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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.

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]

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.

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.

In the field of drug safety, causality assessment aims to determine the level of plausibility of the relationship between an adverse event and exposure to a particular product. It is after the causality assessment process that we will be able to point out a product adverse reaction. While regulators often require pharmaceutical companies to use a structured approach for assessing the causality of their products, the available methods are challenged by a number of procedural differences, even when drawing from the same domain of elements. To mitigate these inconsistencies, as well as the additional challenges associated with incomplete information and differences in the application of clinical judgments at the individual case level, this paper proposes a holistic framework for causality assessment that utilizes a combination of expert judgment/global introspection, evidence-based medicine, and probabilistic method. The goal of the presented approach is to provide a guide of clues to causality reminding medical safety assessors to seek and examine all available streams of evidence in totality and to assess this evidence in a qualitative, structured way. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aim Methods Results Conclusion Evidence‐based clinical practice guidelines drive optimal patient care and facilitate access to high‐quality treatment. Creating guidelines for rare diseases such as haemophilia, where evidence does not often come from randomized controlled trials but from non‐randomized and well‐designed observational studies and real‐world data, is challenging. The methodology used for assessing available evidence should consider this critical fact. In formulating guidelines, it is essential to include treatment goals and patient preference.This paper comprehensively critiques, against this background, the recommendations of the ISTH clinical practice guidelines for the treatment of haemophilia.Each recommendation was critically reviewed against available evidence as well as existing guidelines and commented upon for its scientific validity, impact on clinical practice and access to care globally. The validity of the way in which the GRADE methodology was applied to existing evidence was also assessed.The critique provided shows that these recommendations have major limitations: they did not state treatment goals and contradict existing guidelines; opportunities for providing access to innovation were missed when the therapeutic benefits of the products approved in the last decades were not included. A major reason for this is the inappropriate adoption of the GRADE methodology without adaptations and without considering treatment goals and patient‐relevant outcomes.These recommendations may mislead healthcare professionals, payers and governments and therefore cannot serve the patient community well. They setback the advances made in haemophilia care because they overlook important available evidence and do not guide clinical practice to contemporary standards. [ABSTRACT FROM AUTHOR]

Pharmacokinetic (PK) studies pose unique technical challenges. We present the design of a Phase 1, open‐label, fixed‐sequence, PK trial that aimed to compare the timing accuracy of participant‐ versus staff‐collected data, and we provide safety and tolerability outcomes for centanafadine treatment. Healthy adults aged 18‐55 years received a single 100‐mg centanafadine sustained‐release tablet at Visits 1, 2, and 4. PK samples (venous sampling and blood microsampling) and safety assessments (12‐lead electrocardiograms [ECGs] and vital signs) were collected by clinical site staff only at Visit 1. At Visit 2, site staff collected venous blood, and participants obtained blood microsamples, a 6‐lead ECG, and vital signs under staff supervision. At Visit 4, participants obtained blood microsamples, a 6‐lead ECG, and vital signs remotely. The absolute differences between actual and scheduled collection times for PK samples, ECGs, and vital signs are reported descriptively. Of the 20 participants, at least 75% obtained blood microsamples within 10 minutes of the planned nominal time. Absolute differences between actual and scheduled collection times of ECGs and vital signs were small. No adverse events were related to treatment. Overall, results support the feasibility of at‐home collection of PK samples, ECGs, and vital signs. [ABSTRACT FROM AUTHOR]

Understanding and correctly interpreting statistical results presented in scientific articles is a required skill for practicing evidence‐based veterinary medicine. A prerequisite for doing so is the adequate reporting of the results in scientific journals. However, most authors of veterinary publications determine the importance of their findings based on statistical significance (ie, P < .05), indicating that neither the limitations of using P values for inference nor the existence of more appropriate alternatives are widely appreciated in veterinary medicine. This deficiency in knowledge indicates a need to increase awareness in veterinary medicine regarding reporting statistical measures that quantify the magnitude of an effect along with its level of uncertainty, and then interpreting these results for clinical decision making. We utilize a hypothetical randomized controlled trial of dietary management in cats with chronic kidney disease to discuss some common misconceptions about P values and provide practical suggestions for alternatives. Reporting appropriate effect estimates along with their confidence intervals will allow veterinarians to easily and correctly determine whether the magnitude of the effect of interest meets clinical needs while acknowledging uncertainty in the results. We also describe confidence interval functions and show their utility as visual tools in aiding interpretation of confidence intervals. By providing practical guidance, we show that a change in reporting and interpreting statistical results is feasible and necessary. We hope this crucial step will promote clinical decision making based on effect estimates and confidence intervals. [ABSTRACT FROM AUTHOR]

Objectives: To identify research and development priorities for virtual care following the coronavirus disease 2019 pandemic from the perspective of key stakeholders (patients, clinicians, informaticians and academics). Design: Qualitative study using a modified nominal group technique. Setting: Online semi‐structured interviews and workshops held in November 2022 and February 2023. Participants: Health workers involved in delivering virtual care in two metropolitan local health districts and one specialty statewide network, and people who had received care from these sites, were recruited using passive snowball sampling. Research and academic staff from a tertiary institution were also invited to participate. Main outcome measures: Priorities to support a translational research agenda for virtual care. Results: Twenty‐five individuals participated including 18 innovation deliverers, two innovation recipients and five implementation facilitators. Stakeholders identified several key priorities for developing virtual care models and for sustaining and scaling virtual care services. These included demonstrating the economic and societal value of virtual care, developing a common framework to support evaluation and comparison of virtual care services, ensuring virtual care services integrate acute and primary care, and defining which models of care are most appropriate for virtual care delivery. Conclusion: As the health system recalibrates with the return of in‐person care, there is a growing need to demonstrate the value of virtual care models to patients, the health system, and society at large. Demonstrating this value while also demonstrating improvements to health outcomes will future‐proof virtual care, enabling it to be used to address broader challenges of health care delivery. In addition, sustaining virtual care will depend on robust operational structures and workforce training and education. As services evolve, research and development priorities must be revisited to ensure that translational research aligns with stakeholder interests. [ABSTRACT FROM AUTHOR]

The article highlights the designing of supportive culture at Grady Memorial Hospital in Atlanta, Georgia founded on leadership commitment, mission and core values. It discusses the healthcare organization's utilization of Relationship-Based Care as a transformative framework to address opportunities and challenges around quality and patient/staff safety, patient and family perception of care, employee engagement and cultural transformation. It explains the effect of practicing self-compassion.

Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms. [ABSTRACT FROM AUTHOR]

Educational Challenge: As technological advancements challenge the current roles healthcare workers fill, curiosity and lifelong learning are becoming increasingly important. However, descriptions of specific curricular interventions that successfully develop these attitudes and skills remain limited. Proposed Solution: We aimed to promote curiosity and advance practical application of evidenced-based medicine through a longitudinal, gamified learning activity within a longitudinal integrated clerkship (LIC). Thirty-seven students across two inquiry-themed LICs based at a university hospital and a community-based integrated healthcare delivery system used BINGO cards containing various assignments designed to develop the skill of asking and answering clinical questions. Assignments included: engaging experts, using evidence-based medical resources, attending education events, utilizing medical library resources, and Phone-a-Scientist. Students shared their experiences in a group setting and wrote a reflection for each assignment that was qualitatively analyzed to determine the perceived educational outcomes according to the Kirkpatrick Evaluation Model. Lessons Learned: Results suggest that Inquiry BINGO fosters curiosity and builds skill in applied evidenced-based medicine early in clinical training. Most assignments prompted students to engage in opportunities they might not have otherwise explored. All but three students reported a change in behavior as a result of the assignment and 57% reported positive clinical or research results. Next Steps: Future iterations of this activity should be evaluated by obtaining patient and/or preceptor feedback as well as longitudinal evaluations of student behavior to ensure higher level educational outcomes are being met. [ABSTRACT FROM AUTHOR]

Design is and always has been interventional and clinically relevant. Modern evidence-based designers' lineage was prominently shaped between 1800 and 1970. This article investigates hospital designs during this period that were correlated with patients' health outcomes and suggests how this history influenced our present-day understanding of evidence-based design. [ABSTRACT FROM AUTHOR]

Since the 1980s, science about how built environments influence human health has been used by architects, engineers, and designers to inform decisions about health care organizations' structures and spaces. Because design influences health outcomes, ignoring evidence-based design can be a source of clinical, ethical, legal, and organizational liability. This article introduces concepts related to designs' influence on patient and community health outcomes and suggests strategies for health-legal partnering to promote rigor in health care organizational design practices that promote quality and equity in health service delivery. [ABSTRACT FROM AUTHOR]

When built environments in health care result from an evidence-based design (EBD) process, they are interventions that can improve patients' health outcomes. This commentary on a case discusses which ethical values should guide organizations' capital expenditure decisions about retrofits, which might be more costly than the original budget. This discussion urges reevaluation of the common assumption that capital improvements are "sunk costs," since such improvements can promote long-term positive health outcomes for an organization's patients, thereby advancing both financial value and ethical values. This commentary also suggests that EBD offers key interventions that are clinically and ethically relevant. [ABSTRACT FROM AUTHOR]

The article focuses on the evolution of hospital design and its influence on healthcare. Topics include the historical development of healthcare architecture, the role of human-centered design in improving patient care, and how "design thinking" can assist health professionals in enhancing healthcare delivery.

Objective: This systematic review aims to examine the current literature on help-seeking, hearing device uptake, and hearing health outcomes in individuals with subclinical hearing loss. Design: Systematic review. Study Sample: Searches of three databases (CINAHL, MEDLINE (PubMed), and Scopus) yielded nine studies meeting the inclusion criteria. The quality of the included studies was determined using the National Institute of Health quality assessment tool. The studies' level of evidence was determined according to the Centre for Evidence-Based Medicine. Results: All included studies involved adult participants. Three studies examined help-seeking. Self-reported difficulty, poor speech-in-noise performance, and emotional responses to the hearing difficulty were identified as factors influencing help-seeking. Six studies examined the use of hearing devices as an intervention, including hearing aids (n = 4), hearables (n = 1), and FM systems (n = 1). Using hearing devices improved self-perceived hearing difficulty, speech-in-noise understanding, and motivation to address hearing difficulties. No studies focused on hearing device uptake. The quality assessment indicated limited methodological rigour across the studies, with varying levels of evidence. Conclusions: Current evidence supports the use of hearing devices as an intervention for individuals with subclinical hearing loss. However, more research is essential, particularly focusing on help-seeking, diagnosis, treatment, and long-term outcomes using well-controlled study designs. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To remind yourself of the importance of screening older people for malnutrition • To enhance your awareness of the crucial elements of a holistic nutritional assessment • To find practical guidance on how to undertake a holistic nutritional assessment with an older person. Rationale and key points: Nutrition is a fundamental aspect of nursing care, however older people cared for in hospital, in a care home or in their own home do not always receive adequate support with their nutritional needs, which can leave them at risk of malnutrition. Using a holistic, biopsychosocial framework to support a comprehensive nutritional assessment that includes malnutrition screening can support the nurse to identify the older person’s nutritional status and nutrition needs. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. • Malnutrition in older people can lead to a decline in functional ability, reduced muscle strength, fatigue, impaired immunity, suboptimal wound healing, increased risk of infection and increased risk of falls. • Screening for, and assessing the risk of, malnutrition is an important part of nursing assessments in any healthcare setting. • A holistic nutritional assessment should incorporate physiological, psychological, emotional, spiritual, social and cultural elements. Reflective activity: ‘ How to’ articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a holistic nutritional assessment with an older person. • How you could use this information to educate nursing students or your colleagues on the appropriate techniques and evidence base for undertaking a holistic nutritional assessment with an older person. [ABSTRACT FROM AUTHOR]

