Use Of Evidence-based Strategies Research Articles

Effects of Self-Monitoring on the Praise Rates of Paraprofessionals for Students with Emotional and Behavioral Disorders

The limitations and challenges of paraprofessional training are well documented. These issues are magnified by the increasing reliance on paraprofessionals to provide vital support for students with emotional and behavioral disorders (EBD). Despite evidence supporting self-monitoring for improving teacher and paraprofessional skills, there are limited demonstrations of how paraprofessionals improve their use of evidence-based strategies through self-monitoring. This study examined the effects of self-monitoring on paraprofessionals’ total use of praise and behavior-specific praise. A first exploratory item included the extent to which any increases in praise covaried with paraprofessional use of reprimands. A second exploratory item determined whether any changes in praise covaried with the engagement and disruptive behavior of their students with EBD. Self-monitoring was associated with increased total praise, a moderately increased use of behavior-specific praise, and improvements in student engagement along with decreases in student disruptive behavior. Implications for behavioral interventions for students with EBD are discussed.

Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England

BackgroundBleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals.MethodsRetrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged ≥18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics.ResultsThe study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001).ConclusionsAmong English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery.

Associations Among Professional Development, Teachers’ Use of Naturalistic Language Strategies, and Preschoolers’ Functional Communication

ABSTRACTResearch Findings: Naturalistic instruction is the intentional use of strategies embedded within typical activities of the environment to create learning opportunities for children. We used multilevel modeling to analyze data from this single-case design study that focused on improving teachers’ use of naturalistic language strategies and children’s communication through professional development with bug-in-ear coaching. Our results showed that professional development was positively associated with children’s communication during and after professional development. During generalization sessions in different types of activities, teachers’ use of the naturalistic language strategies was positively associated with children’s functional communication. We also found that children were more likely to communicate during child-led activities. Practice or Policy: Associations among professional development, teachers’ use of evidence-based strategies, and children’s outcomes have yet to be fully understood. Administrators and professional development providers should support teachers’ use of naturalistic language strategies to create equitable exposure to language-learning opportunities for all children. Moreover, professional development efforts should support teachers’ intentional use of child-led activities to embed language-learning opportunities based on children’s interests. Finally, to strengthen children’s generalization of skills across routines, professional development providers should identify methods to support teachers’ generalized use of strategies within the typical activities of the setting.

Immunization Practices of U.S. Obstetrician/Gynecologists for Pregnant Patients

U.S. obstetrician/gynecologists play a critical role as vaccinators of pregnant women. However, little is known about their current immunization practices. Thus, study objectives were to determine (1) practices related to assessment of vaccination status and vaccine delivery for pregnant patients; (2) barriers to stocking and administering vaccines; and (3) factors associated with administering both influenza and tetanus, diphtheria, and acellular pertussis (Tdap) vaccines. An e-mail and mail survey among a national sample of obstetrician/gynecologists conducted July-October 2015 (analysis August 2016-August 2017). The response rate was 73.2% (353/482). Among obstetrician/gynecologists caring for pregnant women (n=324), vaccination status was most commonly assessed for influenza (97%), Tdap (92%), and measles, mumps, and rubella vaccines (88%). Vaccines most commonly administered included influenza (85%) and Tdap (76%). Few respondents reported administering other vaccines to pregnant patients. More physicians reported using standing orders for influenza (66%) than Tdap (39%). Other evidence-based strategies for increasing vaccine uptake were less frequently used (electronic decision support, 42%; immunization information system to record [13%] or assess vaccination status [11%]; reminder/recall, 7%). Barriers most commonly reported were provider financial barriers, yet provider attitudinal barriers were rare. Providers who administered both influenza and Tdap vaccines were more likely to be female, perceive fewer financial and practice barriers, less likely to be in private practice, and perceive more patient barriers. Although most obstetrician/gynecologists administer some vaccines to pregnant women, the focus remains on influenza and Tdap. Financial barriers and infrequent use of evidence-based strategies for increasing vaccination uptake may be hindering delivery of a broader complement of adult vaccines in obstetrician/gynecologist offices.

Can We Identify Minority Patients at Risk of Nonadherence to Antiplatelet Medication at the Time of Coronary Stent Placement?

