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Paid family leave and working conditions are components of employment quality-a key social determinant of health across the life course, particularly during pregnancy. Increased research on prenatal social risk screening has not extended to employment quality. The objective of this systematic review was to identify prenatal screening practices and interventions in health care settings that address employment and working conditions as social risk factors among pregnant adults and to describe their properties and key findings.We searched MEDLINE, PsychINFO, SocINDEX, EMBASE, and the SIREN Evidence and Resource Library for studies published through February 14, 2022. We selected multiple search terms related to four domains: (1) employment or working conditions; (2) screening; (3) health care settings; and (4) pregnancy or maternal health.Of the 2317 unique titles and abstracts that were potentially relevant, eight articles met all inclusion criteria and focused on pregnant populations. The content of identified screening practices varied substantially, highlighting the multiple ways employment is conceptualized as a potential risk factor. Few studies included multidimensional measures of employment to assess working conditions, which may be particularly relevant during pregnancy.Our review suggests that screening for employment as a social risk factor does not regularly occur in prenatal care. Although pragmatic properties of the screening tools we assessed are promising, tools seldom examine the multidimensional nature of work. Understanding the principal intent of screening for employment prenatally could provide greater opportunity to collect and interpret contextual factors that influence how both providers and patients respond to social risk.

Engaging in contraceptive decisions is an important part of reproductive health for women and other people with the capacity for pregnancy. However, not all individuals capable of pregnancy have equal access to information and/or opportunities to make fully informed decisions. The goal of this study was to understand barriers women with disabilities experience around contraceptive decision-making and whether these differ based on type of disability.We conducted focus groups with 17 reproductive age adult women (aged 18-45 years). Focus groups were homogenous with regard to disability type and consisted of one group for each of the following disability categories: 1) physical disability, 2) intellectual and developmental disabilities, 3) blind or low vision, and 4) Deaf users of American Sign Language. Data were collected in the Portland, Oregon, metropolitan area during 2016-2017. We analyzed focus group transcripts using content analysis.Barriers to informed contraceptive decision-making emerged in five main thematic areas: 1) lack of information in accessible formats, 2) incomplete information about contraceptive side effects, 3) limited clinician knowledge and relevant research specific to the care of women with disabilities, 4) taboos around discussing sexual activity, and 5) limited opportunities for shared contraceptive decision-making.Women with disabilities faced numerous barriers to contraceptive decision-making. Although the barriers differed somewhat by disability type, many barriers were consistent across groups, suggesting commonalities associated with the experience of disability in the context of contraceptive decision-making. Increased attention to the reproductive health needs of people with disabilities is important for improving health care equity and quality.

Objective To conduct an initial exploration of the experiences of women with different types of disability when they attempt to obtain contraceptive care. Design Multiple-category focus group design. Setting Multiple community sites. Participants Seventeen women with disabilities of reproductive age. Methods We purposively sampled women with different types of disability and conducted four focus groups organized by disability type: physical disability, intellectual and developmental disability, blind or low vision, and deaf or hard of hearing. We used a semistructured focus group guide to elicit participants’ positive and negative experiences with contraceptive care. We analyzed focus group transcripts using content analysis. Results Participants identified challenges to obtaining high-quality contraceptive care in three main thematic areas: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Participants with physical disabilities encountered inaccessible clinic rooms and examination tables, and those with sensory disabilities or intellectual and developmental disability described inaccessible clinic forms and information. Participants from multiple disability groups described negative attitudes of health care providers and health insurance limitations. Conclusion As described by our participants, the processes and infrastructure of contraceptive care were based on an assumption of an able-bodied norm. Reliance on such a norm, for example, offering a paper pamphlet to a blind woman, is not helpful and can be harmful to women with disabilities. Increased attention to the reproductive health care needs of women with disabilities is important for improving health care equity and quality.

