism is not the target of the paper. Instead, this paper offers an insider clinician’s perspective to outline how austerity has negatively affected the capacity to offer care and containment to patients presenting with life-threatening behaviours.

Dosing overground robotic gait training after spinal cord injury: a randomized clinical trial protocol

BackgroundRobotic exoskeletons have changed rehabilitation care available to people after spinal cord injury (SCI). Yet, the current evidence base is insufficient to identify the optimal dose and neurophysiological mechanism of robotic exoskeleton gait training (RGT) as an effective rehabilitation approach. This study will (1) examine whether the frequency of RGT after motor incomplete SCI impacts function and health outcomes, (2) analyze the neuroplastic effects of RGT dose, and (3) evaluate the safety, tolerability, and feasibility of delivering RGT.MethodsWe will enroll 144 participants with motor incomplete SCI admitted to inpatient rehabilitation within 6 months of SCI. Participants will be randomized based on injury severity and level into one of 3 RGT frequency groups (high, moderate, low) or none/usual care only. Participants will complete 24 RGT sessions and be assessed at admission and discharge to inpatient rehabilitation, post-RGT intervention, 1-month post-RGT, and 9-month post-SCI. Outcomes include Walking Index for Spinal Cord Injury-II, health outcomes (gait speed, Spinal Cord Independence Measure, pain, fatigue, spasticity, general health, quality of life, physical activity), and motor evoked potential amplitudes obtained using transcranial magnetic stimulation.DiscussionSuccessful completion of this study will provide an evidence-based intervention, specifically tailored to meet the unique needs of people with SCI, which supports walking recovery; maximizing health, function, and ultimately participation. The intervention will further support widespread clinical implementation of exoskeleton use during acute rehabilitation.Trial registrationClinicalTrials.gov NCT05218447. Registered on June 23, 2022.

Bidirectional association of sleep disorders with chronic kidney disease: a systematic review and meta-analysis.

Published studies have suggested a link between chronic kidney disease (CKD) and sleep disorders, although the exact nature of this association has not been uniformly described. Clarifying this relationship may facilitate evidence-based interventions that address the interplay between these disease entities. Such interventions could prevent obstructive sleep apnea (OSA) from worsening CKD and improve the quality of life for CKD patients by reducing the risk of developing OSA. Therefore, the objective of this meta-analysis is to assess the bidirectional association between sleep disorders and CKD. Following a PROSPERO-registered protocol, three blinded reviewers conducted a systematic review of the Medline/PubMed, Embase, Cochrane Library and Cumulative Index of Nursing and Allied Health (CINAHL) databases for observational studies pertaining to the relationship between sleep disorders and CKD. A meta-analysis was conducted in risk ratios (RRs). From 63 studies (26 777 524 patients), OSA [RR 1.68; 95% confidence interval (CI) 1.45 to 1.93], albuminuria (RR 1.54; 95% CI 1.18 to 1.99), restless leg syndrome (RLS) (RR 1.88; 95% CI 1.48 to 2.38) and insomnia (RR 1.24; 95% CI 1.01 to 1.54) were significantly associated with CKD. There was a significant association between OSA (RR 1.77; 95% CI 1.56 to 2.01) with incident CKD. There was a significant association of OSA (RR 1.74; 95% CI 1.55 to 1.96), RLS (RR 1.73; 95% CI 1.32 to 2.25) and insomnia (RR 1.14; 95% CI 1.03 to 1.27) in patients with CKD compared with healthy controls. CKD was also significantly associated with incident OSA (RR 1.60; 95% CI 1.35 to 1.89). The bidirectional associations of obstructive sleep apnea with CKD remained consistent across different stages of CKD, modes of diagnosis of sleep disorder and geographical region. A bidirectional association was observed between CKD and obstructive sleep apnea, RLS and insomnia. The treatment of sleep disorders may reduce the risk of CKD, and vice versa.

Life-Course Multidisciplinary Psychosocial Predictors of Dementia Among Older Adults: Results From the Health and Retirement Study.