Fundoplication is a durable, effective, and well-accepted treatment for gastroesophageal reflux disease. Nonetheless, troublesome postoperative symptoms do occasionally occur with management varying widely among centers. In an attempt to standardize definition and management of postfundoplication symptoms, a panel of international experts convened by the Guidelines Committee of the International Society for Diseases of the Esophagus devised a list of 33 statements across 5 domains through a Delphi approach, with at least 80% agreement to establish consensus. Eight statements were endorsed for the domain of Definitions, four for the domain of Investigations, nine for Dysphagia, nine for Heartburn, and four for Revisional surgery. This consensus defined as the treatment goal of fundoplication the resolution of symptoms rather than normalization of physiology or anatomy. Required investigations of all symptomatic postfundoplication patients were outlined. Further management was standardized by patients' symptomatology. The appropriateness of revisional fundoplication and the techniques thereof were described and the role of revisional surgery for therapies other than fundoplication were assessed. Fundoplication remains a frequently-performed operation, and this is the first international consensus on the management of various postfundoplication problems. [ABSTRACT FROM AUTHOR]

Introduction: Autistic children commonly receive simultaneous services from various health‐care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health‐care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children. Methods: This study employed an exploratory qualitative descriptive design. Semi‐structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data. Consumer and Community Consultation: This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines. Findings: Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism‐related frames of reference were perceived to influence interprofessional collaboration. Conclusion: Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model. PLAIN LANGUAGE SUMMARY: This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to examine the feasibility of adapting and translating an evidence‐based occupational therapist‐delivered program shown to be effective in the community to residential aged care (RAC). The program aims to improve quality of care and quality of life for people living with dementia and the wellbeing of the family care partner. Methods: This study took place in a not‐for‐profit RAC home in Adelaide, South Australia. Mixed methods, specifically questionnaires, activity logs, focus group, and one‐on‐one interviews were used to evaluate the feasibility of the program implementation. Staff working in the participating home, occupational therapists trained to deliver the program, and residents and their family carer partners were included. Quantitative data were analysed using proportions, means, and standard deviations. Qualitative data were analysed using a thematic approach. Consumer and Community Involvement: This study was conducted together with a consumer (person living with dementia) and a carer representative (family member of someone residing in RAC). These representatives provided input towards the study design, interpretation of study data, discussion of results, and recommendations for future consideration. Results: Small changes to the program improved feasibility and acceptability for delivery in RAC. While the care home staff required added support during implementation, the intervention therapists felt that the program could be delivered in this setting. Family care partners of residents with dementia felt that the program may be better suited if provided upon entry to RAC or in early stages of dementia. Conclusion: Adapting a community‐based dementia care program to RAC can be safe and feasible. Program adaptations are necessary for feasibility. Further adaptations and evaluations of associated outcomes (related to residents with dementia and their family care partners) are needed to assess the program effectiveness in larger scale. Plain language summary: Spending quality time with family members in residential aged care is important. However, many struggle to know what to say or do when visiting a family member who lives with dementia. Programs that teach families about how to communicate with people living with dementia, how to support them to take part in important everyday living activities, or how to understand why changes in behaviours may occur have not been available in residential aged care. This paper describes how we adapted one such evidence‐based program from community to residential aged care settings. We consulted with people living with dementia, carers, and families and found that the program could also be valuable in this care setting. Residential aged care staff described how the program is very different to what is usually available in residential aged care, but they were optimistic that with the right support, it could be a valuable way to support residents with dementia and their families. Family members of residents with dementia and therapists delivering the program felt that residents in early stages of living in residential aged care and/or early stages of dementia could benefit the most from these programs. We found that including family members in the intervention process can be useful and empowering for families and residents. Future work should also focus on involving other staff members caring for residents in the process. Communication between staff and families is the key for program delivery and success and treating each person as an individual. [ABSTRACT FROM AUTHOR]

Objectives To validate the PEDiatric Behçet's Disease classification criteria (PEDBD) with an evidence-based approach. Methods A total of 210 pediatric patients [70 Behçet's disease (BD), 40 periodic fever, aphthous stomatitis, pharyngitis, adenitis, 35 familial Mediterranean fever, 26 hyper-IgD syndrome, 22 TNF-receptor associated periodic fever syndrome, 17 undefined recurrent fevers] were randomly selected from the Eurofever Registry. A set of 11 experienced clinicians/researchers blinded to the original diagnosis evaluated the patients. Using the table consensus as gold standard (agreement ≥ 80%), the PEDBD, ISG and ICBD criteria were applied to BD patients and to confounding diseases with other autoinflammatory conditions in order to define their sensitivity, specificity and accuracy. Results At the end of the third round, a consensus was reached in 139/210 patients (66.2%). The patients with a consensus ≥80% were classified as confirmed BD (n  = 24), and those with an agreement of 60–79% as probable BD (n  = 10). When comparing these patients with the confounding diseases group, an older age at disease onset, the presence of oral and genital ulcers, skin papulo-pustular lesions, a positive pathergy test and posterior uveitis were BD distinctive elements. The ISG, ICBD and PEDBD criteria were applied to confirmed BD and to the confounding disease group, showing a sensitivity of 0.50, 0.79 and 0.58, a specificity of 1.00, 0.97 and 0.99, and an accuracy of 0.91, 0.94 and 0.92, respectively. Conclusions The PEDBD criteria were very specific, while the ICBD were more sensitive. The complexity of childhood BD suggests larger prospective international cohorts to further evaluate the performance of the criteria. [ABSTRACT FROM AUTHOR]