Background The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team and also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of personal protective equipment (PPE). Objective We sought to analyze the impacts of the COVID-19 pandemic on emergency medical service (EMS) workers and pre-hospital care delivery. Methods We conducted focus groups and one-on-one interviews with fire-based EMS first responders between September 2021 and 2022. Interviews included questions about job-related stress, EMS skills, work experiences and changes during COVID-19. Interviews were recorded, independently dual coded and analyzed for themes. Results Two hundred twenty-three first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of PPE was reported to have significantly impaired efficiency and perceptions of quality of care—among EMS team members and also between EMS workers and patients. EMS personnels also experienced on-scene hostility on arrival (from both families and other agencies). Extensive use of PPE muffles voices, obscures facial expressions and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone’s shoulder, wearing name tags on suits and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. Conclusion Human connection is an important element of health-care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full-body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider–patient interactions in pre-hospital EMS. Additionally, ‘communication-friendly’ adaptations of PPE equipment may be an important area for future research and development in manufacturing and the health-care industry.

ImportanceMortality from pediatric out-of-hospital cardiac arrest (OHCA) is high and has not improved in decades, unlike adult mortality. The low frequency of pediatric OHCA and weight-based medication and equipment needs may lead to lower quality of pediatric resuscitation compared with adults.ObjectiveTo compare the quality of pediatric and adult resuscitation from OHCA in a controlled simulation environment and to evaluate whether teamwork, knowledge, experience, and cognitive load are associated with resuscitation performance.Design, Setting, and ParticipantsThis cross-sectional in-situ simulation study was conducted between September 2020 and August 2021 in the metropolitan area of Portland, Oregon, and included engine companies from fire-based emergency services (EMS) agencies.ExposuresParticipating EMS crews completed 4 simulation scenarios presented in random order: (1) adult female with ventricular fibrillation; (2) adult female with pulseless electrical activity; (3) school-aged child with ventricular fibrillation; and (4) infant with pulseless electrical activity. All patients were pulseless on EMS arrival. Data were captured by the research team in real time during the scenarios.Main outcomes and measuresThe primary outcome was defect-free care, which included correct cardiopulmonary resuscitation depth, rate, and compression to ventilation ratio, time to bag-mask ventilation, and time to defibrillation, if applicable. Outcomes were determined by direct observation by an experienced physician. Secondary outcomes included additional time-based interventions and the use of correct medication doses and equipment size. We measured teamwork using the clinical teamwork scale, cognitive load with the National Aeronautics and Space Administration task load index (NASA-TLX), and knowledge using advanced life support resuscitation tests.ResultsAmong the 215 clinicians (39 crews) who participated in 156 simulations, 200 (93%) were male, and the mean (SD) age was 38.7 (0.6) years. No pediatric shockable scenario was defect free and only 5 pediatric nonshockable scenarios (12.8%) were defect free, while 11 (28.2%) adult shockable scenarios and 27 adult nonshockable scenarios (69.2%) were defect free. The mental demand subscale of the NASA-TLX was higher in the pediatric compared with the adult scenarios (mean [SD] pediatric score, 59.1 [20.7]; mean [SD] adult score, 51.4 [21.1]; P = .01). Teamwork scores were not associated with defect-free care.Conclusions and RelevanceIn this simulation study of OHCA, resuscitation quality was significantly lower for pediatric than adult resuscitation. Mental demand may have been a contributor.

Introduction Faculty training awards are an important means of advancing early career faculty in research. The National Institutes of Health (NIH) Building Interdisciplinary Research Careers in Women's Health (BIRCWH) is a long-running K12 career development program and has been integral in promoting the research success of faculty nationally. We surveyed BIRCWH program directors to understand factors likely to influence long-term research careers and funding success. Materials and Methods We developed an online survey containing open-ended questions about individual and programmatic attributes and activities that promote success in achieving independent research funding. Domains of interest included: 1) strategies for funding success; 2) traits for predicting success; 3) groups considered vulnerable to attrition; and 4) existing resources and means of support. Results Fifteen institutions (75%) were included in the final analysis. Passion for research, persistence, resilience, and strong mentorship relationships were identified by all directors as factors important to scholar success. Responses also revealed an important pattern: program directors attributed attrition either to individual or organizational characteristics. This distinction has meaningful consequences for framing efforts to diminish attrition. Faculty who were clinicians, women, parents and underrepresented minorities were identified as vulnerable to attrition from the research careers. Common perceived challenges in these groups included isolation/feeling alienated, juggling numerous priorities, inadequate research time, lack of role models, and work-life balance issues. Conclusion K12 BIRCWH directors identified persistence and resilience and developing community, networks, and other support opportunities as elements of scholar success. Programs and mentors can help early career faculty by teaching skills and providing tools they can use to maximize the value of these opportunities and expand their mentees’ research relationships. Our study also highlights the importance of social factors, particularly isolation, on clinicians, women, and minoritized scholars on career success.

