Strong Research Evidence Research Articles

A qualitative study of how clinicians reach agreement in perioperative pathway development: the Consensus Model for Standardising Healthcare.

Variation in perioperative care persists globally. Consensus discussions may facilitate standardisation, yet the processes used to reach agreement are poorly understood. This study aimed to develop a model for conducting local consensus discussions when implementing standardised perioperative pathways. Specifically, we 1) describe how local consensus discussions are operationalised; 2) identify what guides decision making and consensus between clinicians; and 3) formulate explanatory mechanisms and identify determinants that facilitate consensus discussions. A qualitative, modified grounded theory study was conducted in one private hospital in metropolitan Sydney, Australia. Thirty-one participants from clinical disciplines and hospital management/leadership were included. Data were collected from nine semi-structured interviews and 16h of participant observations during consensus development or implementation meetings. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Interviews and field notes were recorded and transcribed verbatim. Data were analysed using coding, constant comparison, detailed memo writing and data interpretation. Seven individual and contextual factors crucial for building consensus, and eight mechanisms for reaching agreement were identified and integrated into a conceptual model. Seeking evidence to support decision-making emerged as the primary driver of consensus. Strong research evidence in support of a pathway component facilitated swift agreement. Where there was ambiguous evidence for a pathway component, clinicians based their decisions on a desire for professional autonomy, consideration of how their peers practice, patient preferences, practices from external organisations, or the feasibility of implementing the pathway component. The Consensus Model for Standardising Healthcare provides a map for healthcare organisations seeking to conduct local consensus discussions to reduce variation in care. Our findings advance our understanding of how local consensus discussions are conducted and factors that impact success when standardising care amongst clinicians.

A More Nuanced Story: Pediatric Gender-Affirming Healthcare is Associated With Satisfaction and Confidence

A More Nuanced Story: Pediatric Gender-Affirming Healthcare is Associated With Satisfaction and Confidence

A service evaluation study of the impact of ageless policy in a London inner-city early intervention in psychosis service.

Schizophreniform disorders tend to have an early onset. Early intervention in psychosis (EIP) services aim to provide early treatment, reduce long-term morbidity and improve social functioning. In 2016, changes to mental health policy in England mandated that the primarily youth-focused model should be extended to an ageless one, to prevent ageism; however, this was without strong research evidence. An inner-city London EIP service compared sociodemographic and clinical factors between the under-35 years and over-35 years caseload cohorts utilising the EIP package following the implementation of the ageless policy. Both groups received similar care, despite the younger group having significantly more clinical morbidity and needs. Our results may indicate that service provisions are being driven by policy rather than clinical needs, potentially diverting resources from younger patients. These findings have important implications for future provision of EIP services and would benefit from further exploration.

Adherence to PRISMA 2020 reporting guidelines and scope of systematic reviews published in nursing: A cross-sectional analysis.

Systematic reviews are considered the highest level of evidence that can help guide evidence-informed decisions in nursing practice, education, and even health policy. Systematic review publications have increased from a sporadic few in 1980s to more than 10,000 systematic reviews published every year and around 30,000 registered in prospective registries. A cross-sectional design and a variety of data sources were triangulated to identify the journals from which systematic reviews would be evaluated for adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines and scope. Specifically, this study used the PRISMA 2020 reporting guidelines to assess the reporting of the introduction, methods, information sources and search strategy, study selection process, quality/bias assessments, and results and discussion aspects of the included systematic reviews. Upon review of the 215 systematic reviews published in 10 top-tier journals in the field of nursing in 2019 and 2020, this study identified several opportunities to improve the reporting of systematic reviews in the context of the 2020 PRISMA statement. Areas of priority for reporting include the following key areas: (1) information sources, (2) search strategies, (3) study selection process, (4) bias reporting, (5) explicit discussion of the implications to policy, and lastly, the need for (6) prospective protocol registration. The use of the PRISMA 2020 guidelines by authors, peer reviewers, and editors can help to ensure the transparent and detailed reporting of systematic reviews published in the nursing literature. Systematic reviews are considered strong research evidence that can guide evidence-based practice and even clinical decision-making. This paper addresses some common methodological and process issues among systematic reviews that can guide clinicians and practitioners to be more critical in appraising research evidence that can shape nursing practice.