In clinical clerkship (CC), medical students can practice evidence-based medicine (EBM) with their assigned patients. Although CC can be a valuable opportunity for EBM education, the impact of EBM training, including long-term behavioral changes, remains unclear. One hundred and nine fourth- and fifth-year medical students undergoing CC at a medical school in Japan attended a workplace-based learning program for EBM during CC (WB-EBM), which included the practice of the five steps of EBM. The program's effect on the students' attitudes toward EBM in CC was assessed through questionnaires. A total of 88 medical students participated in the program. Responses to the questionnaire indicated high satisfaction with the WB-EBM program. The most common theme in students' clinical problems with their assigned patients was the choice of treatment, followed by its effect. Based on the responses in the post-survey for the long-term effects of the program, the frequency of problem formulation and article reading tended to increase in the 'within six months' group comprising 18 students who participated in the WB-EBM program, compared with the control group comprising 34 students who did not. Additionally, the ability to self-assess problem formulation was significantly higher, compared with the control group. However, among 52 students who participated in the WB-EBM program more than six months later, EBM-related behavioral habits in CC and self-assessments of the five steps of EBM were not significantly different from those in the control group. The WB-EBM program was acceptable for medical students in CC. It motivated them to formulate clinical questions and enhanced their critical thinking. Moreover, the WB-EBM program can improve habits and self-evaluations about EBM. However, as its effects may not last more than six months, it may need to be repeated across departments throughout CC to change behavior in EBM practice. [ABSTRACT FROM AUTHOR]

Aims: To investigate perioperative opioid requirements in patients on methadone or buprenorphine as medication for opioid‐use disorder (MOUD) who attended a transitional pain clinic (Personalized Pain Program, PPP). Methods: This retrospective cohort study assessed adults on MOUD with surgery and attendance at the Johns Hopkins PPP between 2017 and 2022. Daily non‐MOUD opioid use over 6 time‐points was evaluated with regression models controlling for days since surgery. The time to complete non‐MOUD opioid taper was analysed by accelerated failure time and Kaplan–Meier models. Results: Fifty patients (28 on methadone, 22 on buprenorphine) were included with a median age of 44.3 years, 54% male, 62% Caucasian and 54% unemployed. MOUD inpatient administration occurred in 92.8% of patients on preoperative methadone but only in 36.3% of patients on preoperative buprenorphine. Non‐MOUD opioid use decreased over time postoperatively (β = −0.54, P <.001) with a median decrease of 90 mg morphine equivalents (MME) between the first and last PPP visit, resulting in 46% tapered off by PPP completion. Older age and duration in PPP were associated with lower MME, while mental health conditions, longer hospital stays and higher discharge opioid prescriptions were associated with higher MME. The average time to non‐MOUD opioid taper was 1.79× longer in patients on buprenorphine (P =.026), 2.75× in males (P =.023), 4.66× with mental health conditions (P <.001), 2.37× with chronic pain (P =.031) and 3.51× if on preoperative non‐MOUD opioids; however, higher initial MOUD level decreased time to taper (P =.001). Conclusions: Postoperative opioid tapering utilizing a transitional pain service is possible in patients on MOUD. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to identify patterns in information sharing between Evidence-Based Medicine journals to determine key evidence dissemination areas from co-authorship, co-occurrence and citation networks and to provide a scientific horizon for improving the dissemination of Evidence Based Medicine Research in Iran. And show the trend of Evidence Based Medicine research at Endocrinology & Metabolism Research Institute (EMRI), Tehran University of Medical Sciences. Methods: This was a bibliometric study. Scopus database was used for retrieving and analyzing the publications. We analyzed the relationship between co-authorship and citation and visualized them. Co-occurrence keywords in EBM articles in the Scopus database, and developed subject charts and research field relationship. Results: Journal of Diabetes and Metabolism Disorders (GDMD) contains a large collection of information of relevance to Evidence Based Medicine and its contents are widely cited across many journals in Iran. The investigation of co-authorship network showed that 121 EBM articles from 191 authors, Akbar Soltani has the highest citations in EBM research and he is a pioneer in this subject area. The scientific contributions of GDMD to EBM is mostly in disease control and therapy. An Evidence Based Medicine Research Center focused more on these areas such as education, treatment and research, Evidence Based Clinical Practice, Evidence Based Policymaking and to improve clinical reasoning and clinical thinking. In co-occurrence author keywords, the highest publications were in osteoporosis. From the main journals that had published the most were the journal of diabetes and metabolic disorders (GDMD).From citation organizations, EMRI contains large collections of information of relevance to EBM and are widely cited across 171 organizations in Iran. Conclusions: An Evidence Based Medicine Research Center scientific production contain several key clusters. With authors, organizations and subject area being the source of the majority of articles. The EBM co-authorship author's network in Iran is comprised of 191 authors in 23 clusters in major groups, the largest and most productive in this network is led by Akbar Soltani with Bagher Larijani,Shirin Hasani Ranjbar, Arash Moayyari, Arash Hossen-nazhad, Iraj Nabipour, Ramin Heshmat ,Hamideh Mosapour,Azadeh Aletaha, ,Mahbobeh Khabaz- Mafinejad as central members. The findings shows that EBM research topics are widely communicated to other medical fields like osteoporosis and obesity and have begun to shift from Evidence Based clinical Practice to Evidence based management. [ABSTRACT FROM AUTHOR]

Health inequities are unjust and avoidable differences in health outcomes across populations and between population groups. Though these arise predominantly from social determinants of health, healthcare is estimated to contribute around 20 % and primary healthcare reduces inequities in healthcare outcomes. As each provider works in their local context, we sought to provide an evidence-informed framework for designing, implementing, and evaluating local health inequity interventions in primary care. Mixed methods approach: an integrative evidence review, a multidisciplinary Delphi consensus study and collaborative patient and public participation. We searched published and grey literature for examples of primary care health inequity interventions. Our Delphi survey then asked primary care professionals how feasible and useful similar interventions would be in their local contexts. We incorporated an ongoing dialogue people with lived experience of health inequity in our design, implementation, and analysis. Sixty-nine published papers and 19 grey literature papers were included. Interventions included multiple objectives (e.g., tailored provision, practitioner training) or focus (e.g., medical care, screening). Theory underpinning intervention design was rarely explicit but some specific tools and theory was identified for the framework. Practitioners and our patient group prioritised 28 example interventions to aid the design of local contextually sensitive interventions. We combined evidence synthesis, practitioner consultation and dialogue with people with lived experience produced an evidence-informed framework for the design, implementation and evaluation of local primary care health inequity interventions. The public and practitioner voice increases the credibility of our framework as a useful tool for service development. [ABSTRACT FROM AUTHOR]

