Browsing by Subject "Evidence based practice"

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    American Association for the Surgery of Trauma emergency general surgery guideline summaries 2018: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction
    (BMJ, 2019-03-27) Schuster, Kevin M.; Holena, Daniel N.; Salim, Ali; Savage, Stephanie; Crandall, Marie; Surgery, School of Medicine
    In April 2017, the American Association for the Surgery of Trauma (AAST) asked the AAST Patient Assessment Committee to undertake a gap analysis for published clinical practice guidelines in emergency general surgery (EGS). Committee members performed literature searches to catalogue published guidelines for common EGS diseases and also to identify gaps in the literature where guidelines could be created. For five of the most common EGS conditions, acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction, we found multiple well-referenced guidelines published by leading professional organizations. We have summarized guideline recommendations for each of these disease states stratified by the AAST EGS anatomic severity score based on these published consensus guidelines. These summaries could be used to help inform evidence-based clinical decision-making, but are intended to be flexible and updatable in real time as further research emerges. Comprehensive guidelines were available for all of the diseases queried and identified gaps most commonly represented areas lacking a solid evidence base. These are therefore areas where further research is needed.
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    Standardized Versus Tailored Implementation of Measurement-Based Care for Depression in Community Mental Health Clinics
    (American Psychiatric Association, 2022) Lewis, Cara C.; Marti, C. Nathan; Scott, Kelli; Walker, Madison R.; Boyd, Meredith; Puspitasari, Ajeng; Mendel, Peter; Kroenke, Kurt; Medicine, School of Medicine
    Objective: Measurement-based care (MBC) is an evidence-based practice that is rarely integrated into psychotherapy. The authors sought to determine whether tailored MBC implementation can improve clinician fidelity and depression outcomes compared with standardized implementation. Methods: This cluster-randomized trial enrolled 12 community behavioral health clinics to receive 5 months of implementation support. Clinics randomized to the standardized implementation received electronic health record data captured with the nine-item Patient Health Questionnaire (PHQ-9), a needs assessment, clinical training, guidelines, and group consultation in MBC fidelity. Tailored implementation support included these strategies, but the training content was tailored to clinics’ barriers to MBC, and group consultation centered on overcoming these barriers. Clinicians (N=83, tailored; N=71, standardized) delivering individual psychotherapy to 4,025 adults participated. Adult patients (N=87, tailored; N=141, standardized) contributed data for depression outcome analyses. Results: The odds of PHQ-9 completion were lower in the tailored group at baseline (odds ratio [OR]=0.28, 95% CI=0.08–0.96) but greater at 5 months (OR=3.39, 95% CI=1.00–11.48). The two implementation groups did not differ in full MBC fidelity. PHQ-9 scores decreased significantly from baseline (mean±SD=17.6±4.4) to 12 weeks (mean=12.6±5.9) (p<0.001), but neither implementation group nor MBC fidelity significantly predicted PHQ-9 scores at week 12. Conclusions: Tailored MBC implementation outperformed standardized implementation with respect to PHQ-9 completion, but discussion of PHQ-9 scores in clinician-patient sessions remained suboptimal. MBC fidelity did not predict week-12 depression severity. MBC can critically inform collaborative adjustments to session or treatment plans, but more strategic system-level implementation support or longer implementation periods may be needed.