The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial.

The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone's location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. OSF Registries osf.io/egn3z; https://osf.io/egn3z. PRR1-10.2196/57280.

Feasibility and Effectiveness of Objective Structured Clinical Examination in Indian Collegiate Nursing Programme

Objective: This study was aimed to assess the feasibility and effectiveness of OSCE as an assessment method with an initial exploration of faculty perception on traditional clinical examination (TCE) followed by comparing the feedback on OSCE and TCE among Post Graduate Nursing students. Methods: Needs assessment was conducted to gather necessary evidence before we incorporated OSCE. After ethics approval, as a first step, extensive focus group discussions (FGD) were conducted among 38 faculty members on the existing system of case-based clinical examination. We also identified a group of 30 post graduates who had underwent an OSCE session as part of their academic requirements. A modified, validated version of Examination Feedback Questionnaire was utilized, which is a 22 item five point likert scale with questions in three sections namely, Overall exam evaluation (10 items), Quality of performance testing (8 items) and Validity- reliability (4 items). Students were asked to rate their feedback on TCE and OSCE using the same questionnaire. Results: Faculty members had real concerns on the way the TCEs were conducted. The main themes emerged are ambiguous task assignment, non-standardized patients, task overload, examiner burden and time constraints. The students’ overall feedback scores on OSCE were better when compared to TCE (p <0.001) with higher scores on all three sections of the tool. Conclusion: OSCE is a preferred and feasible method of assessment in the selected set-up, inclusive of advanced learners. It is also inferred that strong and evocative research evidence makes the implementation of an innovative curricular change enduring and meaningful.

Circadian misalignment impairs oligodendrocyte myelination via Bmal1 overexpression leading to anxiety and depression‐like behaviors

AbstractCircadian misalignment (CM) caused by shift work can increase the risk of mood impairment. However, the pathological mechanisms underlying these deficits remain unclear. In the present study, we used long‐term variable photoperiod (L‐VP) in wild‐type mice to better simulate real‐life shift patterns and study its effects on the prefrontal cortex (PFC) and hippocampus, which are closely related to mood function. The results showed that exposure to L‐VP altered the activity/rest rhythms of mice, by eliciting phase delay and decreased amplitude of the rhythms. Mice with CM developed anxiety and depression‐like manifestations and the number of mature oligodendrocytes (OL) was reduced in the medial prefrontal cortex and hippocampal CA1 regions. Mood impairment and OL reduction worsened with increased exposure time to L‐VP, while normal photoperiod restoration had no effect. Mechanistically, we identified upregulation of Bmal1 in the PFC and hippocampal regions of CM mice at night, when genes related to mature OL and myelination should be highly expressed. CM mice exhibited significant inhibition of the protein kinase B (AKT)/mTOR signaling pathway, which is directly associated to OL differentiation and maturation. Furthermore, we demonstrated in the OL precursor cell line Oli‐Neu that overexpression of Bmal1 inhibits AKT/mTOR pathway and reduces the expression of genes OL differentiation. In conclusion, BMAL1 might play a critical role in CM, providing strong research evidence for BMAL1 as a potential target for CM therapy.

The built environment and child obesity: A review of Australian policies.

Child obesity is a serious public health challenge affected by both individual choice and societal and environmental factors. The main modifiable risk factors for child obesity are unhealthy eating and low levels of physical activity, both influenced by aspects of the built environment. Coordinated government policy across jurisdictions, developed using strong research evidence, can enable built environments that better support healthy lifestyles. This study reviewed current Australian and Western Australian government policies to understand if and how they address the impact of the built environment on child obesity, physical activity, sedentary behavior, and diet. Current government policy documents related to the built environment and child health were analyzed using the Comprehensive Analysis of Policy on Physical Activity framework. Ten Australian and 31 Western Australian government policy documents were identified. Most referred to the role of the built environment in supporting physical activity. Very few policies mentioned the built environment's role in reducing sedentary behaviors, supporting healthy eating, and addressing obesity. Few recognized the needs of children, and none mentioned children in policy development. Future government policy development should include the voices of children and child-specific built environment features. Inter-organizational policies with transparent implementation and evaluation plans are recommended.

Evidence-Based Expository Intervention: A Tutorial for Speech-Language Pathologists.

