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VA Health Systems Research

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Reports in Progress

ESP Reports    ESP Topic Nomination    ESP Reports in Progress

The following reports are currently under development. If you would like to provide comments about a particular topic, serve as a peer reviewer for the draft report, or know the timeline for completion, please contact the ESP Coordinating Center.

To review the most up-to-date protocols, please visit the PROSPERO or OSF websites. Protocol registration details for individual projects can be found along with the brief abstract for the project, below.




Chronic Xerostomia Management Following Radiation Therapy

PROSPERO registration number: CRD420251145073

Key Questions

KQ1: Among adults who have undergone radiation therapy for head and neck cancer, what interventions are effective for management of chronic xerostomia?

KQ2: Among adults who have undergone radiation therapy for head and neck cancer, what interventions have been used for management of chronic xerostomia?

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Nutrition Care for Chronic Kidney Disease

PROSPERO registration number: CRD420261306976

Key Questions

KQ1: What is the effectiveness of nutritional counseling/education* interventions for non-dialysis dependent CKD when delivered by a dietitian?

KQ1a: What is the comparative effectiveness of nutritional counseling/education* interventions for non-dialysis dependent CKD delivered by a dietitian compared to other professionals?

*Dietitians providing some sort of education, training, nutritional counseling, medical nutrition therapy, nutritional classes, precision nutrition, or similar interventions, to patient (individual or group).

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Opioid Overdose Prevention Education

Key Questions

KQ1: What is the quantity, distribution, and characteristics of the evidence on the impacts of opioid overdose prevention education among adults at elevated risk for opioid overdose?

Participants/population: Adults at elevated risk of opioid overdose, their family caregivers, and/or clinicians of adult patients. Elevated risk of opioid overdose is defined as individuals with:

  • Opioid use disorder (OUD) or in recovery for OUD;
  • History of opioid overdose;
  • An opioid prescription;
  • Stimulant use disorder;
  • Histories of housing insecurity or homelessness; or
  • Histories of being justice-involved

Intervention(s)/exposure(s): Educational interventions focused on knowledge, attitudes and/or practices/behaviors related to opioid overdose prevention.

  • At a minimum, these educational interventions would focus on 1 or more of these topics: opioid overdose prevention, opioid overdose recognition, and/or opioid overdose response.
  • Educational interventions must be delivered in the context of clinical care and can extend before, during, or after a single clinical encounter.
  • Interventions can be delivered synchronously or asynchronously deployed from a patient’s health care provider or system.
  • Clinician-focused interventions that 1) encompass educational content directed to patients, and 2) intended to impact patient-level outcomes.
  • Self-branded Opioid Overdose Education and Naloxone Distribution (OEND) interventions, regardless of description of patient-focused educational content

Comparator(s): Usual care/standard of care, waitlist control, historical controls

  • Other active comparator
  • Other comparator including “pre-post” comparators

Context:

  • Outpatient health care (eg, primary and specialty care; emergency room; home health, community pharmacy, EMS/ ambulance services)
  • Inpatient health care setting (eg, critical care; acute care, long term care)

Outcome(s): Changes in overdose prevention, recognition or response across these 3 domains:

  • Patient knowledge (eg, risk factors for overdose, signs of overdose,
  • Patient attitudes (eg, self-efficacy, motivation, risk perceptions)
  • Patient practices (eg, acceptance of naloxone kit, overdose prevention behaviors such as not using alone or mixing with alcohol)

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Military Exposure and Risk for Neurological Disease

PROSPERO registration number: CRD420251268353

Key Questions

KQ1: Among current and former members of the military service, what is the association between military-related exposures (ie, deployment, combat injury, and environmental substances) and the development of key neurologic diseases?

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Clinical Hypnosis

PROSPERO registration number: CRD420261280788

Key Questions

KQ1: What are the benefits and harms of clinical hypnosis to treat adults with posttraumatic stress disorder (PTSD), anxiety, depression, or substance use disorders?

KQ2: What are the benefits and harms of clinical hypnosis to treat adults with chronic pain?