To examine the association between clinical personnel's general attitudes towards new interventions and implementation outcomes related to an evidence-based individualized, culturally tailored, computerized decision aid (DA) for the management of lupus. To assess attitudes, the validated Evidence-Based Practice Attitudes Scale (EBPAS) survey was emailed to personnel in 15 rheumatology clinics across the U.S. The survey also included questions related to three validated implementation outcomes: lupus DA acceptability, appropriateness and feasibility. The baseline round of the survey was fielded from August 2019 to January 2020 and yielded a 56.8% response rate (n = 76 respondents). We also collected organizational characteristics from each clinic and personnel-level control variables. Overall, respondents reported modest levels of lupus DA acceptability, appropriateness and feasibility (3.54, 3.45 and 3.40, respectively, on a scale of 1–5). Multilevel regression analyses demonstrated statistically significant positive relationships between a respondent's openness to new practices/interventions and perceived lupus DA acceptability (β = 0.31, p <.01) and feasibility (β = 0.28, p <.05). Divergence (a respondent's perceived difference between current and new practices) was not associated with clinic personnel perceptions of the DA. These findings suggest that understanding clinic personnel general attitudes toward new interventions is an important precursor to implementing evidence-based practices and may provide important diagnostic information about places to intervene in preparation for implementation and improving shared decision-making with patients. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are prevalent among individuals diagnosed with gestational diabetes mellitus (GDM), significantly impacting their overall quality of life. Objective: This study sought to adopt a person-centered methodology to unveil the latent profiles of sleep quality and identify factors influencing sleep patterns in patients with GDM. Methods: The cross-sectional study gathered sociodemographic features, clinical information, sleep problems (Pittsburgh Sleep Quality Index), personality traits (Type D Personality Scale), social support (Perceived Social Support Scale), and self-efficacy (General Self-efficacy Scale). Latent profile analysis was conducted to identify profiles of sleep quality, while multinomial logistic regression was employed to ascertain the factors influencing these identified profiles. Results: Among the 431 participants, 423 (98.1%) completed the questionnaire, with 53.0% reporting moderate-to-poor sleep quality. This study identified 4 distinct profiles of sleep quality among patients with GDM: the "good sleep quality" group (47.0%), the "poor sleep quality—long sleep duration" group (10.0%), the "moderate sleep quality" group (25.3%), and the "poor sleep quality—short sleep duration" group (17.7%). Individuals with type D personality were associated with the "poor sleep quality—long sleep duration" [odds ratio (OR) = 3.21, P =.005], "moderate sleep quality" (OR = 2.65, P =.003), and "poor sleep quality—short sleep duration" group (OR = 2.31, P =.018). Individuals with a history of GDM were associated with "poor sleep quality—long sleep duration" group (OR = 3.46, P =.005). Conclusions: The research revealed significant classification characteristics of sleep quality in patients with GDM, offering valuable insights for tailoring interventions to address distinct subcategories of sleep-related issues. [ABSTRACT FROM AUTHOR]

Aim: To systematically search, evaluate and synthesise the most robust evidence regarding pressure injury prevention in orthopaedic patients admitted to general wards. Design: The present study provides an evidence‐based summary of the most robust findings, adhering to the evidence guidelines established by the Center for Evidence‐Based Nursing of Fudan University. Method: According to the "6S" model, a systematic search was conducted for literature on pressure injury prevention among orthopaedic patients in general wards. The types of literature included guidelines, clinical decisions, expert Consensus, evidence summaries, etc. The search period covered the time from the beginning of the database up to December 2023. Data Source s : The following databases and resources were systematically searched: Up To Date, JBI, NICE, WOCN, NZWCS, etc. Results: Fifteen literature sources were included, comprising one clinical decision, eight guidelines, one systematic review, and one expert Consensus. In these sources, a comprehensive collection of 34 pieces of best evidence was formed across six key topics: risk assessment, position management, skin care, device used for device‐related pressure injury, nutritional assessment, and support, as well as health education and training. Among the evidence gathered, a strong recommendation was made for 18 pieces, while the remaining 16 received a weak recommendation. Conclusion: This study provides a comprehensive synthesis of the most robust evidence on pressure injury prevention in orthopaedic patients, encompassing 34 pieces of evidence that can serve as valuable references for clinical practice. Before implementing this evidence, it is crucial to evaluate the specific contextual factors within different countries and medical institutions, as well as the facilitators and barriers influencing its application by healthcare professionals and patient's preferences. Furthermore, targeted evidence selection should be conducted through careful screening and subsequent adjustments in implementation, thereby offering a more scientifically grounded basis for clinical nursing practice. Future research endeavours should prioritise investigating strategies for effective evidence utilisation. Implications for the Profession and Patient Care: The prevention of pressure injuries poses a significant challenge for orthopaedic patients. This study presents a synthesis of 34 pieces of best evidence to provide guidance on preventive measures for pressure injuries in orthopaedic patients. Adhering to and implementing these 34 pieces of evidence can effectively aid in preventing pressure injuries in clinical practice. This evidence encompasses risk assessment, position management, skin care, device usage for device‐related pressure injuries, nutritional support and evaluation, and health education and training, establishing a comprehensive and systematic implementation process. Assessing the risk of pressure injuries during interventions serves as an essential prerequisite for developing effective strategies to prevent such injuries among orthopaedic patients. Ultimately, this study will offer valuable guidance to healthcare professionals worldwide regarding preventing pressure injuries in orthopaedic patients. Impact: Upon admission to the hospital, it is essential to conduct a risk assessment and implement evidence‐based, individualised prevention measures for pressure ulcers in patients to prevent their occurrence. This study will provide valuable insights into preventing pressure injuries in orthopaedic patients admitted to orthopaedic wards for healthcare workers worldwide. State: The PRIMA manifest is utilised during the text preparation process. Trail Registration: ES20245365 [ABSTRACT FROM AUTHOR]