This tutorial guides speech-language pathologists (SLPs) through the research base for expository intervention and evidence-based decision making for clinical implementation. In the first half of the tutorial, the nature and development of expository discourse is described, and then attention is turned to the research base that informs SLP expository intervention. The many educational domains in which relevant research can be found and the diverse terminology used are explained. From reading comprehension and compositional writing, two areas with strong research evidence that are suitable to SLP use-text structure and learning strategies-are identified. The second half of the tutorial focuses on crafting SLP interventions from the educational evidence. An expository intervention designed specifically for SLPs from this research base, called Sketch and Speak, is presented. In this intervention, visual and written note-taking strategies are combined with oral formulation and practice strategies and taught through individualized oral interactions around informational texts. SLPs are guided on how to adapt this and other expository treatments to their own priorities and service delivery situations while maintaining quality features or "active ingredients" of researched treatments. There is considerable educational research on expository intervention. From this literature, SLPs can strategically adopt and adapt to implement evidence-based interventions to help students understand, speak, and write in this important discourse form.

Internet-Based Versus Face-to-Face Cognitive-Behavioral Therapy for Social Anxiety Disorder: A Randomized Control Trial

Internet-Based Versus Face-to-Face Cognitive-Behavioral Therapy for Social Anxiety Disorder: A Randomized Control Trial

Migration and Social Work: Approaches, Visions and Challenges, Emilio José Gómez-Ciriano, Elena Cabiati and Sofia Dedotsi

I acknowledge the children and adults who, having experienced hostility around immigration, chose to share their stories. In doing so they enabled the authors to amplify their voices and offer sharp focus on the issues surrounding refugees, asylum seekers and migrants (RASM). The structure and readability of the book makes much of the text accessible, enabling the reader to understand the need for solidarity with people affected by borders. Strong ethics are demonstrated in each chapter, with a consistent, hopeful message that social workers can make a difference in how they manage individual case work and by challenging oppressive, hostile practices, harmful organisational decision making and inhumane application of policies. This book makes it clear that social workers are positioned to see and understand what is happening to RASM though a unique lens. Communicating this perspective could change the way migrants are perceived and treated, but especially, the authors assert, if we use research in a way that informs social work education, direct practice, policies and politics. Presented as a collection of eleven essays, the book offers strong practice and research evidence to aid understanding and clarity regarding why people migrate, for instance poverty, war and persecution.

UNICEF’S Rights Respecting Schools Award as children’s human rights education

Children’s human rights education is a complex area for schools to handle. Therefore, it is not uncommon for schools and teachers to seek guidance from actors outside school. This article examines UNICEF UK’s Rights Respecting Schools Award with the aim of shedding light on ways in which the programme can support successful work with children’s human rights education. The programme’s main aims are identified, and research about the programme is examined to determine to what extent the aims seem to be achieved in schools that use it. The analysis shows that the programme holds good potential to support successful work with children’s HRE, but that some areas of the programme need to be developed to provide a full HRE. A lack of strong research evidence for a programme effect is also noted.

High Intensity Gait Training for Patient With Apraxia Following Ischemic and Hemorrhagic Stroke

High Intensity Gait Training for Patient With Apraxia Following Ischemic and Hemorrhagic Stroke

Are Dietary Supplements, Harmful or Good for Athletes?

Athletes are bombarded with nutritional/dietary supplements (NSs/DSs) that promise to improve health, function, and performance. Many of these claims, however, are based on little evidence, and the efficacy and safety of many products are debatable. A review of doping, risk factors, protective factors, performance enhancement, sports performance, dietary supplements, nutritional supplements (NSs), and health consequences was completed using PubMed, Google Scholar, Web of Science, and Science Direct. The inclusion criteria were studies published up until June 2021, which analyzed the content of nutritional/dietary substances and their influence on sports performance. Seventy-three review articles were included in this review. In summary, supplementation will always be a part of athletes’ careers due to its perception of ergogenic capabilities, and there is evidence of some dietary nutritional supplements DSs/NSs substances supporting performance enhancement and recovery. However, there is data that due to real harm and unethical manufacturing and marketing practices, some products may contain unwanted/illegal substances. Athletes should be aware of the risk of being tested positive due to contamination of NSs/DSs with a World Anti-Doping Agency (WADA)-banned substance. Athletes and coaches should stick only to supplements that show strong research evidence supporting sports performance and safety use.