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Nurse Transition to Practice Programs

Key Questions

The overarching aim is to develop and refine a causal logic model explaining how and why RN transition-to-practice programs work, for whom, and in what health system contexts, as well as how their components and functions influence organizational-, nurse-, and patient-level outcomes. Within the model, we will be specifically addressing 2 key questions:

KQ1: Are RNTTPs for entry-to-practice registered nurses (RNs) effective for improving patient-level outcomes (eg, clinical outcomes measured at the patient level, patient satisfaction)?

KQ2: What is the return on investment (ROI) for RNTTPs for entry-to-practice RNs?

Participants/population: Entry-to-practice RNs in the first 12 months of employment following graduation and/or licensure for entry to practice

Intervention(s)/exposure(s): Transition to practice or nurse residency programs specifically designed for entry-to-practice RNs to provide support or preceptorship during the first 12 months of employment following graduation and/or licensure for entry to practice

Comparator(s): Any comparator (eg, usual care, active comparator, historical controls)

Context: Any health care setting; programs implemented in countries listed on the 2022 Organization for Economic Co-operation and Development to approximate US health care delivery context.

Outcome(s):

Aim: Develop logic model

  • Any implementation outcomes (see Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011 Mar;38(2):65-76. doi: 10.1007/s10488-010-0319-7. PMID: 20957426; PMCID: PMC3068522.)
  • Any organization-, nurse-, or patient-level outcomes (see National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): National Academies Press (US); 2021 May 11. Available from: https://www.ncbi.nlm.nih.gov/books/NBK573914/ doi: 10.17226/25982)

KQ1:

  • Program costs (eg, educator time, preceptor time, simulation costs, equipment, space, IT software and hardware, backfill/protected time, admin overhead, etc. **TAKING INTO ACCOUNT ORG LEVELS**)
  • Cost offsets (eg, reduced turnover costs; reduced contract labor usage)
  • Cost avoidance

KQ2:

  • Patient outcomes (eg, nurse sensitive indicators, clinical outcomes, patient satisfaction, adverse events)

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Psilocybin for Depression

PROSPERO registration number: CRD420261326473

Key Questions

KQ1: What are the benefits and harms of the therapeutic use of psilocybin as a primary or adjunct treatment for depressive disorders?

KQ2: Do the benefits or harms of psilocybin for depression vary based on patient, intervention, or setting characteristics?

  • Patient characteristics: age or other demographic factors, depression severity, duration of depressive symptoms, number and types of previous therapies tried, etc
  • Intervention characteristics: psilocybin dosage, number of doses given, availability and type of psychotherapy delivered pre- and post- psilocybin dosing, number and duration of psychotherapy sessions, psilocybin facilitator credentials and training, etc
  • Setting characteristics: treatment area (ie, dark or quiet area), engagement with psilocybin facilitator, individual or group treatment, etc
  • Patient experience: psilocybin-occasioned acute perceptual changes and subjective experiences (eg, mystical-type experiences)

KQ3: What evidence is available to inform implementation of psilocybin treatment?

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Low-Dose Radiation Therapy for Treatment of Osteoarthritis

PROSPERO registration number: CRD420261399085

Key Questions

KQ1: What are the benefits and harms of low-dose radiation therapy for the treatment of osteoarthritis in adults?

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Chronic Widespread or Overlapping Pain Conditions

Key Questions

KQ1: What assessment tools are effective for identifying the presence of chronic widespread pain or chronic overlapping pain conditions?

KQ2: What is the prognosis of adults with chronic widespread pain or chronic overlapping pain conditions compared to adults with chronic pain that is not widespread and does not include overlapping pain conditions?

KQ3: What is the effectiveness of interventions for chronic pain in adults with chronic widespread pain or chronic overlapping pain conditions compared to adults with chronic pain that is not widespread and does not include chronic overlapping pain conditions?