Nous proposons dans ce travail de nous intéresser au soin énergétique, une pratique encore peu étudiée en France, malgré sa forte influence sur une grande variété de dispositifs thérapeutiques alternatifs. Cet article tente de préciser les raisons du succès de ces soins et de décrire leurs logiques thérapeutiques à partir de l'analyse des processus psychiques qui les caractérisent. Vingt-cinq thérapeutes (énergéticiens, magnétiseurs, thérapeutes alternatifs) ont été sollicités pour participer à plusieurs entretiens semi-directifs centrés sur la phénoménologie des soins qu'ils proposent à leurs consultants. Le corpus de données a été analysé selon une approche phénoménologique et psychanalytique afin de mettre en évidence les spécificités de ces pratiques. Le soin énergétique est un ensemble de pratiques thérapeutiques aux méthodes hétérogènes qui reposent sur la représentation d'une « énergie vitale ». Ces pratiques sont fréquemment sollicitées dans des contextes de « malheurs ordinaires » qui associent symptômes somatiques récurrents, souffrances psychiques et étapes critiques de la vie. La pratique et l'efficacité du soin énergétique semblent s'appuyer sur des processus largement inconscients, qui favorisent l'émergence d'états non ordinaires de conscience et potentialisent des processus de transformation psychique. Ces dispositifs pourraient s'apparenter par certains aspects à une forme de médiation dans laquelle le thérapeute s'appuie sur des manipulations corporelles et d'objets pour induire des effets psychiques. Le caractère apparemment « magique » de ces thérapies polarise le débat scientifique et médiatique autour de la manière dont elles peuvent se conformer ou non aux exigences de la médecine fondée sur des preuves. La modélisation proposée dans cet article permet de se décentrer de ces questions en soulignant notamment le contexte anthropologique associé à l'émergence des dispositifs thérapeutiques alternatifs en Occident. L'approche développée dans cet article prolonge et ouvre le champ de recherche de la clinique des expériences exceptionnelles, en montrant que l'étude des thérapies alternatives, lorsqu'elle n'est pas seulement centrée sur la question de la preuve d'efficacité spécifique, offre une perspective féconde pour mieux comprendre la nature de la relation et des effets thérapeutiques. In this paper, we look at energy healing, a relatively under-studied therapeutic approach in France, despite its strong influence on a wide variety of complementary and alternative therapies. This article attempts to clarify the reasons for the success of these approaches by analyzing the psychic processes inherent in them. Twenty-five therapists (energy therapists, magnetic healers, alternative therapists) were recruited to take part in several semi-directive interviews focusing on the phenomenology of energy healing. The corpus of data was analyzed using a psychoanalytical approach in order to highlight the specific features of these practices. Energy healing is a set of therapeutic practices with heterogeneous methods based on the representation of a vital energy. These practices are frequently used in contexts of "ordinary misfortune" that combine persistent somatic symptoms, psychological suffering, and critical stages in life. The practice and effectiveness of energy healing seem to be based on unconscious psychic processes. These processes encourage the emergence of non-ordinary states of consciousness that potentiate processes of psychic transformation. In some aspects, this setting could be compared to a form of mediation in which the therapist uses body and object manipulations to induce psychic effects. The apparently "magical" nature of these therapies polarizes the scientific and media debate around the way in which they do or do not comply with the requirements of evidence-based medicine. The model proposed in this article allows us to move away from these issues and take into account the anthropological aspects of alternative therapeutic systems. The approach developed in this article extends and opens up clinical research on exceptional experiences, by showing that the study of alternative therapies, when it is not solely centered on the question of specific proof of efficacy, offers a fruitful perspective for making more explicit the processes of the caregiving relationship. [ABSTRACT FROM AUTHOR]

Academic centers play a vital role in advancing knowledge, driving innovation, and fostering collaboration. The University of Texas at Austin Center for Health Communication was established in 2014 with the mission to improve public health through evidence-based communication research and practice. In this article, we reflect on the center history, explain our practice-oriented funding structure, and showcase examples of public health campaigns informed by theory and data, as well as professional-oriented educational programs. We also discuss the academic and community impact of our research, education, and practice and the benefits and challenges associated with this practice-led funding model. Although there are other approaches to operating academic centers, we hope the lessons we have learned can be of help to other centers dedicated to health communication research and practice. [ABSTRACT FROM AUTHOR]

Vaccines (a medical product) and vaccination recommendations (expert advice on who should receive, when, and how often) have grown in importance and prominence in the past 15 years, including because of a recent COVID-19 pandemic. This essay highlights contributions from vaccine and vaccination-related health communication research since 2010. This research has had significant impacts – that is, visible and discernible positive effects – on the ways health communication is undertaken broadly (e.g. at the campaign level) and at the health care provider-patient level (e.g. conversations with parents and patients regarding vaccine benefits, risks, and safety). As this essay illustrates, health communication research has resulted in greater use of formative research to guide vaccination campaign and education efforts, better identification and understanding of the factors behind vaccination delay and declination, and greater recognition that communication efforts can fail to achieve desired outcomes or generate unintended consequences. Health communication research has also documented the powerful influence of healthcare provider communication on parent and patient understanding and compliance with immunization recommendations. Importantly, this research has also shown the characteristics of provider-patient communication matter much. Healthcare providers must have or establish a high degree of trust, be well-versed in vaccine efficacy and safety, and be adept at using their personal experiences, information tailoring/personalization, and evidence-based communication strategies to increase the likelihood of success. [ABSTRACT FROM AUTHOR]

Health communication research applies communication science to develop generalizable knowledge capable of improving the health and well-being of individuals and communities. But to what extent does the knowledge generated by the health communication field actually achieve public health impact? To answer this question, we discuss the application of health communication science and research within a tobacco regulatory science framework. We describe three areas in which health communication research funded by the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) contributed to 1) youth tobacco prevention campaigns, 2) cigarette health warnings, and 3) regulation of labeling, advertising, and marketing claims. These examples demonstrate how communication regulatory science achieves public health impact in the real world by informing national policies, regulatory actions, and public health practice. [ABSTRACT FROM AUTHOR]