Objectives Although medications for opioid use disorder (MOUD) save lives, treatment retention remains challenging. Identification of interventions to improve MOUD retention is of interest to policymakers and researchers. On behalf of the Agency for Healthcare Research and Quality, we conducted a rapid evidence review on interventions to improve MOUD retention. Methods We searched MEDLINE and the Cochrane Library from February 2009 through August 2019 for systematic reviews and randomized trials of care settings, services, logistical support, contingency management, health information technology (IT), extended-release (XR) formulations, and psychosocial interventions that assessed retention at least 3 months. Results Two systematic reviews and 39 primary studies were included; most did not focus on retention as the primary outcome. Initiating MOUD in soon-to-be-released incarcerated people improved retention following release. Contingency management may improve retention using antagonist but not agonist MOUD. Retention with interventions integrating medical, psychiatric, social services, or IT did not differ from in-person treatment-as-usual approaches. Retention was comparable with XR- compared to daily buprenorphine formulations and conflicting with XR-naltrexone monthly injection compared to daily buprenorphine. Most psychosocial interventions did not improve retention. Discussion Consistent but sparse evidence supports criminal justice prerelease MOUD initiation, and contingency management interventions for antagonist MOUD. Integrating MOUD with medical, psychiatric, social services, delivering through IT, or administering via XR-MOUD formulations did not worsen retention. Fewer than half of the studies we identified focused on retention as a primary outcome. Studies used different measures of retention, making it difficult to compare effectiveness. Additional inquiry into the causes of low retention would inform future interventions.Registration: PROSPERO: CRD42019134739.

Evidence-based decision-making is predicated on the ability of users to find and comprehend results from systematic review. Evidence producers have an obligation to support evidence users in this process. The Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program-a producer of rigorous and comprehensive systematic reviews for two decades-has set a gold standard for reliability in health evidence reviews in the United States. It has recently begun a program of active support for evidence dissemination and uptake beyond mere publication of lengthy reports. This Brief Methods Note critiques the current paper-based format for systematic reviews and describes the development of a next generation (NxGen) AHRQ EPC Effective Health Care website. This redesigned platform will allow end-users of all types to find and share the evidence they need through data visualizations and other interactive displays. Several design principles guided the development of NxGen to make systematic review findings more accessible, customizable, adaptable, interactive, and shareable. NxGen will include visualizations for report results that are expressed as meta-analyses as well as those with narrative syntheses, through forest or bubble plots, respectively. Visual and interactive evidence heat maps are also planned. The NxGen version of the Effective Health Care website is planned to go live in the latter half of 2020 or early 2021.

To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians.This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer.One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome.Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.

In this month's issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we highlight two interventions related to labor induction and initiation as well as a review of adhesion-prevention techniques in gynecologic surgery. The summaries are published below. The complete references with hyperlinks are listed in Box 1.

