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Clinical Scenario: As of 2020, the lifetime prevalence of at least one self-reported concussion is 24.6%. Athletic trainers in all settings work with patients who are at risk of sustaining a concussion or mild traumatic brain injury (mTBI) and developing persistent postconcussive symptoms. Aerobic exercise is emerging as an intervention for decreasing symptoms in patients who have sustained mTBI; however, the majority of research has been performed on pediatric patients. It is of interest whether aerobic exercise is an effective intervention for adult patients with mTBI. Focused Clinical Question: In adults who have sustained mTBI, does traditional therapy decrease symptoms more than aerobic exercise? Summary of Search: A systematic search of 4 databases was performed to answer this question. Three randomized controlled trials were identified that compared aerobic exercise to traditional therapy, which consists of physical and cognitive rest. Two studies found no significant differences in symptoms between the 2 groups while 1 study found decreased symptoms in the aerobic exercise group. Clinical Bottom Line: The current evidence is clear that there is no decrease in mTBI symptoms with traditional therapy as compared with aerobic exercise, with 1 study showing decreased symptoms with aerobic exercise. Strength of Evidence: Based on the Center for Evidence-Based Medicine grades of evidence, the clinical bottom line is based on grade A evidence. [ABSTRACT FROM AUTHOR]

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance. [ABSTRACT FROM AUTHOR]

ObjectiveAfter the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring.DesignThese RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsA total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided.ConclusionsWhile the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

ObjectiveTo describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines.DesignThis report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR.SettingTransdisciplinary, international collaboration in academia, referral practice, and general practice.ResultsFor this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science.ConclusionsLarge collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.

ObjectiveTo systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.DesignStandardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsTwenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation.ConclusionsThese updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.

ObjectiveTo systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps.DesignStandardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsSeventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.ConclusionsThese updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.

AbstractThe evidence underlying the use of advanced diagnostic imaging is based mainly on diagnostic accuracy studies and not on well-designed trials demonstrating improved patient outcomes. This has led to an expansion of low-value and potentially harmful patient care and raises ethical issues around the widespread implementation of tests with incompletely known benefits and harms. Randomized clinical trials are needed to support the safety and effectiveness of imaging tests and should be required for clearance of most new technologies. Large, diverse cohort studies are needed to quantify disease risk associated with many imaging findings, especially incidental findings, to enable evidence-based management. The responsibility to minimize the use of tests with unknown or low value requires engagement of clinicians, medical societies, and the public.

Introduction: Evidence-based medicine (EBM) is a critical skill for physicians, and EBM competency has been shown to increase implementation of best medical practices, reduce medical errors, and increase patient-centered care. Like any skill, EBM must be practiced, receiving iterative feedback to improve learners’ comprehension. Having residents document patient interactions in logbooks to allow for residency program review, feedback, and documentation of competency has been previously described as a best practice within emergency medicine (EM) to document practice-based learning (PBL) competency. Quantifying how residents use the information they query, locate, evaluate, and apply while providing direct patient care can measure the efficacy of EBM education and provide insight into more efficient ways of providing medical care.Methods: Practice-based learning logs were surveys created to record resident EBM activity on-shift and were placed into our residency management software program. Residents were required to submit 3–5 surveys of EBM activity performed during a 28-day rotation during which additional information was sought. This study included all PBL logs completed by EM residents from June 1, 2013–May 11, 2020. Using qualitative methodology, a codebook was created to analyze residents’ free-text responses to the prompt: “Based on your research, would you have done anything differently?” The codebook was designed to generate a three-digit code conveying the effect of the researched information on the patient about whom the log was written, as well as whether the information would affect future patient care and whether these decisions were based on scientific evidence.Results: A total of 10,574 logs were included for primary analysis. In total, 1,977 (18.7%) logs indicated that the evidence acquired through research would affect future patient care. Of these, 392 (3.7%) explicitly stated that the EBM activity conducted as part of our project led to real-time changes in patient care in the ED and would change future management of patients as well.Conclusion: We present a proof of concept that PBL log activity can lead to integration of evidence-based medicine into real-time patient care. While a convenience sample, our cohort recorded evidence of both lifelong learning and application to patient care.

With the onset of the COVID-19 pandemic, rates of medical hospitalization for severe malnutrition in the context of eating disorders increased dramatically among children and adolescents. (1) First-time presentations rose, [...]

Author(s): Mahammad A. Aspari [1]; Habib M. R. Karim (corresponding author) [1]; Poornima S. Reddy [2] Randomised controlled trials (RCTs) are pivotal in generating evidence-based medicine and practice. They produce [...]