This paper describes three spiritual practices utilized for healing. These modalities—meditation, mindfulness, and prayer—share a spiritual foundation and appear to operate, in part, through mind–body connections that can be accessed to ameliorate physical and psychological symptoms and to promote health. For each modality, this paper discusses pertinent conceptual issues, summarizes empirical evidence suggestive of a role in healing, and outlines theoretical support for such a relationship. Also discussed is a fourth modality, energy healing, and how it might be studied, as well as why further investigation of spiritual healing is merited and a worthwhile topic for medical research. [ABSTRACT FROM AUTHOR]

Psychiatric clinical diagnostic formulation has evolved over time. The changes alter our understanding and our ability to provide a public health perspective on the epidemiology of mental disorders in large populations. Epidemiology is an important perspective and set of tools to assess prevalence, treated prevalence, untreated prevalence, individual risks for mental disorders, and possible links to the etiology of disorders by following the trails of environmental exposures, biological measures, interpersonal dynamics, and genetic risk factors. As communities develop health-care services to treat individuals with mental disorders, knowledge about their prevalence and treatment requirements is also important. Since severe mental disorders may require institutional care, the diagnostic criteria used may either protect an individual's liability for dangerous behavior (i.e. the insanity defense) or be used to control political and social dissidents. The criteria may also be used to determine evidence-based treatment options and eligibility for disability benefits. In this paper, using my vantage points as a physician scientist and public health officer, with leadership positions in national federal and professional mental health organizations, I address the developments in these areas over the past 50 years that have influenced institutional positions in the U.S. National Institute of Mental Health, the World Health Organization, the American Psychiatric Association, and the Center for the Study of Traumatic Stress. These perspectives may aid the next generation of investigators to advance the epidemiological and mental disorder classification scientific fields. [ABSTRACT FROM AUTHOR]

Biomedical deployments of data science capitalize on vast, heterogeneous data sources. This promotes a diversified understanding of what counts as evidence for health-related interventions, beyond the strictures associated with evidence-based medicine. Focusing on COVID-19 transmission and prevention research, I consider the epistemic implications of this diversification of evidence in relation to (1) experimental design, especially the revival of natural experiments as sources of reliable epidemiological knowledge; and (2) modeling practices, particularly the recognition of transdisciplinary expertise as crucial to developing and interpreting data models. Acknowledging such shifts in evidential, experimental, and modeling practices helps avoid harmful applications of data-intensive methods. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the feasibility of the Swiss complex interprofessional intervention, NEODOL© (NEOnato DOLore), for improving the management of procedural pain in neonates in the Finnish context. Background: Interprofessional collaboration is important for all professionals involved in the care of neonates and for neonates' parents, to understand the appropriate use of non‐pharmacological and/or pharmacological methods for each pain situation and how to assess pain in real‐life situations. Appropriate methods of pain relief for neonates should be preferred as they protect the development of the neonate's brain. Design: A descriptive qualitative design. Method: Data were collected through semi‐structured focus group discussions following the Medical Research Council's framework for evaluation of complex interventions, in this case NEODOL© which aims to improve the procedural pain management of neonates. A purposive sample (n = 13) included eleven professionals representing various professions within Finnish Neonatal Intensive Care Units and two parents of infants who have received care in a Neonatal Intensive Care Unit. Data were analysed using inductive content analysis, and the results were reported in accordance with the COREQ guidelines. Results: Professionals' and parents' evaluations suggest that NEODOL© is feasible, because it is consistent and addresses a current need. They assessed its overall content to be relevant and accessible, and its components to be internally coherent. However, they emphasise the need for further evaluation and refinement of the intervention to achieve the desired outcomes and cost‐effectiveness. Conclusions: While NEODOL© is considered feasible, it requires further evaluation and refinement in the local context of each hospital before implementation. [ABSTRACT FROM AUTHOR]

The current cost‐of‐living crisis is disproportionately affecting families experiencing poverty and is likely to be amplifying existing dietary inequalities and challenges, such as food insecurity (FI). Government policies designed to address diet inequality in the UK have historically had minimal impact on population diet and health and may have even widened existing inequalities. Therefore, the effect of nutrition policies on those experiencing FI in the context of the current cost‐of‐living crisis needs to be better understood. The aim of the Diet and Health Inequalities (DIO Food) project is to work with early years, people living on a low income and retailers to generate opportune evidence‐based research and commentary that will inform diet‐related health inequalities policy and practice. DIO Food is related to the existing Food Insecurity in people living with Obesity (FIO Food) project, which consists of four interlinked work packages (WPs1‐4). DIO Food consists of three interlinked work packages (WPs5‐7), which enhance the scope of FIO Food, and are described in this article. WP5 addresses a paucity of research on maternal and infant food insecurity in the UK, by applying a qualitative research approach to capture parents' and carers' perceptions of the relationship between the food system and other influences impacting infant feeding practice, associated with the cost‐of‐living crisis. WP6 will conduct the first‐ever cross‐retailer independent evaluation of England's high fat, sugar and salt (HFSS) product placement legislation. Researchers will analyse store‐level supermarket sales data provided by large UK retailers to produce sector‐level insights into whether HFSS legislation reduced HFSS purchasing, improved the healthiness of retailer product portfolios, and was equitable across areas with different characteristics. WP7 will support WP5 and 6, by strengthening engagement with key stakeholders, including at‐risk consumers and representatives of major supermarkets, and effectively translating research outcomes and stakeholder perspectives for policy and industry decision‐makers. [ABSTRACT FROM AUTHOR]