Introduction Pediatric out-of-hospital cardiac arrests (P-OHCA) are infrequent, have low survival rates, and often have poor neurologic outcomes. Recent evidence indicates that high-performance emergency medical service (EMS) care can improve outcomes. Objectives To evaluate Pediatric Advanced Life Support (PALS) guideline performance in the out of hospital setting and introduce an easy-to-use tool that scores guideline compliance and patient safety. Methods We observed EMS teams responding to standardized pediatric resuscitation simulations. Teams were dispatched to a mock assisted living home for a choking 6-year-old with a complex medical history. The child manikin was presented as unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals; initiate airway management and cardiopulmonary resuscitation (CPR); and establish vascular access and administer epinephrine based on PALS guidelines. We developed a tool to score the quality of care for critical tasks and had a clinical expert evaluate technical performance using blinded video review. Results We observed 34 EMS teams providing care in P-OHCA simulations. Teams were proficient at assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. Teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions. Many teams (53%) deviated from guidelines in chest compressions with 17 (50%) performing continuous compressions before establishing an advanced airway and one (3%) not performing compressions. Similarly, 20 (59%) teams deviated from medication guidelines with 12 (35%) failing to administer epinephrine, six (18%) underdosing, and two (6%) overdosing by more than 20%. Conclusion EMS teams were successful in selecting the appropriate equipment but delayed initiating ventilations in a child with severe bradycardia. We also noted frequent use of continuous chest CC rather than the AHA recommended 15:2 ratio. We developed a scoring tool with time-based criteria that can be used to assess guideline compliance, individual performance, and/or educational effectiveness.

Create an easy-to-use pediatric out-of-hospital cardiac arrest (OHCA)-specific chart review tool to reliably detect severe adverse safety events (ASEs) in the prehospital care of children with OHCA.We revised our previously validated pediatric prehospital adverse event detection system (PEDS) tool, used to evaluate ASEs in the prehospital care of children during emergent calls, to create an OHCA-specific chart review tool. We developed decision support for reviewers, reviewer training, and a dedicated section for chart data abstraction. We randomly selected 28 charts for independent review by 2 expert reviewers who determined the presence or absence of a severe ASE for each care episode and identified the domain of care and preventability for each ASE. We calculated inter-rater agreement in the assessment of the presence or absence of a severe ASE using Gwet's first-order agreement coefficient (AC1).The PEDS-OHCA chart review tool has 6 sections, with a minimum of 70 and maximum of 667 total possible fields. We found inter-rater agreement of 0.83 (95% confidence interval, 0.63-0.99) between our 2 reviewers for the overall detection of a severe ASE and an average time to complete of 8 minutes (range, 2-25 minutes). Inter-rater agreement in the detection of a severe ASE in each individual domain ranged from 0.36 to 0.96.The PEDS-OHCA is the first chart review tool to systematically evaluate the safety and quality of EMS care for children with OHCA. This tool may help improve understanding of the quality of EMS care for children with OHCA, which is essential to improving outcomes.

Background The purpose of this study was to characterize implicit gender bias among residents in US Emergency Medicine and OB/GYN residencies. Methods We conducted a survey of all allopathic Emergency Medicine and OB/GYN residency programs including questions about leadership as well as an implicit association test (IAT) for unconscious gender bias. We used descriptive statistics to analyze the Likert-type survey responses and used standard IAT analysis methods. We conducted univariate and multivariate analyses to identify factors that were associated with implicit bias. We conducted a subgroup analysis of study sites involved in a multi-site intervention study to determine if responses were different in this group. Results Overall, 74% of the programs had at least one respondent. Out of 14,234 eligible, 1634 respondents completed the survey (11.5%). Of the five sites enrolled in the intervention study, 244 of 359 eligible residents completed the survey (68%). Male residents had a mean IAT score of 0.31 (SD 0.23) and females 0.14 (SD 0.24), both favoring males in leadership roles and the difference was statistically significant (p p Conclusions We found that gender bias is present among US residents favoring men in leadership positions, this bias differs between male and female residents, and is associated with discipline. Implicit bias did not differ across training years, and is associated with explicit bias.