Purpose: This German S3 clinical practice guideline offers evidence-based recommendations for the use of composite materials in direct restorations of permanent teeth. Outcomes considered were the survival rates and restoration quality and process quality of the manufacturing process. Part 1 of this two-part presentation deals with the indication classes. Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Six PICO questions were developed to guide the search. Recommendations were formulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence. Results: Composite materials are a viable option for the direct restoration of cavity Classes I-V and may also be used for restorations with cusp replacement, and tooth shape corrections. In the posterior region, direct composite restorations should be preferred over indirect composite inlays. For Class V restorations, composite materials can be used if adequate contamination control and adhesive technique are ensured. Conclusion: The guideline is the first to provide comprehensive evidence on the use of direct composite materials. However, further long-term clinical studies with comparators such as (modified) glass-ionomer cements are necessary. Regular updates will detail the future scope and limitations of direct composite restorations. [ABSTRACT FROM AUTHOR]

Specialty drugs treat complex, severe diseases and offer significant therapeutic advances. Despite their potential to transform patient care, little is known about the drivers of their diffusion. In this study, the authors develop a framework for the diffusion of specialty drugs that is motivated by the drugs' novelty, complexity, and importance, with a focus on the role of scientific evidence production. They propose that the effects of scientific evidence on specialty drug diffusion are multifaceted and generated through the three stages of the scientific evidence production process: unpublished clinical studies, publications in medical journals not cited in clinical guidelines, and clinical guidelines. The findings from the empirical analysis of two specialty drugs validate the framework, supporting the idea of multistage scientific evidence effects. In contrast, marketing activities do not have a significant effect. Although this could be attributed to specialty drug prescribers discounting information from commercial sources, it may also be due to limited marketing support. An additional analysis on a nonspecialty drug further validates the proposed framework. Calculations of scientific evidence contributions to trial prescriptions indicate that scientific evidence production can generate returns beyond the publication stage, which should provide specialty drug manufacturers with strong incentives to commit to quality and innovation. [ABSTRACT FROM AUTHOR]

The National Institutes of Healths (NIH) Pathways to Prevention panel on postpartum health provides a consensus statement on the evidence, research gaps, and future priorities to prevent maternal morbidity and mortality. The panel reviewed an NIH-commissioned evidence review and workshop that included epidemiologic studies, demonstration interventions, and other maternal morbidity and mortality research to create these national recommendations. The panel concludes that a maternal morbidity and mortality crisis reflects a systemic failure of current U.S. health care, research efforts, and social policies. The panel recommends improving maternal health through a maternal morbidity and mortality prevention moonshot that adopts a comprehensive, multilevel life course conceptual framework; strengthens the research methods used within the science of maternal health; establishes and conducts national prevention, treatment, and policy interventions; and reimburses evidence-informed clinical approaches to improve maternal health across the life course. Without a national focus on fundamentally transformative interventions and other initiatives aimed at redressing structural racism and inequities in health care, current interventions and clinical advances in maternal morbidity and mortality prevention will remain tragically insufficient.

An important concept in managing clozapine's clinical issues and adverse effects is that not all approaches possess the highest levels of evidence from randomized clinical trials (RCTs), leaving clinicians to [...]

I began my career when the major treatments for schizophrenia were haloperidol and chlorpromazine. Since then, treatments for schizophrenia have improved slowly and incrementally, especially when looking back in the [...]

Clinical Scenario: Stress fractures are one of the most common injuries in athletes. Unfortunately, they are hard to diagnose, require multiple radiology exams and follow-up which leads to more exposure to radiation and an increase in cost. Stress fractures that are mismanaged can lead to serious complications and poorer outcomes for the athlete. During the rehabilitation process, it would be beneficial to be able to monitor the healing of fractures to know when it is safe to gradually allow a patient to a return to sport because the return to activity is not usually objective and based on pain level. Clinical Question: Can infrared thermography (IRT) be a useful tool to measure the pathophysiological state of the fracture healing? The aim of this critically appraised topic is to analyze the current evidence of IRT for measuring the temperature change in fractures to provide recommendations for medical practitioners. Summary of Key Findings: For this critically appraised topic, we examined 3 articles that compared medical imaging and IRT over multiple time points during the follow-up. The 3 articles concluded that a 1 °C asymmetry in temperature followed by a return to normal (less than 0.3 °C) temperature during the healing process of fractures can be monitored using IRT. Clinical Bottom Line: Once the patient has been diagnosed with a fracture, IRT can safely be used to monitor the evolution of a fracture. When the thermogram progresses from a hot thermogram to a cold thermogram, the healing is considered good enough to return to sport. Strength of Recommendation: Grade 2 evidence exists to support IRT being used by clinicians to monitor fracture healing. Due to the limited research and novelty of the technology, the current recommendations are for following the treatment of the fracture once the initial diagnosis is made. [ABSTRACT FROM AUTHOR]

Understanding and incorporating evidence‐based veterinary medicine (EBVM) into clinical practice and research continues to pose a challenge for our profession despite over 2 decades of increasing awareness of this concept. Reasons for this include a lack of understanding of its importance to the practice of medicine, veterinary literature that often fails to adhere to evidence‐based standards, inadequate attention to teaching EBVM at the university level, and the inherent reluctance of clinicians to alter historical practice styles. For many practitioners, EBVM continues to be an abstract concept they believe requires advanced training in statistics and epidemiology resulting in them relying on less robust sources for clinical guidance. This unfortunately results in suboptimal care for our patients and delayed medical advancements for our profession. As part of the 20th anniversary of the founding of the Evidence‐Based Veterinary Medicine Association (EBVMA), we are refocusing our efforts to highlight the need for dedicated teaching of EBVM at the university level, for rigorous adherence to established research reporting guidelines, for expansion of EBVM infrastructure, and for the provision of easily accessible tools that permit clinicians to incorporate EBVM into their daily practice. As the quality of veterinary literature improves, so too will development of more effective clinical practice guidelines that ultimately can be widely adopted if they are flexible enough to support the triadic relationship between veterinarians, our clients and our patients. Ultimately, EBVM is not an end unto itself, but rather a means to improve the quality of care we provide our patients. [ABSTRACT FROM AUTHOR]