Homelessness duration and stability: A typology of emergency accommodation usage patterns in Dublin

This article presents an analysis of data on the use of emergency accommodation (EA) by single homeless people in Dublin, Ireland between 2016 and 2018. The objective is to reflect on, test and critique the use of administrative data in research on homelessness heretofore in Ireland and internationally. The article focuses on Culhane, Kuhn and colleagues' ground-breaking analysis of data on single adult users of homeless shelters. Their typology focuses on ‘homelessness episodes’, which may disguise important patterns in EA usage and lead to the mis-categorisation of some shelter residents. As an alternative, the analysis of EA usage in Dublin presented in this article focuses on transitions into and out of EA and the stability of EA usage between these transitions. This design is grounded in strong research evidence which indicates that stability of EA usage is a critical consideration in terms of successful exit from homelessness. Applying this design to our dataset on EA usage in Dublin between 2016 and 2018 reveals four clear EA usage patterns – short stay, medium stay, long stay inconsistent and long stay stable. We believe that this four-part typology more accurately represents patterns of EA use in Dublin in recent years.

Recruiting Military Veterans into Alcohol Misuse Research: The Role of Social Media and Facebook Advertising.

Background: The use of digital technology within health care service delivery, monitoring, and research is becoming progressively popular, particularly given the ongoing COVID-19 pandemic. Mobile health (m-health) apps, one form of digital technology, are increasingly being used to promote positive health related behavior change. Therefore, it is important to conduct research to understand the efficacy of m-health apps. The process of participant recruitment is an essential component in producing strong research evidence, along with ensuring an adequately powered sample to conduct meaningful analyses and draw robust conclusions. Methods: In this work we outline and reflect on the strategies used to recruit help-seeking military veterans into an intervention study, which aimed to evaluate the efficacy of an app (Drinks:Ration) to modify behavior in alcohol misusers. Recruitment strategies included through (1) partner organizations and (2) social media and Facebook advertising (ads). Results: Facebook ads were live for a period of 88 days and were viewed by a total audience of 29,416 people. In total 168 military veterans were recruited across all recruitment strategies, meaning that Drinks:Ration exceeded its recruitment targets. Half of the sample (n = 84) were recruited through social media, including Facebook ads. Conclusions: The current article highlighted that targeted Facebook ads were an efficient strategy to recruit military veterans into a digital intervention trial aiming to reduce alcohol consumption because they reduced the amount of time and resources required to contact a large number of potentially eligible individuals for our study. This article acts as a starting point for other researchers to evaluate their recruitment pathways for recruiting military veterans into alcohol misuse research.

Why some do but too many don\u2019t? Barriers and enablers to physical activity in regional Tasmania \u2013 an exploratory, mixed-methods study

BackgroundThe interconnectedness of physical inactivity and sedentarism, obesity, non-communicable disease (NCD) prevalence, and socio-economic costs, are well known. There is also strong research evidence regarding the mutuality between well-being outcomes and the neighbourhood environment. However, much of this evidence relates to urban contexts and there is a paucity of evidence in relation to regional communities. A better understanding of available physical activity (PA) infrastructure, its usage, and community perceptions regarding neighbourhood surroundings, could be very important in determining requirements for health improvement in regional communities. The aims of this research were to 1. Explore and evaluate the public’s perception of the PA environment; and 2. Evaluate the quantity, variety, and quality of existing PA infrastructure in regional Northwest (NW) Tasmania.MethodsA mixed methods approach guided data collection, analysis, and presentation. Quality of PA infrastructure was assessed using the Physical Activity Resource Assessment (PARA) instrument and public perception about PA environment was evaluated using the International Physical Activity Questionnaire – Environmental (IPAQ-E) module. Quantitative data were analysed using descriptive summative methods and a team-based researcher triangulation approach was utilised for qualitative data.ResultsOverall, a wide array of high-quality PA infrastructure (with minimal incivilities such as auditory annoyance, litter, graffiti, dog refuse, and vandalism etc.) was available. Survey respondents rated neighbourhoods positively. The overall quality of PA infrastructure, rated on a scale from 0 to 3, was assessed as high (all rated between 2 to 3) with minimal incivilities (rated between 0 and 1.5). Of note, survey respondents confirmed the availability of numerous free-to-access recreational tracks and natural amenities across the 3 local government areas (LGAs) studied. Importantly, most respondents reported minimal disruption to their routine PA practices due to the COVID-19 pandemic.ConclusionThis exploratory research confirmed the availability of a wide range of high-quality PA infrastructure across all three LGAs and there was an overwhelming public appreciation of this infrastructure. The challenge remains to implement place-based PA interventions that address extant barriers and further increase public awareness and utilisation of high-quality PA infrastructure.