Background Women spend most of their reproductive years avoiding pregnancy. However, we know little about contraceptive knowledge and use among women with disabilities, or about strategies to improve contraceptive knowledge and decision-making in this population. Objective To systematically review published literature on women with disabilities and: 1) contraceptive knowledge; 2) attitudes and preferences regarding contraception; 3) contraceptive use; 4) barriers and facilitators to informed contraceptive use; and 5) effectiveness of interventions to improve informed contraceptive decision-making and use. Methods We searched MEDLINE, PsychINFO, the Cochrane Library, CINAHL, and ERIC databases from inception through December 2017. Two reviewers independently reviewed studies for eligibility, abstracted study data, and assessed risk of bias following PRISMA guidance. Results We reviewed 11,659 citations to identify 62 publications of 54 unique studies (total n of women with disabilities = 21,246). No standard definition of disability existed across studies. The majority of studies focused on women with intellectual disabilities (ID). Women with ID and those who were deaf or hard-of-hearing had lower knowledge of contraceptive methods than women without disabilities. Estimates of contraceptive use varied widely, with some evidence that women with disabilities may use a narrower range of methods. Five of six studies evaluating educational interventions to increase contraceptive knowledge or use reported post-intervention improvements. Conclusions Women with disabilities may use a more narrow mix of contraceptive methods and are often less knowledgeable about contraceptives than women without disabilities. Interventions to improve knowledge show some promise. A lack of data exists on contraceptive preferences among women with disabilities.

OBJECTIVE: Emergency medical services providers may be called to a variety of sites to transport pediatric patients, whether it be a scene call for initial evaluation and care, a clinic for transportation of a patient who has been assessed by medical providers, or a hospital where assessment and stabilization have already begun. We hypothesize that there may be a direct relationship between adverse event rates and adverse event severity in transports from less medically stabilizing origins. METHODS: Emergency medical services records of all critical pediatric transports in an urban Oregon county in 2011 were reviewed and abstracted using a standardized tool. From this, UNSEMs (unintended injury, near miss, suboptimal action, error, management complication) were determined, and the potential severity of the issue was assessed. Then, UNSEMs were compared with the origin of transport using logistic regression. RESULTS: Four hundred ninety records were abstracted: 59 hospital transports, 48 clinic transports, and 384 scene transports. Furthermore, UNSEMs were noted in 24 hospital transports (40.7%), 33 clinic transports (68.8%), and 263 scene transports (68.5%). Severe UNSEMs were reported on 0 hospital transports (0.0%), 12 clinic transports (25.0%), and 65 scene transports (16.9%). The odds ratio of UNSEM occurrence from a hospital compared with nonmedical scenes was 0.35 (95% confidence interval, 0.20-0.60), and the odds ratio of a severe UNSEM from a hospital compared with nonmedical scenes was 0.09 (95% confidence interval, 0.01-0.63). CONCLUSIONS: In conclusion, UNSEMs involving the emergency medical services care of children are more likely to occur when transport originates from a clinic or scene compared with a hospital. Language: en

IntroductionThere is growing concern about the declining physician-scientist workforce. NIH recently provided a national dashboard describing the biomedical research workforce, but local strategies are needed.MethodsWe used curated local and national data to develop a workforce dashboard.ResultsMany trends at Oregon Health & Science University (OHSU) were similar to those nationally, such as the increasing percentage of Research Project Grant (RPG)-holding PhDs and the aging RPG population, but differences were also apparent. At OHSU, nearly ¾ of physician-scientist RPGs hold MD-only, compared with nationally, where nearly half are MD/PhD. OHSU also lags in the percentage of RPGs held by women physician-scientists.ConclusionsOur analysis also permitted us to gain a more complete picture of research funding that has been done nationally. We used these data to develop a dashboard that allows our institution to develop policies to increase the numbers of physician-scientists. The data generation approaches and dashboard are likely to be useful at other institutions, as well.

IntroductionEfforts to improve the quality of emergency medical services (EMS) care for adults with out-of-hospital cardiac arrest (OHCA) have led to improved survival over time. Similar improvements have not been observed for children with OHCA, who may be at increased risk for preventable adverse safety events during prehospital care. The purpose of this study is to identify patient and organisational factors that are associated with adverse safety events during the EMS care of paediatric OHCA.Methods and analysisThis is a large multisite EMS study in the USA consisting of chart reviews and agency surveys to measure, characterise and evaluate predictors of our primary outcome severe adverse safety events in paediatric OHCA. Using the previously validated Paediatric prehospital adverse Event Detection System tool, we will review EMS charts for 1500 children with OHCA from 2013 to 2019 to collect details of each case and identify severe adverse safety events (ASEs). Cases will be drawn from over 40 EMS agencies in at least five states in geographically diverse areas of the USA. EMS agencies providing charts will also be invited to complete an agency survey to capture organisational characteristics. We will describe the frequency and proportion of severe ASEs in paediatric OHCA across geographic regions and clinical domains, and identify patient and EMS organisational characteristics associated with severe ASEs using logistic regression.Ethics and disseminationThis study has been approved by the Oregon Health & Science University Institutional Review Board (IRB Approval# 00018748). Study results will be disseminated through scientific publications and presentations, and to EMS leaders and staff through local EMS medical directors, quality and training officers and community engagement activities.