Background: Asthma is a common chronic respiratory inflammatory disease that adversely affects patients' quality of life (QoL) and overall well-being. When asthma is not adequately controlled, there is a higher risk of exacerbations and hospitalizations, thereby increasing the direct and indirect costs associated with the treatment and productivity loss. Overreliance on SABA and underutilization of ICS in the management of asthma can result in suboptimal treatment and poor asthma control. Patients who visit the emergency department are more likely to have poorly controlled asthma. Ensuring that these patients are provided with an evidence-based treatment plan during discharge can help reduce the risk of future exacerbations and consequently reduce the burden on the UAE healthcare system. Methods: A joint task force comprising experts from the Emirates Society of Emergency Medicine (ESEM) and Emirates Thoracic Society (ETS) reviewed published evidence and updated guidelines in asthma management to optimize the post-discharge recommendations. Results: The ESEM-ETS experts' joint task force has developed a step-by-step plan for emergency department/hospital discharge, which is based on the GINA 2023 guideline recommendations and the medications available in the UAE. By adhering to this structured plan, emergency department physicians can play a crucial role in improving asthma care, long-term patient outcomes, and the utilization of healthcare resources. Conclusions: Prioritizing patient education and ensuring patients are equipped with the best-suited asthma treatment plans prior to discharge can help ED physicians improve patient outcomes and reduce healthcare resource utilization in UAE hospitals. [ABSTRACT FROM AUTHOR]

The Wound Care Association UK (WCAUK) is committed to supporting both the accurate and consistent delivery and reporting of pressure ulcers/injuries based on the best available research and evidence. It is known that strategic and clinical guidance to support the delivery of evidence-based care does have a significant impact. Recent proposals to change pressure ulcer categorisation led the WCAUK to undertake a questionnaire survey of its members. This article outlines the importance of evidence-based guidance on the categorisation and assessment of pressure ulcer, highlighted by the responses to published changes to pressure ulcer categorisation for nurses in England, and presents the results of the survey. The article concludes that, although the discipline of tissue viability is constantly developing, the changes must be based on evidence, and clinicians must be supported strategically and practically to implement any proposed changes. Since publication of the new guidance the document has become the subject of further discussion, following concerns raised by tissue viability nurse specialists with strategic responsibility for change, as well as generalists who are expected to implement the changes. [ABSTRACT FROM AUTHOR]

Objective: Artificial intelligence (AI) is revolutionizing healthcare, but less is known about how it may facilitate methodological innovations in research settings. In this manuscript, we describe a novel use of AI in summarizing and reporting qualitative data generated from an expert panel discussion about the role of electronic health records (EHRs) in implementation science. Materials and methods: 15 implementation scientists participated in an hour-long expert panel discussion addressing how EHRs can support implementation strategies, measure implementation outcomes, and influence implementation science. Notes from the discussion were synthesized by ChatGPT (a large language model—LLM) to generate a manuscript summarizing the discussion, which was later revised by participants. We also surveyed participants on their experience with the process. Results: Panelists identified implementation strategies and outcome measures that can be readily supported by EHRs and noted that implementation science will need to evolve to assess future EHR advancements. The ChatGPT-generated summary of the panel discussion was generally regarded as an efficient means to offer a high-level overview of the discussion, although participants felt it lacked nuance and context. Extensive editing was required to contextualize the LLM-generated text and situate it in relevant literature. Discussion and conclusions: Our qualitative findings highlight the central role EHRs can play in supporting implementation science, which may require additional informatics and implementation expertise and a different way to think about the combined fields. Our experience using ChatGPT as a research methods innovation was mixed and underscores the need for close supervision and attentive human involvement. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is responsible for a significant burden of disease worldwide. Despite the publication of multiple international guidelines, anecdotal evidence suggests significant clinical variation exists in the diagnostic and management pathways of pulmonary embolism (PE). We conducted a retrospective cohort study using electronic medical records to examine clinical variation in patients admitted to a tertiary referral center in Australia with a diagnosis of PE between November 2018 and January 2020. Three hundred cases met the inclusion criteria; we found variation in rates of compression ultrasonography, acute investigation of the right ventricle, and planning of repeat imaging at specialist follow‐up. Guidelines do not address the use of compression ultrasonography in already diagnosed PE, are conflicting in their recommendation for acute investigation of the right ventricle, and recommend repeat imaging only if there are persistent symptoms at the time of specialist follow‐up. The variations we found in this study may in part be due to physician preference or due to the paucity of evidence for some of these diagnostic practices. Robust future studies are required to guide the use of these investigations in PE. [ABSTRACT FROM AUTHOR]