Identifying predictors of dementia may help improve risk assessments, increase awareness for risk reduction, and identify potential targets for interventions. We use a life-course psychosocial multidisciplinary modeling framework to examine leading predictors of dementia incidence. We use data from the Health and Retirement Study to measure 57 psychosocial factors across 7 different domains: (i) demographics, (ii) childhood experiences, (iii) socioeconomic conditions, (iv) health behaviors, (v) social connections, (vi) psychological characteristics, and (vii) adverse adulthood experiences. Our outcome is dementia incidence (over 8 years) operationalized using Langa-Weir classification for adults aged 65+ years who meet criteria for normal cognition at the baseline when all psychosocial factors are measured (N = 1 784 in training set and N = 1 611 in testing set). We compare the standard statistical method (Logistic regression) with machine learning (ML) method (Random Forest) in identifying predictors across the disciplines of interest. Standard and ML methods identified predictors that spanned multiple disciplines. The standard statistical methods identified lower education and childhood financial duress as among the leading predictors of dementia incidence. The ML method differed in their identification of predictors. The findings emphasize the importance of upstream risk and protective factors and the long-reaching impact of childhood experiences on cognitive health. The ML approach highlights the importance of life-course multidisciplinary frameworks for improving evidence-based interventions for dementia. Further investigations are needed to identify how complex interactions of life-course factors can be addressed through interventions.

The Importance of Patient-Reported Outcome Measures (PROMs) in Oncological Vulvoperineal Defect Reconstruction: A Systematic Review.

Patient-reported outcome measures (PROMs) have gained increased importance in assessing outcomes after reconstructive surgery. This also applies to the reconstruction of vulvoperineal defects after resection of gynecological or colorectal cancers in women. The objective of this study is to analyze the current state of PROM tool use within this patient population. By systematic literature searches in Embase, Medline, and Web of Science, English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series reporting on vulvoperineal defect reconstruction, which were included if they also analyzed quality of life (QoL) and/or PROMs. The PROM tools used by each study were extracted, analyzed, and compared. The primary search yielded 2576 abstracts, of which 395 articles were retrieved in full text. Of these, 50 reported on vulvoperineal defect reconstruction, among which 27 studies analyzing QoL were found. Of those, 17 met the inclusion criteria for this systematic review. After full-text screening, 14 different PROM tools and 5 individual, non-standardized questionnaires were identified. Only 22% of studies used a validated PROM tool. Far too few studies currently use PROM tools to assess outcomes in oncological vulvoperineal defect reconstruction. Less than half of the used PROMs are validated. No PROM was designed to specifically measure QoL in this patient population. The standardized implementation of a validated PROM tool in the clinical treatment of this patient population is an essential step to improve outcomes, enable the comparison of research, and support evidence-based treatment approaches.

Development and Pilot Testing of Evidence-Based Interventions to Improve Adherence after Receiving a Genetic Result.

Previous research indicates that population genomic screening can benefit individuals who act on the genetic results. However, there remains a significant gap between individuals receiving genetic information and acting on current risk management recommendations, prompting exploration of interventions to close this gap. This study aimed to determine the feasibility and acceptability, and conduct a pilot implementation, of existing evidence-based interventions (EBIs) for adherence to disease management for select genetic conditions among individuals ascertained through a population genomic screening program. Surveys of and interviews with individuals who received a genomic screening result were conducted to assess barriers to guideline-recommended care and assess the acceptability of problem solving (PS) and motivational interviewing (MI) EBIs to facilitate adherence to recommendations. A Design Thinking Workshop was conducted with clinicians to co-develop a MI- and PS-based intervention that would fit with current workflows to be piloted. Post-pilot engagement sessions with implementers determined acceptability and feasibility of the MI/PS pilot program for clinical implementation and elicited proposed adaptations for improvement. PS and MI EBIs were reported to be acceptable and feasible to individuals with a result, and barriers to performing recommended management were identified. The pilot program included outreach by genetic counselors to individuals with a result, review of a checklist of barriers, and delivery of PS or MI as appropriate to facilitate care. The protocol as piloted was deemed acceptable and feasible for clinicians to deliver, with adaptations suggested. These results will inform an effectiveness trial to address gaps in adherence in patients who have received actionable genomic results.