Children's exposure to polycyclic aromatic hydrocarbon (PAHs): a review on urinary 1-hydroxypyrene and associated health effects.

This article reviewed the published studies on theenvironmental exposure to polycyclic aromatic hydrocarbons (PAHs) among children and assessed the urinary 1-hydroxypyrene (1-OHP) level as a biomarker of exposure to PAHs. The current knowledge of the potential health effects of increased 1-OHP in children was reviewed. Additionally, the influence of genetic polymorphism on the urinary 1-OHP level was discussed in this review. The assembled data showed that children who are attending schools or living close to industrial and polluted urban areas might have greater exposure to higher concentrations of PAHs with a higher level of urinary 1-OHP when compared to those children living in rural areas. Urinary 1-OHP may be a reliable biomarker for determining the genotoxic effects, oxidative stress and inflammation caused by exposure to PAHs. Strong research evidence indicated that the total body burden of PAHs should be evaluated by biomonitoring of 1-OHP in line with other urinary PAHs metabolites (with 2-3 rings) to evaluate recent total exposure to PAHs. Overall, the study suggests implementing a mitigation plan to combat air pollution to provide a cleaner environment for children.

Reductive Stress and Male Infertility.

Male infertility research and clinical advances had vast progress in the last few decades. Strong research evidence underpinned the concepts of oxidative stress (OS)-mediated male reproductive disruptions, which bear answers to several cases of idiopathic male infertility. Antioxidant treatment held the prime solution for OS-mediated male infertility. But excess use of antioxidants is challenged by the research breakthrough that reductive stress also predisposes to male infertility, resolutely instituting that any biological extremes of the redox spectrum are deleterious to male fertility. Superfluity of reducing agents may hinder essential oxidation mechanisms, affecting physiological homeostasis. These mechanisms need to be explicated and updated time and again to identify the fine thread between OS-mediated male infertility treatment and induction of reductive stress. This chapter thus presents the evidence-based concepts pertaining to the antioxidants actions to combat OS-induced male infertility, the mechanism of induction of reductive stress and its impact on male reproduction.

Down-regulation of BMAL1 by MiR-494-3p Promotes Hepatocellular Carcinoma Growth and Metastasis by Increasing GPAM-mediated Lipid Biosynthesis.

The circadian clock confers daily rhythmicity to many crucial biological processes and behaviors and its disruption is closely associated with carcinogenesis in several types of cancer. Brain and muscle arnt-like protein 1 (BMAL1) is a core circadian rhythm component in mammals and its dysregulation has been shown to contribute to aberrant metabolism in human diseases. However, the biological functions of BMAL1, especially its involvement in aberrant lipid metabolism in hepatocellular carcinoma (HCC), remain elusive. In the present study, we found that BMAL1 was frequently down-regulated in HCC cells mainly due to the up-regulation of miR-494-3p. Down-regulation of BMAL1 was significantly associated with poor survival in HCC patients. BMAL1 down-regulation promoted HCC cell growth and metastasis both in vitro and in vivo. Mechanistically, through cooperating with EZH2, BMAL1 transcriptionally suppressed the expression of glycerol-3-phosphate acyltransferase mitochondrial (GPAM), a key enzyme involved in the regulation of lipid biosynthesis, leading to reduced levels lysophosphatidic acid (LPA), which have long been known as mediator of oncogenesis. Particularly, treatment with SR8278, an activator of BMAL1, exhibited a therapeutic effect on HCC in vitro and in vivo. In conclusion, BMAL1 plays a critical anti-oncogenic role in HCC, providing strong research evidence for BMAL1 as a prospective target for HCC therapy.