Objective: Dialectical behavior therapy (DBT) is an evidence‐based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability. Methods: Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Results: Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement. Discussion: A novel DBT‐based app may serve as an acceptable, low‐intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted. [ABSTRACT FROM AUTHOR]

Background: Primary care providers are qualified to treat, diagnose, and manage common mental health issues like anxiety and depression. Anxiety and depression are common among college age students, with the average age of onset occurring in one's late teens to early 20s. Screening tools are commonly used to recognize patients who may be at risk for anxiety and depression. Purpose: The purpose of this evidence-based practice project was to (a) implement evidence-based guidelines for screening and management of college-aged patients with anxiety and/or depression and (b) to develop an algorithm that describes evidence-based management to guide providers at two student health centers. Methods: All patients who registered for a sick visit or other appointment at the project site were screened for anxiety and depression using two validated tools. An algorithm to help healthcare providers properly assess and better treat anxiety and depression was developed and implemented for this project. Results: A total of 366 patients were screened for depression and anxiety over a 3-month period. Using the created algorithm, patients received education on anxiety and/or depression and a counseling referral. If warranted, patients were prescribed medication therapy for depression and/or anxiety. Conclusion: Screening for anxiety and depression has become the standard of care in primary care clinics. Routine screening tools help healthcare providers identify patients with anxiety and depression. Early identification and diagnosis of anxiety and depression leads to better outcomes in treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with advanced stages of breast cancer are at high risk of the cancer metastasizing or spreading to areas of the central nervous system, including the brain, cerebrospinal fluid, and the protective tissue layers of the brain, termed leptomeninges. Although guidelines recommend screening for central nervous system disease in other cancers, such as non-small cell lung cancer, there are no such recommendations for patients with breast cancer unless they have symptoms such as headaches, weakness, or vomiting. This review discusses the evidence behind screening for breast cancer that has spread to the central nervous system, as well as new methods of diagnosis, including specialized imaging, serum testing, and cerebrospinal fluid analysis. Brain and leptomeningeal metastases are complications of breast cancer with high rates of morbidity and mortality and have an estimated incidence of up to 30%. While National Comprehensive Cancer Network (NCCN) guidelines recommend screening for central nervous system metastasis in other neurotropic cancers such as non-small cell lung cancer, there are no such recommendations for asymptomatic breast cancer patients at any stage of disease. This review highlights ongoing studies into screening and diagnostics for breast cancer with brain and leptomeningeal metastasis (BCBLM) as they relate to patient outcomes and prognostication. These include imaging methods such as MRI with novel contrast agents with or without PET/CT, as well as 'liquid biopsy' testing of the cerebrospinal fluid and serum to analyze circulating tumor cells, genomic material, proteins, and metabolites. Given recent advances in radiation, neurosurgery, and systemic treatments for BCBLM, screening for CNS involvement should be considered in patients with advanced breast cancer as it may impact treatment decisions and overall survival. [ABSTRACT FROM AUTHOR]

Clinicians, researchers, regulators, and other decision-makers increasingly rely on evidence from real-world data (RWD), including data routinely accumulating in health and administrative databases. RWD studies often rely on algorithms to operationalize variable definitions. An algorithm is a combination of codes or concepts used to identify persons with a specific health condition or characteristic. Establishing the validity of algorithms is a prerequisite for generating valid study findings that can ultimately inform evidence-based health care. In this paper, we aim to systematize terminology, methods, and practical considerations relevant to the conduct of validation studies of RWD-based algorithms. We discuss measures of algorithm accuracy, gold/reference standards, study size, prioritization of accuracy measures, algorithm portability, and implications for interpretation. Information bias is common in epidemiologic studies, underscoring the importance of transparency in decisions regarding choice and prioritizing measures of algorithm validity. The validity of an algorithm should be judged in the context of a data source, and one size does not fit all. Prioritizing validity measures within a given data source depends on the role of a given variable in the analysis (eligibility criterion, exposure, outcome, or covariate). Validation work should be part of routine maintenance of RWD sources. This article is part of a Special Collection on Pharmacoepidemiology. [ABSTRACT FROM AUTHOR]

Early literacy promotion in pediatric primary care supports parents and caregivers reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the AAP as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level. [ABSTRACT FROM AUTHOR]