Objective: To evaluate performance of initial steps of newborn resuscitation according to the American Heart Association and American Academy of Pediatrics’ Neonatal Resuscitation Program (NRP) guidelines in the prehospital setting. Study Design: Observational study of 265 paramedics and Emergency Medical Technicians (EMTs) from 45 EMS teams recruited from public fire and private transport agencies in a major metropolitan area. Participants completed a baseline questionnaire assessing demographics, experience, and comfort in caring for children. Simulations were conducted April 2015 to March 2016. Technical performance was evaluated by blinded video review. NRP actions were assessed using a structured performance tool. Results: Two hundred sixty-five EMS providers responded to survey questions and participated in simulations. In total, 16% reported feeling very or extremely comfortable caring for children

Aims American deaths from opioid overdose now approach 50,000 annually. While evidence shows that medications for addiction treatment (MAT) save lives, retaining patients in MAT programs is challenging. The U.S. Agency for Healthcare Research and Quality, on behalf of the U.S. Department of Health and Human Services, commissioned a rapid evidence review on the effectiveness of interventions to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD). Methods We searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). We summarized evidence for six retention intervention types: care settings/services/logistical support, contingency management, health information technology (IT), extended-release (XR) medication-based treatment, psychosocial support, and financial support. Our primary outcome was retention, defined as continued medication engagement for at least 3 months after MAT initiation. Secondary outcomes included mortality and harms. Findings Key findings from 2 SRs and 39 primary studies include: Most studies of MAT for OUD do not focus on retention as the primary outcome, are small (e.g., one to two trials per intervention), and have design flaws. Care setting interventions that initiated MAT in soon-to-be-released incarcerated patients improved retention following release. Contingency management improved retention when combined with antagonist MAT, but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges. Preliminary trials suggest that retention in MAT supported with health IT approaches may be no worse than in-person approaches. Early studies suggest no difference in retention with XR–buprenorphine in either injectable or implant formulations compared with daily buprenorphine. There were conflicting results with XR-naltrexone injection compared with daily buprenorphine. The addition of psychosocial interventions did not improve retention; however, many studies included some form of counseling in the control groups, potentially obscuring evidence of effectiveness. Harms were infrequently reported across studies except in studies of XR formulations. Similarly, few studies reported whether participant characteristics influenced retention. Conclusions While patients who receive longer-term treatment with MAT have improved outcomes, fewer than half of the identified studies measured treatment retention as a primary outcome. Limited evidence suggests criminal justice prerelease MAT initiation and the use of contingency management for patients on antagonist forms of MAT may aid retention. XR and daily buprenorphine formulations appear to be equivalent for treatment retention and comparisons of XR–naltrexone versus daily buprenorphine showed conflicting results. Integrating MAT treatment with medical and social services and the use of health IT did not change retention. Some studies were conducted outside of the United States, where policies and practices differ, focused on highly selected populations and/or conditions that are not fully representative of the spectrum of OUD, or were studied in situations that may not be easily implemented in real-world conditions. There is a critical need for studies that use standardized definitions of retention, include measures of harms as well as benefits, and reflect the full spectrum of real-life conditions.

In March 2020, the United States experienced an unprecedented event that suddenly demanded that researchers cease all nonessential activities to mitigate the rapid spread of the SARS-CoV2. Within the research community, the impact of this cessation on early career investigators was significant, in part because the support systems (i.e., mentors and institutions) that early career investigators typically rely on were also significantly impacted. This article presents the stories of the impact of COVID-19 on early career investigators within the NIH Building Interdisciplinary Research Careers in Women's Health and Women's Reproductive Health Research K12 career development programs. We discuss the common challenges that we faced across our respective fields ranging from basic to clinical to epidemiological women's health research, including the impact it had on our career trajectories. In addition, we share lessons learned in an effort to strengthen our research workforce and increase our resiliency during this and future challenges.