Nutrition label serving sizes are determined primarily based on typical consumption when such data are available. However, such data are not available for certain foods such as spray cooking oil (cooking spray). Our study assessed cooking spray use by the United States (US) adults compared to the 0.25‐s serving size used on US‐sold cooking spray labels. Adults (n = 1041, aged 33 ± 16.7 years) completed a 13‐question survey on cooking spray use and perceptions. In the survey, participants reported using cooking spray for 1.9 ± 0.9 s per use, and 42.3%–43.1% of participants reported being more likely to purchase products if they were labelled calorie‐ or fat‐free. Next, 30 adults (aged 29.7 ± 11.0 years) completed a laboratory‐based study which assessed cooking spray durations for seven cookware items. Spray times ranged from 1.0 ± 0.5 (smallest pan) to 2.5 ± 1.3 s (largest baking sheet), with 100% of sprays (210/210) exceeding the 0.25‐s US serving size. Our results suggest that cooking spray serving size should be increased to 1 s to better reflect actual consumption, and this would have the added benefit of aligning better with cooking spray serving sizes in other developed countries (0.5–1.0 s). A 1‐s serving size would also preclude cooking spray advertised as calorie‐ or fat‐free, allowing consumers to make more informed choices on the dietary implications of using cooking spray. [ABSTRACT FROM AUTHOR]

Rationale: Reimbursement process of oncology drugs in Europe occurs within a complex decision‐making process that varies between Member States. Distinctions between the States trigger societal debates since it is necessary to balance access to medicines and health systems sustainability. Aims and Objectives: We aimed to review the evidence concerning factors associated with the reimbursement decision or Health Technology Agency recommendation of oncology drugs in Europe. Methods: A systematic literature search was performed in two databases from inception to august 2023. Screening and data extraction were performed by pairs. Results: Thirteen articles were included and encompassed data from 11 nations. Seven articles showed that cost‐effective (C‐E) drugs and lower Incremental Cost‐Effectiveness Ratios (ICERs) had higher likelihood of reimbursement. Disease severity might influence the reimbursement decision with financial agreements. Improvement in clinical outcomes, substantial clinical benefit (p < 0.01) or overall survival gains (p < 0.05) were positively associated. Orphan drug designation impact varies between countries but positive decisions are usually achieved under specific conditions. Clinical and C‐E uncertainty frequently led to reimbursement with financial agreements or outcomes‐based conditions. Sociodemographic factors as: social health insurance system, higher Gross Domestic Product and larger elderly population were positively associated with reimbursement (p < 0.01). Conclusion: There is a need for further research into key determinants of reimbursement decisions in Europe and the development of drug access models that can effectively address and overcome costs and effectiveness uncertainties. [ABSTRACT FROM AUTHOR]

Introduction: This review aims to synthesise the literature on the efficacy, evolution, and challenges of implementing Clincian Decision Support Systems (CDSS) in the realm of mental health, addiction, and concurrent disorders. Methods: Following PRISMA guidelines, a systematic review and meta‐analysis were performed. Searches conducted in databases such as MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science through 25 May 2023, yielded 27,344 records. After necessary exclusions, 69 records were allocated for detailed synthesis. In the examination of patient outcomes with a focus on metrics such as therapeutic efficacy, patient satisfaction, and treatment acceptance, meta‐analytic techniques were employed to synthesise data from randomised controlled trials. Results: A total of 69 studies were included, revealing a shift from knowledge‐based models pre‐2017 to a rise in data‐driven models post‐2017. The majority of models were found to be in Stage 2 or 4 of maturity. The meta‐analysis showed an effect size of −0.11 for addiction‐related outcomes and a stronger effect size of −0.50 for patient satisfaction and acceptance of CDSS. Discussion: The results indicate a shift from knowledge‐based to data‐driven CDSS approaches, aligned with advances in machine learning and big data. Although the immediate impact on addiction outcomes is modest, higher patient satisfaction suggests promise for wider CDSS use. Identified challenges include alert fatigue and opaque AI models. Conclusion: CDSS shows promise in mental health and addiction treatment but requires a nuanced approach for effective and ethical implementation. The results emphasise the need for continued research to ensure optimised and equitable use in healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: Antipsychotics remain the first‐line treatment for people diagnosed with psychotic disorders despite adverse effects which lead many people to stop their medication. Many stop without the support of the prescriber, who may fear relapse. The objective of this study is to better understand the process of withdrawal from antipsychotics, from the perspective of people taking antipsychotics. Design: Online survey. Methods: An international online survey elicited quantitative responses about pre‐withdrawal planning (560) and qualitative responses about what was helpful and unhelpful when withdrawing from antipsychotics (443). Responses came from users of antipsychotics in 29 countries. Results: Forty‐seven per cent did not consult their psychiatrist before discontinuing. Only 40% made preparations, most commonly making a plan, gathering information and informing family. The most frequently reported helpful factors were focussing on the benefits of getting off the drugs (including ending adverse effects and feeling more alive), information about withdrawal symptoms and how to withdraw safely, withdrawing slowly, and support from psychologists, counsellors and psychotherapists. The most common unhelpful factor was the psychiatrist/doctor, largely because of their lack of knowledge, refusal to support the patient's wishes and the threat or use of coercion. Conclusions: Evidence‐based, respectful, collaborative responses to patients' concerns about adverse effects and desires to withdraw would probably reduce relapse rates and improve long‐term outcomes. It would definitely help end pervasive breaching of the principle of informed consent and human rights legislation. [ABSTRACT FROM AUTHOR]

The primary objective of nutrition research is to make discoveries that will improve human health, and this is more likely to happen when researchers collaborate and share research findings with clinicians, program and policy makers, and the public. Nutrition research directly informs evidence-based care provided by registered dietitian nutritionists. However, the current academic model often lacks sufficient incentives and preparation for researchers to effectively disseminate their work. Consequently, research findings can be misrepresented, misinterpreted, distorted from their original context, or fail to reach the intended audience altogether. The aim of this article was to describe the importance and value of communication and disseminating nutrition research with various audiences and discuss what material should be disseminated. The information presented can serve as a guide for nutrition researchers to effectively disseminate their research for maximal impact and relevance. [ABSTRACT FROM AUTHOR]