Purpose: The World Health Organisation (WHO) recommends that health professionals develop and implement "adherence counselling toolkits" to promote adherence to long-term therapies in people with chronic conditions. This prospectively registered review aimed to systematically identify and evaluate existing toolkits developed to promote adherence to physical activity in people with chronic conditions. Materials and methods: Grey literature and six e-databases were searched for studies investigating the use of "toolkits" to promote adherence to physical activity or exercise recommendations in people with chronic conditions (Medline, PsycInfo, EmCare, Cochrane, CINAHL Plus, Pedro). A two-stage screening process was completed by two independent reviewers. Results: Five studies describing five toolkits were included. Three toolkits displayed all WHO recommended features, including information on adherence, a clinically useful way of using this information, and behavioural tools for maintaining habits. The included toolkits featured "adherence" to the intervention; however, this was not their primary aim. There were trends towards improved physical activity with some of the included toolkits. Conclusions: There are a lack of rigorously developed toolkits that focus on adherence to physical activity in people with chronic conditions. Toolkits should be developed, tested, and implemented to improve adherence and outcomes for people with chronic conditions. IMPLICATIONS FOR REHABILITATION: Health outcomes for people with chronic conditions may be enhanced with a focus on adherence, however there are currently no rigorously developed toolkits that meet this need. Adherence counselling toolkits should be co-designed with stakeholders for use with people with specific chronic conditions. Adherence-focused toolkits should be developed, implemented, and evaluated to ensure they are feasible to use and beneficial for health professionals working with people with chronic conditions. [ABSTRACT FROM AUTHOR]

Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As 'digital natives', particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative study explored the experiences of speech-language pathologists (SLPs) in professional learning communities (PLCs) during a yearlong virtual professional development (PD) opportunity using an implementation science (IS) framework in an urban public school district for dynamic assessment (DA) training. The DA presented in the PD was modified based on ongoing discussions with key stakeholders in the district, so that it could be reasonably implemented in clinical practice while preserving the integrity of the DA’s purpose. Method: SLPs in an urban district were trained virtually using DA over the course of the school year. PD topics focused on decreasing bias and incorporating evidence-based practice into SLP approaches to speech-language evaluations. The SLPs underwent three training sessions and three separate PLC sessions. The SLPs were assigned a series of case studies to complement PLC sessions. An IS framework informed each step of the PD and PLCs to ensure applicability and integration of the content. Of the 366 SLPs working in the district, 209 consented and filled out two questionnaires and three exit slips to gather information on their experiences with the DAs and PLC models. Results: SLPs reported new insights into their practice, including changes in assessment practices, awareness of bias in assessment practices, and increased confidence in working with families during the evaluation process. Two additional themes emerged: increased collaboration and enhanced group problem-solving skills when working with peers in PLC groups, and expanded proficiencies and heightened skills when applying DA practices to evaluations. The two challenges faced by SLPs included time constraints and confidence in the mastery of DA. Conclusion: This study offers an approach to shifting evaluation practices in large districts to incorporate more evidence-based approaches. [ABSTRACT FROM AUTHOR]

Objectives: Musicians who wear hearing aids are a unique subset of hearing-impaired individuals. There are a number of issues musicians experience with hearing aids, making effective hearing rehabilitation a challenge. Research suggests hearing aid satisfaction in musicians is lower partly due to their advanced listening skills, however, qualitative research addressing musicians who wear hearing aids for music is scarce. The current study aimed to record the barriers encountered by musicians who wear hearing aids when playing their instrument/singing, listening to recorded music and listening to live music. Design: Professional musicians who wear hearing aids were interviewed. Participants were questioned about their experiences with hearing loss and hearing aids, with particular emphasis on experiences listening to recorded and live music, and playing or performing music with the hearing aids. Study Sample: Eight professional musicians were interviewed, using a semi-structured interview style, with a question and prompt guide. Results: Thematic analysis revealed three main themes in the data: the musicians' journey, communication, and flexibility/adjustability. Conclusions: The results have implications for future research into specific fitting parameters for hearing aids for musicians (particularly for music performance), the need for evidence-based rehabilitation programs for musicians with hearing loss, and the need for a glossary of terms to assist communication between Audiologists and musicians. [ABSTRACT FROM AUTHOR]

Background: Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular. Methods: The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process. Results and conclusions: The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO. [ABSTRACT FROM AUTHOR]

Background: Intraoperative conversion to open surgery is an adverse event during minimally invasive distal pancreatectomy (MIDP), associated with poor postoperative outcomes. The aim of this study was to develop a model capable of predicting conversion in patients undergoing MIDP. Methods: A total of 352 patients who underwent MIPD were included in this retrospective analysis and randomly assigned to training and validation cohorts. Potential risk factors related to open conversion were identified through a literature review, and data on these factors in our cohort was collected accordingly. In the training cohort, multivariate logistic regression analysis was performed to adjust the impact of confounding factors to identify independent risk factors for model building. The constructed model was evaluated using the receiver operating characteristics curve, decision curve analysis (DCA), and calibration curves. Results: Following an extensive literature review, a total of ten preoperative risk factors were identified, including sex, BMI, albumin, smoker, size of lesion, tumor close to major vessels, type of pancreatic resection, surgical approach, MIDP experience, and suspicion of malignancy. Multivariate analysis revealed that sex, tumor close to major vessels, suspicion of malignancy, type of pancreatic resection (subtotal pancreatectomy or left pancreatectomy), and MIDP experience persisted as significant predictors for conversion to open surgery during MIDP. The constructed model offered superior discrimination ability compared to the existing model (area under the curve, training cohort: 0.921 vs. 0.757, P < 0.001; validation cohort: 0.834 vs. 0.716, P = 0.018). The DCA and the calibration curves revealed the clinical usefulness of the nomogram and a good consistency between the predicted and observed values. Conclusion: The evidence-based prediction model developed in this study outperformed the previous model in predicting conversions of MIDP. This model could contribute to decision-making processes surrounding the selection of surgical approaches and facilitate patient counseling on the conversion risk of MIDP. [ABSTRACT FROM AUTHOR]