Participants/population: Adults with chronic (lasting ≥ 3 months) widespread pain or chronic overlapping pain conditions including:

  • Chronic diffuse pain in multiple areas of the body, including across body quadrants (upper-lower/left-right side of the body), and the axial skeleton (neck, back, chest, abdomen).
  • Chronic overlapping pain conditionsa
  • Functional somatic syndrome or somatic symptom disorder
  • Nociplastic pain
  • Fibromyalgia (KQ2 & 3)

Studies in patients with multisite/multifocal pain (discrete pain in 2 or more sites) that is not described as widespread or diffuse will be excluded.

Intervention(s)/exposure(s):

KQ1: Tools for assessing the presence of chronic widespread pain or chronic overlapping pain conditions in a clinical or research setting

KQ2: None

KQ3: Pharmacological and non-pharmacological interventions for treating chronic pain

Comparator(s):

KQ1: Any

KQ2 & 3: Adults with chronic pain that is not widespread and does not include overlapping pain conditions

Outcome(s):

KQ1: Reliability, validity, accuracy

KQ2: Prognosis (eg, course and severity of chronic pain, number of medication trials, polypharmacy, health care utilization, other clinical outcomes)

KQ3: Pain, functioning, quality of life, health care utilization, other clinical outcomes.

aChronic overlapping pain conditions defined as a set of disorders that show high levels of cooccurrence and include 2 or more of the following chronic pain conditions: Vulvodynia, Temporomandibular Disorders, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Interstitial Cystitis/Painful Bladder Syndrome, Fibromyalgia, Endometriosis, Chronic Tension-Type Headache, Chronic Migraine Headache, Chronic Low Back Pain.

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Interventions for Improving Retention on Medication Treatment for Opioid Use Disorder

PROSPERO registration number: CRD420261437123

Key Questions

KQ1: What is the effectiveness of interventions to improve retention in medication for opioid use disorder (MOUD) for adults with opioid use disorder (OUD)?

KQ2: Does the effectiveness of interventions to improve MOUD retention vary based on patient and/or health care team characteristics?

KQ3: What are the harms or adverse events of interventions to improve MOUD retention?

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GLP-1RA Use in Older Adults

Key Questions

KQ1: What are the risks of age-important adverse events of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual gastric inhibitory polypeptide (GIP)/GLP-1RAs among older adults?

Participants/population: Adults aged 65 and older prescribed GLP-1RAs or (GIP)/GLP-1RAs.

If a study includes mixed age groups or presents a subgroup by age, we will include if 80% or more of the individuals are aged 65 and over.

Intervention(s)/exposure(s):

FDA-approved GLP-1RAs or (GIP)/GLP-1RAs:

  • Dulaglutide (Trulicity®).
  • Liraglutide (Victoza®).
  • Lixisenatide (Adlyxin®).
  • Semaglutide injection (Ozempic®, Wegovy®).
  • Semaglutide tablets (Rybelsus®)
  • Orforglipron
  • Tirzepatide (Mounjaro, Zepbound)

GLP-1RAs or (GIP)/GLP-1RAs under review at the FDA with approvals expected by 2026:

  • Retatrutide

  • Cagrisema

  • Survodutide

Comparator(s): Usual care, standard of care; non-GLP-1RA or non-GIP/GLP-1RA comparator (eg, basal insulin, metformin, lifestyle modification interventions)

Context: Any outpatient or inpatient health care setting

Outcome(s):

Age-important adverse events:

  • Sarcopenia (including severity)
  • Muscle Loss
  • Falls
  • Frailty
  • Fractures
  • Reduced skin integrity (eg, wound healing, tears, skin thinning)
  • Malnutrition
  • Dehydration that requires medical intervention
  • Loss of physical function (eg, lower extremity strength, upper extremity strength, gait and functional mobility, aerobic capacity/endurance, speed and endurance, balance, multidomain physical function)
  • Depression
  • Suicide, suicide ideation, suicide attempts

Secondary adverse events:

  • Total adverse events (included only if a study also has one of the other adverse events outcomes above; not used as an eligibly criteria or in search strategy)

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