Exploring characteristics and severity of road traffic injuries in Lebanon using emergency department hospital-based data

In Lebanon, the lack of quality data on road traffic injuries (RTIs) led to the implementation of a hospital-based RTI surveillance system by the Ministry of Health in in private and public-run hospitals in the Bekaa governorate. This paper aims to describe the characteristics and severity of RTIs recorded over two years during the pilot phase. It also assesses the strengths and challenges of the surveillance system, highlighting areas for enhancement. The data collected from the Emergency department (ED) was used to conduct a retrospective analysis of population-based injuries hospitalized for road traffic crashes (RTC). Designated focal persons reported injuries weekly using a standardized form, which included demographic and crash-related variables, body lesions, and vital signs. Data were coded per the International Classification of Diseases (ICD-10), entered into Epidata, and analyzed using SPSS. The RTI surveillance system was assessed using Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. Over two years, a total of 1576 cases of RTIs were reported. The male-to-female ratio was 2.16 and the majority of RTIs (44.4%) were recorded among those aged between 15 and 29 years old. From 2013 to 2015, a decrease of 0.7% in the revised trauma score (RTS < 4) was recorded. On the contrary, an increase of 3.9% in injury severity score (ISS) that ranged between 15 and 75 was reported. The probability of survival of an injured individual at one month was improved. The hospital-based surveillance system demonstrated strengths in structured data collection and ethical considerations but faced challenges like underreporting, limited coverage, and resource constraints. Recommendations for improvement include enhancing data quality and timely reporting, ultimately supporting evidence-based road safety interventions.

Perceived Pain in People Living with Amyotrophic Lateral Sclerosis-A Scoping Review.

(1) Background: Pain is a common symptom in patients with Amyotrophic Lateral Sclerosis (ALS). There are no evidence-based pharmacological treatments for pain in ALS; recommendations are based on guidelines for chronic non-oncological pain and clinical experience. The aim is to map the literature on how people with ALS experience pain, and how this affects their daily activities and social relationships. (2) Methods: This scoping review included studies concerning patients with spinal/bulbar ALS aged ≥ 18 years who experience pain, focusing on perception, characteristics, treatment, and impact on quality of life. Temporal and linguistic criteria were applied when searching the MEDLINE, CINAHL, and SCOPUS databases. (3) Results: The management of pain in these patients is complex and involves the use of anti-inflammatory drugs, analgesics, and opioids. Pain is associated with other conditions such as depression and anxiety, which contribute to a deterioration in the quality of life. Moreover, pain may also negatively influence patient compliance with prescribed treatment regimens and the quality of care they perceive themselves to be receiving. (4) Conclusions: It is of the most importance to identify effective ways to assess and treat this issue, with health care professionals taking an active role in this process.

The Michigan Collaborative for Type 2 Diabetes (MCT2D): Development and implementation of a statewide collaborative quality initiative

BackgroundType 2 diabetes (T2D) is one of the most prevalent chronic diseases worldwide and a leading cause of cardiorenal disease and mortality. Only one-third of individuals with T2D receive care as recommended by the American Diabetes Association’s clinical practice guidelines. Effective strategies are needed to accelerate the implementation of guideline concordant T2D care.MethodsThe Michigan Collaborative for Type 2 Diabetes (MCT2D) is a statewide population health collaborative quality initiative (CQI) developed to improve the care of all people with T2D in Michigan. MCT2D has developed a learning health system with physician organizations and their constituent practices to support quality improvement initiatives focused on (1) improving use of guideline-directed pharmacotherapy to improve cardiorenal outcomes, (2) increasing evidence-based use of continuous glucose monitoring, and (3) supporting use of lower carbohydrate eating patterns.ResultsBetween 2021 and 2022, MCT2D recruited 28 of the 40 Michigan-based physician organizations participating in Blue Cross’ Physician Group Incentive Program with 336 constituent practices and 1357 physicians in primary care (304), endocrinology (21) and nephrology (11). In January 2022, baseline data included a sample of 96,140 unique individuals with T2D. The baseline HbA1c was ≤ 7.0% for 66.3% of patients (n = 32,787), while 14.9% of patients had a most recent HbA1c ≥ 8.0% (n = 7,393). The most recent body mass index (BMI) was ≥ 30.0 for 64.8% of patients (n = 38,516).DiscussionMCT2D has organized a statewide collaborative to recruit and engage a diverse and large set of physician organizations and their constituent practices. This is a promising opportunity to accelerate adoption of guideline-concordant care for people with T2D and may be a model for other state or regional collaboratives. Future directions include specific evidence-based interventions targeted at reducing diabetes-linked comorbidities and associated healthcare costs as well as strategies focused on T2D prevention among at-risk populations.