Background Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. Methods This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. Discussion We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health.

Additional file 4. Stakeholders across the 18 steps.

Additional file 3. PRISMA-P reporting checklist.

Additional file 2. The MuSE Consortium.

Additional file 1: Table S1. Levels of engagement.

BACKGROUND: Patients with diabetes lack information on which commercially available applications (apps) improve diabetes-related outcomes. We conducted a rapid evidence review to examine features, clinical efficacy, and usability of apps for self-management of type 1 and type 2 diabetes in adults. METHODS: Ovid/Medline and the Cochrane Database of Systematic Reviews were searched for systematic reviews and technology assessments. Reference lists of relevant systematic reviews were examined for primary studies. Additional searches for primary studies were conducted online, through Ovid/Medline, Embase, CINAHL, and ClinicalTrials.gov. Studies were evaluated for eligibility based on predetermined criteria, data were extracted, study quality was assessed using a risk of bias tool, information on app features was collected, and app usability was assessed. Results are summarized qualitatively. RESULTS: Fifteen articles evaluating 11 apps were identified: six apps for type 1 and five apps for type 2 diabetes. Common features of apps included setting reminders and tracking blood glucose and hemoglobin A1c (HbA1c), medication use, physical activity, and weight. Compared with controls, use of eight apps, when paired with support from a healthcare provider or study staff, improved at least one outcome, most often HbA1c. Patients did not experience improvements in quality of life, blood pressure, or weight, regardless of app used or type of diabetes. Study quality was variable. Of the eight apps available for usability testing, two were scored “acceptable,” three were “marginal,” and three were “not acceptable.” DISCUSSION: Limited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes is unclear. More rigorous and longer-term studies of apps are needed. REGISTRATION: This review was funded by the Agency for Healthcare Research and Quality (AHRQ). The protocol is available at: http://www.effectivehealthcare.ahrq.gov/topics/diabetes-mobile-devices/research-protocol. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-018-4410-1) contains supplementary material, which is available to authorized users.

OBJECTIVE: The objective of this study was to explore the types of patient safety events that take place during pediatric out-of-hospital cardiac arrest resuscitation. METHODS: Retrospective medical record review from a single large urban EMS system of EMS-treated pediatric (

Background Once a proposed topic has been identified for a systematic review and has undergone a question formulation stage, a protocol must be developed that specifies the scope and research questions in detail and outlines the methodology for conducting the systematic review. Rationale Framework modifications are often needed to accommodate increased complexity. We describe and give examples of adaptations and alternatives to traditional analytic frameworks. Discussion This article identifies and describes elements of frameworks and how they can be adapted to inform the protocol and conduct of systematic reviews of complex interventions. Modifications may be needed to adapt the population, intervention, comparators, and outcomes normally used in protocol development to successfully describe complex interventions; in some instances, alternative frameworks may be better suited. Possible approaches to analytic frameworks for complex interventions that illustrate causal and associative linkages are outlined, including time elements, which systematic reviews of complex interventions may need to address. The need for and specifics of the accommodations vary with details of a specific systematic review. This in turn helps determine whether traditional frameworks are sufficient, can be refined, or if alternate frameworks must be adopted.

Background: Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations. Rationale: This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances. Discussion: Systematic reviews of complex interventions comprising multiple questions may use multiple analytic approaches. Parameters to consider when choosing analytic methods for complex interventions include nature and timing of the decision (clinical practice guideline, policy, or other); purpose of the review; extent of existing evidence; logistic factors such as the timeline, process, and resources for deciding the scope of the review; and value of information to be obtained from choosing specific systematic review methods. Reviewers may elect to revise their analytic approach based on new or changing considerations during the course of the review but should guard against bias through transparency of reporting. (C) 2017 The Authors. Published by Elsevier Inc. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services [HHSA290201200004C] This project was funded under contract no. HHSA290201200004C from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.