AbstractDynaMed is a point-of-care clinical decision support database created by EBSCO Health Services. This database was designed to provide busy healthcare professionals with the most accurate evidence-based information on diseases, diagnosis, treatment options, prognosis, and much more. The DynaMed content is updated daily and is very comprehensive; it also includes multiple images, tables, and practice-changing updates. Additionally, users can gain access to drug information, drug interaction checkers, and clinical calculators, set up personalized alerts, and download the DynaMed mobile app. [ABSTRACT FROM AUTHOR]

Single-case designs substantiate the effectiveness of interventions for people with disabilities and other populations through the repeated measurement of behavior over time. Consequently, employing accurate and reliable systems of measurement is critical to the validity of single-case designs. Much of the data in single-case research are collected through systematic direct observation. Direct observation often involves the use of time sampling, wherein an observer indicates whether a behavior occurred during a specific period. Although scholars have highlighted the potential for time sampling to distort the results of single-case design, targeted reviews indicate time sampling continues to be used in literature involving people with disabilities. The current study reviews literature from the field of special education, in which single-case designs are frequently used to evaluate the efficacy of practices. Using a large, representative sample of 1,425 randomly selected single-case design articles from 33 special education journals, we coded articles to determine the type and features of measurement systems employed by researchers. Findings indicate one-fifth of articles feature some form of time sampling. In addition, time sampling is more prevalent in journals pertaining to individuals with emotional/behavioral disorders. A discussion of implications for research quality follows an overview of results. [ABSTRACT FROM AUTHOR]

Non-compliance is a challenge for practitioners serving children with and without disabilities. Many interventions have been developed to increase compliance. High-probability request sequences (HPRS), an antecedent-based intervention that is based on behavioral momentum theory, is one way to increase compliant behavior. HPRS includes the presentation of two-to-five easy or known tasks with a high probability of compliance immediately before requesting tasks with a low probability of compliance. The purpose of the current meta-analysis was to review the literature in the last 40 years on high- p request sequences as an intervention to improve compliance in children with autism spectrum disorder (ASD). Specifically, we examined the methodological rigor of the high-p single-case research for students with autism, identified the descriptive characteristics of these studies, and estimated treatment effects with Tau- U to determine whether HPRS is an evidence-based practice (EBP) for increasing compliance in children with ASD. Our results showed that HPRS is a very effective practice in increasing compliance in children with ASD (Tau- U =.87) and a promising EBP for improving compliance in children with ASD. Implications for future research and practice are discussed. [ABSTRACT FROM AUTHOR]

The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence regarding postoperative precautions for patients following endoscopic skull base surgery for intradural pathology. These topics include the administration of postoperative nasal hygiene; patient mobilization and activity level; the resumption of continuous positive airway pressure in patients with obstructive sleep apnea; and the timing and capacity with which a patient may be subjected to barotrauma, such as air travel postoperatively. This EPS was developed following the recommended methodology and approval process as previously outlined. Given the diverse practices and limited agreement on the accepted principles regarding postoperative precautions for patients following skull base surgery, this EPS seeks to summarize the existing literature and provide clinically relevant guidance to bring clarity to these differing practice patterns. Following a modified Delphi approach, four statements were developed, all of which reached consensus. Because of the paucity of literature on these topics, these statements represent a summation of the limited literature and the experts' opinions. These statements and the accompanying evidence are summarized below, along with an assessment of future needs. [ABSTRACT FROM AUTHOR]

Introduction: This is the first systematic review and meta‐analysis to investigate the effectiveness of the nasal airflow‐inducing maneuver (NAIM) in olfactory rehabilitation for total laryngectomy (TL) patients. Methods: We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The inclusion criteria required that patients must have undergone a TL with subsequent NAIM training for at least 2 weeks and olfactory evaluation. The impact of NAIM on olfactory outcomes compared to that at baseline was measured. Olfactory measures included the Sniffin' Sticks Test, Smell Disk Test, Scandinavian Odor Identification Test, and Quick Odor Detection Test. The primary outcome measures were the proportion of patients with normosmia at baseline and after intervention. Results: Seven studies from 2000 to 2023 comprising a total of 290 TL patients met the inclusion criteria. The meta‐analysis revealed that prior to intervention, the pooled proportion of patients with normosmia was 0.16 (95% confidence interval [CI]: 0.09‒0.27, p = 0.01). After intervention, the same proportion increased to 0.55 (95% CI: 0.45‒0.68, p = 0.001). Among the included patients, 88.3% were initially anosmic or hyposmic, which was reduced to 48.9% after NAIM practice, with 51.1% achieving normosmia. The percent improvement was not found to be significantly associated with the timing of intervention post‐TL (p = 0.18). Conclusions: NAIM increased the proportion of patients who achieved normosmia in TL patients. NAIM stands out as a safe, easily teachable maneuver with promising results. Further efforts are warranted to provide specific recommendations and guidelines for the use of NAIM in clinical practice. [ABSTRACT FROM AUTHOR]

The article highlights the comprehensive focus of the sixth issue of the periodical which addresses critical topics pertinent to nurses in this field. Topics include respiratory care, delirium, and the well-being of patients and families, reflecting a wide range of evidence-based studies and reviews aimed at improving practice and outcomes in critical care settings.