Socioeconomic and behavioral factors of road traffic accidents among drivers in Ethiopia: systematic review and meta analysis

BackgroundRoad traffic accidents (RTAs) are a pressing public health issue in Ethiopia, exacerbated by rapid urbanization and motorization. Despite efforts, escalating rates persist due to various factors like human behavior and road infrastructure deficiencies. This study addresses the need for comprehensive data on RTAs in Ethiopia, aiming to uncover socioeconomic and behavioral factors to inform evidence-based policies.MethodsA systematic review and meta-analysis were conducted from March to April 2024, adhering to PRISMA guidelines. Major databases like Google Scholar, PubMed, and the Cochrane Library were searched using specific keywords related to RTAs and Ethiopia. Studies conducted between 2014 and 2024 were included, with eligibility criteria. Data extraction followed a standardized Microsoft Excel format. Study quality was assessed using the JBI checklist, with high-quality articles included. Statistical analysis, conducted using STATA version 17, included descriptive analysis, forest plots for RTA prevalence, and examination of publication bias using Egger and Begs tests. Subgroup analysis and meta-regression explored moderating factors and sources of heterogeneity.ResultsThe systematic review identified eight studies meeting inclusion criteria, conducted between 2014 and 2022. RTA prevalence was 36% (95% CI: 23; 49). Sensitivity analysis confirmed the robustness of the estimated prevalence. Publication bias was detected via Egger’s test, though Begg’s test was non-significant. Meta-regression found no significant influence of publication year or sample size on RTA prevalence. Socioeconomic factors like income level and driving experience, alongside behavioral factors like traffic rule violations and substance use, were identified as key drivers of RTAs in Ethiopia.ConclusionsThe study highlights the significant burden of road traffic accidents in Ethiopia, influenced by socioeconomic and behavioral factors. Socioeconomic factors such as income level and driving experience, along with behavioral factors like traffic rule violations and substance use, emerged as prominent determinants of RTAs. Policymakers should prioritize evidence-based interventions targeting these factors to improve road safety nationwide.

Management and Return to Play of the Elite Athlete for Common Sports-Related Injuries About the Foot

Foot injuries are one of the most commonly injured areas of the body in many collegiate and professional sports. The wide range of pathology, pathophysiology, mechanisms of injury, differences in sport demands, evolution of treatment, and variable return-to-play time lines make it difficult, at times, for physicians to treat these injuries. Modern diagnostic tools, surgical treatment devices, and rehabilitation protocols have allowed for more accurate and rapid diagnosis, an improved ability to reestablish normal anatomy, and accelerated return to play for many sports-related foot injuries. This summary will provide the most up-to-date, evidence-based treatment options for common sports-related foot injuries along with the authors’ preferred method of treatment and return-to-play algorithms for the elite athletes.

African American Patients' Perspectives on Determinants of Hemodialysis Adherence and Use of Motivational Interviewing to Improve Hemodialysis Adherence.

Compared to White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis non-adherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of AA hemodialysis patients on unique factors impacting dialysis adherence, and use of motivational interviewing, an evidence-based intervention, to improve these factors, dialysis adherence, and outcomes in AAs. Self-identified AA hemodialysis patients (N=22) watched a brief video describing motivational interviewing and then completed a semi-structured interview or focus group session. Interview questions explored unique barriers and facilitators of hemodialysis adherence in AAs, and perceived utility of motivational interviewing to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Three experienced coders independently coded the same two transcripts. Coding was compared and discrepancies were reconciled by a fourth coder or consensus. Transcripts, quotations, and codes were managed using Microsoft Excel 2016 and SPSS version 28.0. Themes and sub-themes emerged and culminated in a novel conceptual model informed by three theoretical models of behavior change: Theory of Self-Care Management for Vulnerable Populations; Social Cognitive Theory; and Self Determination Theory. This conceptual model will inform the design of a culturally tailored, motivational interviewing-based intervention to improve dialysis adherence in AAs. Integrating AA hemodialysis patient perspectives is critical for enhancing dialysis care delivery and the design of effective interventions such as motivational interviewing to improve dialysis adherence in AA and promote kidney health equity. AA hemodialysis patients view motivational interviewing as a tool to clarify patient priorities, build trust, and promote patient-provider therapeutic alliance. Cultural tailoring of motivational interviewing to address unique barriers of AAs with kidney failure will improve adherence and health outcomes in these vulnerable patients.