Lack of medication adherence is associated with significant morbidity and mortality, particularly among minorities. We aim to identify predictors of nonadherence to antiplatelet medications at the time of percutaneous coronary intervention (PCI) with stent among African American and Hispanic patients. We used data collected for a randomized clinical trial that recruited 452 minority patients from a large US health insurance organization in 2010 post-PCI to compare telephone-based motivational interviewing by trained nurses with an educational video. The primary outcome was 12-month adherence to antiplatelet medications measured by the claims-based medication possession ratio (MPR). Adequate adherence was defined as an MPR of 0.80 or higher. More than half of the sample (age, 69.52 ± 8.8 years) was male (57%) and Hispanic (57%). Most (78%) had a median income below $30 000 and 22% completed high school or higher. Univariate analyses revealed that symptoms of depression (<.01) and not having a spouse (P = .03) were associated with inadequate adherence. In multivariate analysis, baseline self-reported adherence (1.4; 95% confidence interval [CI], 1.05-1.89), depressive symptoms (0.49; 95% CI, 0.7-0.90), comorbidity (0.89; 95% CI, 0.80-0.98), and telephone-based motivational interviewing by trained nurses (3.5; 95% CI, 1.9-2.70) were associated with adherence. Having multiple comorbidities, depression, suboptimal adherence to medications, and low English proficiency at the time of PCI increase the risk of poor 12-month adherence to antiplatelets among minorities. Identifying these risk factors can guide PCI therapy and the use of evidence-based strategies to improve long-term adherence.

Current and Binge Drinking Among High School Students - United States, 1991-2015.

Excessive drinking accounted for approximately 4,300 deaths each year among persons aged <21 years during 2006-2010,* and underage drinking cost the United States $24.3 billion in 2010 (1). CDC analyzed data from the national Youth Risk Behavior Survey (YRBS) for the years 1991-2015 to examine trends in drinking by U.S. high school students, and from the 2015 YRBS to assess the usual source of alcohol consumed† and binge drinking intensity (i.e., the average number of drinks consumed per binge drinking occasion).§ During 1991-2007, the prevalence of current drinking¶ among high school students declined significantly, from 50.8% (1991) to 44.7% (2007), and then significantly declined to 32.8% in 2015. The prevalence of binge drinking** increased from 31.3% in 1991 to 31.5% in 1999, and then significantly declined to 17.7% in 2015. Most high school students who drank were binge drinkers (57.8%), and 43.8% of binge drinkers consumed eight or more drinks in a row. Despite progress, current drinking and binge drinking are common among high school students, and many students who binge drink do so at high intensity (i.e., eight or more drinks in a row). Widespread use of evidence-based strategies for preventing excessive drinking (e.g., increasing alcohol taxes, regulating alcohol outlet density, and having commercial host liability laws) could help reduce underage drinking and related harms.††.

A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team.

Multiple randomized controlled trials have demonstrated that mailed fecal testing programs are effective in increasing colorectal cancer screening participation. However, few healthcare organization in the US have Implemented such programs. Stakeholders from one clinic in an integrated healthcare system in Washington State initiated collaboration with researchers with expertise in CRC screening, aiming to increase screening rates at their clinic. Age-eligible individuals who were overdue for CRC screening and had previously completed a fecal test were randomized to receive mailed fecal immunochemical test kits (FIT) at the start of the project (Early) or 6 months later (Late). Outcomes included comparing FIT completion at 6 months by randomization group, and overall CRC screening rates at 12 months. We also assessed implementation facilitators and challenges. Overall 2,421 FIT tests were mailed at a cost of $10,739. At 6 months, FIT completion was significantly higher among the Early compared to the Late group (62% vs.47%, p <0.001). By 12 months, after both groups had received mailings, 71% in each group had completed a FIT. The clinic's overall CRC screening rate was 75.1% at baseline and 78.0% 12 months later. Key constructs associated with successful program implementation included strong stakeholder involvement, use of evidence-based strategies, simplicity, and low cost. Challenges included lack of a plan for maintaining the program. Collaboration between clinic stakeholders and researchers led to a successful project that rapidly increased CRC screening rates. However, institutional normalization of the program would be required to maintain it.

Childcare Providers' Use of Practices to Promote Young Children's Social–Emotional Competence

Findings are presented regarding childcare providers' use of evidence-based strategies to promote preschoolers' social–emotional competence in 38 urban childcare classrooms. Descriptive results from classroom observations and childcare teachers' interviews indicated that in the absence of training, childcare teaching staff implemented few of these strategies. Teachers also reported a lack of infrastructure elements such as professional development, a leadership team, data-based tools for decision making, and monetary resources that are associated with the adoption and sustained use of strategies. Findings are described and recommendations are presented to support implementation of practices associated with young children's social–emotional competence in childcare settings.

Teachers Engaging Parents as Reading Tutors

This study examined the application of evidence-based tutoring for oral reading fluency (ORF) to a natural setting, using teachers as parent trainers. Three teachers were trained in a 3-h workshop to develop individualized tutoring programs with parents. Following training, the teachers trained four parents to use individualized tutoring programs. A multiple-baseline design was used to evaluate the effects of teacher training on parents’ use of evidence-based reading strategies. Students’ ORF outcomes were also measured at pre and post. Following training, three parents showed immediate improvement in their use of evidence-base strategies. Parent tutoring produced some improvements in students’ ORF. Results are discussed in terms of the importance of teachers engaging parents as active participants in their child’s learning. Discussion focuses on the need for additional research in natural settings to more closely examine the conditions needed for successful implementation of parent-tutoring programs.

Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol.

BackgroundReducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, “RLAS” (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes.Methods/DesignMixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science.Trial registrationClinicalTrials.gov, NCT02875535 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0507-2) contains supplementary material, which is available to authorized users.

Early Intervention Practices for Children With Hearing Loss

Early identification and appropriate intervention services for children who are deaf or hard of hearing significantly increase the likelihood of better language, speech, and social-emotional development. However, current research suggests that there is a critical shortage of professionals trained to provide early intervention services to deaf and hard of hearing infants and toddlers. In an effort to address the shortage, Illinois State University designed an interdisciplinary program aimed at providing the coursework and training needed by professionals to effectively serve infants and toddlers with hearing loss. The current study sought to evaluate the competencies of graduate students employing evidence-based strategies in listening and spoken language development following the completion of the program. It was hypothesized that the training program would lead to an increase in the use of evidence-based early intervention strategies specific to infants and toddlers with hearing loss and an increase in the frequency of their use. The results of the current study did not suggest that there was a significant difference in the use of evidence-based strategies following the completion of coursework; however, they did indicate that the interventionists involved were utilizing the strategies in both the home and the clinic-based setting.

An Evidence-based Project to Improve Influenza Immunization Uptake

Influenza, a severe acute respiratory illness, infects between 5% and 20% of the United States population annually. Immunization is recognized as the best protection against influenza. The US Centers for Disease Control and Prevention has recommended annual immunization (> 6 months); however, < 42% of the population and < 20% of college students receive an annual vaccination. An evidence-based awareness project was implemented in a college health setting to increase the number of influenza vaccinations administered. The number of students vaccinated at the college increased by 226%. The use of evidence-based strategies by college health practitioners can target health messages to increase student awareness.

Evidence-based strategies to support children’s emergent literacy in the Gulf Cooperation Council (GCC) countries

This study was designed to examine teachers’ reported use of evidence-based strategies to support children’s emergent literacy in Arab countries of the Gulf Cooperation Council (GCC). The study participants comprised 644 kindergarten teachers from four countries, including Saudi Arabia (n = 154), Qatar (n = 105), United Arab Emirates (UAE) (n = 190), and Oman (n = 195). The researchers designed a 29-items questionnaire that addressed five dimensions, examining evidence-based strategies that support emergent literacy: phonological awareness, knowledge and understandings of books and other texts, print awareness, knowledge of letters and words, and early writing. The results showed that teachers reported higher use of strategies concerning knowledge of letters and words, followed by those concerning print awareness. In addition, they reported lower use of strategies concerning early writing. Moreover, teachers in the UAE reported higher use of strategies in support of emergent literacy followed by teachers in Qatar and Oman, whereas teachers in Saudi Arabia reported lower use of evidence-based strategies. Finally, statistically significant differences were found regarding teachers’ use of emergent literacy strategies due to teachers’ demographic background. Implications for future research are discussed, and they include highlighting evidence-based emergent literacy strategies in early years settings in the GCC countries as well as expanding the scope of the study to include samples from different contexts.

The diffusion of evidence-based decision making among local health department practitioners in the United States.

Evidence-based decision making (EBDM) is the process, in local health departments (LHDs) and other settings, of translating the best available scientific evidence into practice. Local health departments are more likely to be successful if they use evidence-based strategies. However, EBDM and use of evidence-based strategies by LHDs are not widespread. Drawing on diffusion of innovations theory, we sought to understand how LHD directors and program managers perceive the relative advantage, compatibility, simplicity, and testability of EBDM. Directors and managers of programs in chronic disease, environmental health, and infectious disease from LHDs nationwide completed a survey including demographic information and questions about diffusion attributes (advantage, compatibility, simplicity, and testability) related to EBDM. Bivariate inferential tests were used to compare responses between directors and managers and to examine associations between participant characteristics and diffusion attributes. Relative advantage and compatibility scores were high for directors and managers, whereas simplicity and testability scores were lower. Although health department directors and managers of programs in chronic disease generally had higher scores than other groups, there were few significant or large differences between directors and managers across the diffusion attributes. Larger jurisdiction population size was associated with higher relative advantage and compatibility scores for both directors and managers. Overall, directors and managers were in strong agreement on the relative advantage of an LHD using EBDM, with directors in stronger agreement than managers. Perceived relative advantage has been demonstrated to be the most important factor in the rate of innovation adoption, suggesting an opportunity for directors to speed EBDM adoption. However, lower average scores across all groups for simplicity and testability may be hindering EBDM adoption. Recommended strategies for increasing perceived EBDM simplicity and testability are provided.