Background: Diaries have been used regularly in international settings as an evidence‐based and easily applicable intervention following a person‐centred approach in the intensive care unit (ICU). In addition, a diary web application known as 'Post‐ICU' has been implemented. Aim: To explore the usability of an innovative digital diary from the perspectives of intensive care patients' relatives. Study Design: A cross‐sectional online survey study was applied among a convenience sample of relatives in the ICUs of two hospitals in the Netherlands. The investigator‐developed questionnaire included, among other things, items with the appreciation of the layout, user friendliness and functionality of the diary. Relevance and applicability were rated between 1 and 10. Data were analysed with SPSS© software, version 27, and reported as the means (±standard deviation [SD]) and percentages. Results: Sixty‐three relatives with an average age of 51 years (SD ± 14.3) participated in the study; there was a slight predominance of women (57%). All but one participant found using the digital diary easy and were able to upload photos to the diary. The participants had invited other relatives (75%) and nurses (61%) to write in the diary, which they viewed as easily feasible (89%). The relevance and applicability of the diary were rated with mean scores of 8.1 (SD ± 1.9) and 8.3 (SD ± 1.6), respectively. Conclusions: The participants found the Post‐ICU diary web application highly valuable and easily feasible. Perceived ease of use, perceived usefulness and technophobia were not found to influence the usability of the digital diary. Relevance to Clinical Practice: The implementation of this new digital tool supports a person‐centred ICU policy because of its focus on the personal diary entries of the patient and the collaborative writing process featuring relatives and professionals. [ABSTRACT FROM AUTHOR]

A growing body of literature uses the concept of core components to better understand small-scale programmatic interventions. Instead of interventions being viewed as unitary "black boxes," interventions are viewed as configurations of core components, which are the parts of interventions that carry their causal potential and therefore need to be reproduced with fidelity to produce the intended effect. To date, the concept of core components has not been as widely applied to public health policy interventions as it has to programmatic interventions. The purpose of this topical review is to familiarize public health practitioners and policy makers with the concept of core components as applied to public health policy interventions. Raising the profile of core component thinking can foster mindful adaptation and implementation of public health policy interventions while encouraging further research to enhance the supporting evidence base. We present 3 types of multilevel interactions in which the core components of a public health policy intervention produce effects at the population level by (1) seeking to directly affect individual behavior, (2) facilitating adoption of programmatic interventions by intermediaries, and (3) encouraging intermediaries to take action that can shape changes in upstream drivers of population health. Changing the unit of analysis from whole policies to core components can provide a basis for understanding how policies work and for facilitating novel evidence-generating strategies and rapid evidence reviews that can inform future adaptation efforts. [ABSTRACT FROM AUTHOR]

The federal Ending the HIV Epidemic (EHE) initiative was created to reduce new US HIV infections, largely through pre-exposure prophylaxis and HIV treatments that reduce HIV transmissibility to zero. Behavioral health disorders (mental health and substance use) remain significant barriers to achieving EHE goals. Addressing behavioral health (BH) disorders within HIV primary care settings has been promoted as a critical EHE strategy. Implementation of efficacious HIV-BH care integration and its impact on HIV-related health outcomes is not well documented. In a federally-funded, exploratory phase implementation science study, we used the Collective Impact Framework to engage partners in seven EHE jurisdictions about the feasibility, acceptability, and sustainability of implementing HIV-BH integration interventions within local HIV settings. Partners concluded that full integration will remain the exception unless health systems invest in collaborative practice, professional training, appropriate health technology, and inter-system communication. Partners supported smaller incremental improvements including transdiagnostic approaches to reinforce each team member's sense of value in the shared endeavor. This early phase implementation science study identified research and implementation gaps that are critical to fill to end the HIV epidemic. Both the Collective Impact Framework and implementation science show promise for guiding future implementation of evidence-based HIV-BH intervention integration. [ABSTRACT FROM AUTHOR]

To improve outcomes for youth who do not respond optimally to existing treatments, we need to identify robust predictors, moderators, and mediators that are ideal targets for personalisation in mental health care. We propose a solution to leverage the Individual Patient Data Meta‐analysis (IPDMA) approach to allow broader access to individual‐level data while maintaining methodological rigour. Such a resource has the potential to answer questions that are unable to be addressed by single studies, reduce researcher burden, and enable the application of newer statistical techniques, all to provide data‐driven strategies for clinical decision‐making. Using childhood anxiety as the worked example, the editorial perspective outlines the rationale for leveraging IPDMA methodology to build a data repository, the Platform for Anxiety Disorder Data in Youth. We also include recommendations to address the methods and challenges inherent in this endeavour. [ABSTRACT FROM AUTHOR]

The article offers information on evidence-based approaches for treating obsessive-compulsive disorder (OCD) as outlined in the latest clinical guideline. Topics discussed include the evolution of OCD's classification in the DSM-5; the effectiveness of cognitive-behavioral therapy (CBT) as a frontline treatment; and the incorporation of recent advances in therapeutic practices and access to treatment.