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    The effect of resilience on bipolar mood during specialty clinic treatment
    (Elsevier, 2024) Chiang, Karl; di Scalea, Teresa Lanza; Smith, Tawny; Spelber, David; Siegel-Ramsay, Jennifer; Nemeroff, Charles B.; Strakowski, Stephen M.; Almeida, Jorge; Psychiatry, School of Medicine
    Background: Limitations in mental health resources behoove exploration of factors that may enhance treatment response. One such factor, resilience, has been minimally examined in bipolar disorder. Methods: With multi-level modeling of clinical care data, we examined associations among longitudinal measurements of resilience and mood rating trajectories in a sample of 100 individuals with bipolar disorder during 6 weeks of evidence-based pharmacotherapy and psychotherapy. Results: Individuals with high self-care subscale scores from the Resilience Questionnaire for Bipolar Disorder exhibited an improving rate of depression change -0.18 (SE = 0.04, p < .001) completing treatment with a subthreshold depression rating of 3.1 (SE = 1.39, p < .05). In contrast, treatment recipients who disagreed or were neutral towards self-care experienced worsening or no change in depression, respectively. This subscale also decreased mood elevation. Each one-point increase yielded a -0.27 (SE = 0.13 p < .05) point decrease in mania. Limitations: Resilience may develop longitudinally. In this study, it was examined during active treatment which was a relatively brief period of time. Conclusions: Higher bipolar resilience could identify individuals more likely to exhibit improvement in mood during bipolar specialty clinic treatment.
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    Understanding the Influence of Applied Behavioral Analysis Therapy in the Management of Children with ASD in the US
    (2024-03-31) Ogunmola, Botiwuoluwa
    Introduction: Over the last few decades, autism spectrum disorder (ASD) has become increasingly common among children, teenagers, young adults, and even adults. In 2020, it had a global prevalence of 2 in 200 people according to the World Health Organization (WHO,2023) and 2 in 72 people in the United States (Centers for Disease Control and Prevention, (CDC), 2024). Autism Spectrum Disorder is a neurodevelopmental disturbance that influences how individuals interact with other people, converse, gain knowledge and act. Applied behavioral therapy (ABA) is used behavioral therapy that is evidence-based and involves helping children with autism enhance positive skills and/or behavior and discourage negative ones (Child Mind Institute, 2024). This paper seeks to understand the role of behavioral intervention programs and its impact in the management of Individuals with Autism Spectrum Disorder. Methods: A secondary data collection of scholarly articles on the impact of applied behavioral analysis on children with autism was done using the PCC framework. Out of the 1900 articles identified, 39 duplicates were removed and after screening, 1791 articles were excluded due to wrong setting, intervention, comparator, patient population. 25 articles met the inclusion criteria and were included in the review. Results: Out of the 25 articles included, each article was reviewed to measure the effectiveness of ABA intervention, which was grouped into 3 outcomes, 1) Positive outcomes 2) Negative Outcomes 3) Unchanged. A cross-sectional design was done by Saar et al., 2023 to assess the perception of ABA intervention among autistic children, their families and caregivers using about 960 posts from social media although the type of ABA was not specified. Results showed that there were more positive outcomes (32%) than negative outcomes (12%) and a considerable number were unchanged (36%). Other studies done showed similar outcomes and were also outlined. . Discussion: The use of ABA therapy has proven to be an evidence-based intervention in the management of individuals with autism. Evidence-based interventions are grouped into 2 namely direct and broad-based interventions. Early intensive behavioral intervention is a type of broad-based intervention (Hume et al., 2021). Applied behavioral analysis uses both direct and broad-based interventions. From the articles reviewed, applied behavioral analysis positively impacts children with autism. Additionally, the availability of ABA services differs by race. According to Rosales et al., 2021, Black and Latinos families who have children with autism are less likely to receive ABA services early and more likely to stay longer on the waitlist before their children can receive care. However, once they receive care, most of these families are satisfied with the services they receive and are likely to recommend it to other families who have children with ASD. When compared with other articles reviewed in this study, ABA services rank high in terms of productivity and long-term benefits. Conclusion: Autism spectrum disorder and its management is a topic of public health importance, and several peer-reviewed articles, journals and grey literature serve as a helpful tool in understanding the importance of intervention strategies such as applied behavioral analysis in the management of individuals with ASD. The type of ABA service was not specified in most of the papers making it complex to analyze the effectiveness of a certain type of ABA compared to another. Although several articles exist on autism and ABA, many of them have small sample sizes therefore results gotten cannot be generalized. More studies will need to be conducted across different races, population, and geographical location to fully grasp the effectiveness of ABA services.