Using community health needs assessments to improve population health.

This commentary describes the community health assessment process that is required of local health departments, and it explains how action plans targeting identified priorities can improve population health. It also highlights the use of evidence-based strategies to increase the overall impact of health improvement efforts.

Barriers and facilitators to the implementation of SPNS interventions designed to engage and retain HIV positive women of color in medical care.

The use of evidence-based strategies to increase access to medical care and improve health outcomes for people living with HIV is a major public health priority in the United States. As part of a multi-site evaluation funded under the Health Resources and Services Administration(HRSA), a process evaluation was conducted with the goal of understanding barriers and facilitators to the implementation of eleven heterogeneous interventions designed to engage and retain HIV positive women of color (WoC) in medical care. Findings identified barriers and facilitators to program implementation at five levels: (1) program; (2) team; (3) agency; (4) partner network; and (5) the larger socio-ecological context. We conclude with a series of recommendations that may be useful for the implementation of similar interventions focused on recruitment and retention of WoC in HIV medical care.

Variation in daily median respiratory rate identifies patients at higher risk of worsening HF in 30 days

Methods: Using the IOWA model, our EBP team reviewed the evidence and decided to implement the Teach Back to improve our patient education process. We participated on a multidisciplinary team to develop new patient education materials that used the HF Zone tool and a new book centered on 5 key messages for HF selfcare. Learning assessment and Teach back included nurses, nurse technicians and student nurses. Further hardwiring of the practice change included review of patient education as part of daily interdisciplinary rounds and charge nurse documentations reviews. Based on the success of the practice change, key EBP Teammembers participated in the pilot for a system-wide roll-out of Teach Back, serving as trainers and competency validators for their peers. Results: The practice change was measured by a nurse survey, clinical pathway documentation audits and follow-up call data as well as HF 30 day readmission data. These process improvements contributed to reducing LOS and HF readmission rate, enabling the Health System to avoid CMS penalties for two years in a row. A key reason for the success of this programwas the levels of staff buy-in. Staff initiated the EBP project and embraced the evidence to support their practice change. Conclusion: Post implementation, HF to HF 30 day readmission rates and LOS has decreased from 16% to 3% and 5.01 to 4.11 respectively. Readiness for discharge and instructions given increased from 85% to 89.8%, and 84.6% to 89.5% respectively. The use of evidence-based strategies is clearly making a difference in the quality of our patient education and thereby improving the clinical outcomes of our HF patients.

A qualitative assessment of psychosocial impact, coping and adjustment in high-risk melanoma patients and caregivers

The present study qualitatively assessed the psychosocial impacts experienced by stage III melanoma patients and caregivers throughout the course of the disease, and the coping responses they utilized in an attempt to promote psychosocial adjustment. The purpose of the study was to inform the development of a supportive care strategy for this population. Nineteen stage III melanoma patients and 14 of their caregivers were recruited from the clinical research database of the Melanoma Institute Australia. Data were collected using semistructured telephone interviews and analysed using thematic analysis. Participants reported psychosocial impacts related to diagnosis (shock, panic and devastation), treatment (challenges and unsatisfactory care, pain and limitation, practical impacts, new roles and responsibilities for the caregiver, caregiver inadequacy) and survivorship (ongoing physical problems, watchful waiting, feeling abandoned). They also reported global themes relevant to multiple phases of the disease (emotional distress, disfigurement, injustice, caregiver devaluation). Coping responses were identified related to diagnosis (avoidance), treatment (confidence in the treatment team, taking action) and survivorship (finding a positive meaning, acceptance and moving on) as well as global themes pertaining to multiple disease phases (receiving support, helpful thinking, putting on a brave face, redirecting attention, religion). The current findings support routine screening for the presence of symptoms and psychological distress and appropriate referral when necessary, and for provision of psychosocial interventions to provide information and support to stage III melanoma patients and caregivers. In addition, provision of communication skills training to all health professionals treating melanoma, use of evidence-based strategies for improving patient/caregiver understanding and recall, and routine assessment of patient-reported outcomes to inform clinical practice would be helpful.

Lessons Learned and Future Directions

Lessons Learned and Future Directions

Exploring Best Practices in Home Health Care

This article summarizes publicly available research related to outcomes and best practices in skilled home health and other kinds of home-based care. As the population ages and the home health care sector grows, the home health community must address current deficiencies in care and expand the use of evidence-based strategies to improve the quality and efficiency of care. Many promising innovations in service delivery currently exist, a wide variety of which have been tested and evaluated in postacute and long-term care settings. Our review found that home health agencies are well positioned to improve patient outcomes through a variety of approaches, including care coordination, telehealth, and data-driven quality of care monitoring. For the most part, evaluations of these interventions show that they can improve patient outcomes and/or cost-effectiveness.