For public health protection, informed decision-making relies on having a robust foundation of evidence concerning risks and their prevention. Application of an evidence-based framework depends on the availability of pertinent, scientifically sound data generated by well-directed and valid research endeavors. In this essay, we address the current state of research in humans and the evidential base concerning high-concentration delta-9-tetrahydrocannabinol (delta-9-THC) products, which are readily available in the United States. Furthermore, we explore the intricate challenges faced in carrying out research on these products, which reflect the full range of study design issues: measurement of exposure and outcomes, confounding, selection bias, and the generalizability of findings. We offer recommendations to guide future research toward providing more informative evidence. By following these recommendations, researchers and funders on this emerging topic could move toward generating the valid and comprehensive evidence needed to effectively inform public health initiatives and guide policy decisions regarding high-concentration delta-9-THC products and their use. The urgency of generating such evidence cannot be overstated, given the widespread legalization and increasing availability and use of these products. (Am J Public Health. 2024;114(S8):S639–S644. https://doi.org/10.2105/AJPH.2024.307724) [ABSTRACT FROM AUTHOR]

Me and my family is a knowledge-based motivational program that includes eight weekly therapeutic sessions provided via the social services for families in which parent(s) have substance use problems (SUP). Purpose: The aim of this study was to report experiences gained while conducting the research project, in which social workers' active participation was a core feature. Materials and method: Guided by the implementation framework AIF (Active Implementation Framework) data were collected from multiple sources, such as minutes from guidance sessions, meetings with managers, booster days, and transcriptions of focus group interviews with social workers. Results: Findings indicate that social workers need to receive training in research activities before program start and to have time for pre- and post-therapeutic session reflections To deliver and maintain an intervention like Me & my Family require cross-sectional cooperation and staff having academic degrees to develop reflections on program delivery. Research design experiences indicate that RCT methods proved difficult to accomplish. An additional finding was organizational structures in silos as a barrier to recruiting families. Conclusion: Involving social workers in doing research on practices concern needs for managerial support regarding scheduling, routines and interest in evidence-based practice, well-educated social workers, and special attention to research design in relation to clients' needs. Conclusions drawn from using the AIF framework include the need for continuous coaching and consultations as well as feed-back on results. [ABSTRACT FROM AUTHOR]

The article discusses effective strategies for educating healthcare professionals in critical airway management techniques. Topics include the importance of simulation training to enhance hands-on skills and decision-making in real-time scenarios; the role of evidence-based practices in shaping educational curricula for airway management; and the need for continuous learning and assessment to maintain proficiency in advanced airway techniques.

The healthcare sector is ubiquitously plagued by workforce shortages in economies around the globe. The fragility of this structural shortage becomes apparent when external shocks, such as the COVID-19 pandemic, exacerbate the lack of workers in clinical practice. In this article, we summarize current trends in healthcare workforce development across the globe, review theoretical concepts of workforce shortages, and discuss policies to address them. In practice, developed countries often address workforce shortages with targeted migration policies. However, targeted workforce migration policies only intensify workforce shortages in low-and middle-income countries. Theoretical macroeconomic models suggest that supply shortages may result from too low wages, supply lagging behind demand, and social perception. Changes in the wage rate cannot sufficiently increase the supply of health professionals as scholars find inelastic wages for physicians and nurses. Nonpecuniary factors such as working conditions, job satisfaction, and intrinsic motivation are at least equally important as financial incentives. In conclusion, increased wages can only be part of a heterogeneous policy plan to address shortages. Migration and retirement levels of health professionals can temporarily mitigate workforce shortages but rarely change the underlying systemic issues. Increasing the number of places available in medical and nursing schools while also improving, both, financial and nonfinancial incentives for employees are long-term structural policy options. [ABSTRACT FROM AUTHOR]

Background: Forty percent of individuals within the Disorders of Consciousness (DoC) spectrum are misdiagnosed as in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) when in fact they are minimally conscious or emerged, underscoring a need to optimize evaluation techniques and interprofessional care management. Primary Objective: Conscious Care is a proposed care model that aims to improve interprofessional care of patients with DoC in the hospital setting. The aim of this paper is to describe this model's key ingredients and various components. Conclusions: This care model will advance clinician and caregiver preparedness to manage the complexities of this population and advocate for equal access to post-hospital medical and rehabilitative services. Evaluation and treatment of survivors of DoC should incorporate current evidence which drives continuous quality improvement and education to clinicians across the continuum of care. Immediate action must be taken to decrease the vulnerability and neglect of this marginalized population. Conscious Care is an innovative, sustainable solution that will improve interprofessional awareness of best practices and available science, strengthen care, and advocate for the right to quality of life that this population is so often denied. [ABSTRACT FROM AUTHOR]