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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 website. Protocol registration numbers for an individual project can be found along with the brief abstract for the project, below.




Automation of Nutrition Delivery

PROSPERO registration number: RD42022347945

Key Questions

KQ1: What are the effects of automating the delivery of oral, enteral, or parenteral nutrition supplements to hospitalized patients on patient and process outcomes?

KQ2: How is automating the delivery of oral, enteral, or parenteral nutrition supplements to hospitalized patients experienced by the staff involved in implementing and delivering it?

PICOTS

Population(s): KQ1: Hospitalized patients - including long-term care, skilled nursing facility residents and end of life patients - at risk of malnutrition (ie, who have difficulty eating or absorbing nutrients through GI tract)

KQ2: Hospital staff involved in automating the delivery oral, enteral, or parenteral nutrition supplements to patients (eg, nurses and nursing assistants, pharmacists, food service, registered dietitians)

Interventions: Automated nutrition delivery of oral, enteral, or parenteral nutrition supplements (ie, medical food supplements) that includes automated notifications to the hospital care team (eg, nurses and nursing assistants, physicians pharmacists, food service, registered dietitians) that nutrition supplements have been ordered/ prescribed and requires responses that the care team has administered nutrition supplements and/or how much the patient actually received (eg, electronic health record alerts, barcode scanning)

Automation is defined as the "creation of a process or application of a technology to deliver hospital-based nutrition to patients minimizing human intervention” (ie, hospital staff provide the thinking on the ordering side (inputs) and the delivery side (outputs) is automated to minimize human touch points).

Automation should include one or both of the following aspects of implementation:

  • Automation of documentation
  • Automation of ordering nutritional supplements, or
  • Automation of the delivery of nutrition supplements

Comparator: KQ1: Any comparator (eg, usual care, active comparator, historical controls)

Outcome(s): KQ1:

Process outcomes:

  • supplements delivered, completion documentation (eg, documentation of supplement administration or reason for non-administration);
  • supplement delivery errors (eg, missed administration, erroneous administration, duplicate intake)

Performance outcomes (eg, time required for supplement administration)

Patient outcomes:

  • Calories consumed, macronutrients consumed (eg, protein)
  • BMI and body weight
  • Fluid intake
  • Wound infections
  • Length of hospital stay
  • Readmission rate
  • Change in nutritional status
  • Post-op ileus (ie, surgery patients)
  • Patient satisfaction

Patient-level harms among patients exposed to automated delivery of nutrition (eg, all-cause mortality, pressure injury, falls, organ damage, aspiration, refeeding syndrome (ie, consuming calories too quickly after starvation), failure to thrive diagnosis, medication-nutrition interactions

KQ2:

Primary purpose of evaluation is to explore the experiences and attitudes of hospital staff (eg, nursing, pharmacy, food service, dietetics) who interact with some aspect of implementing and delivering the automated delivery of nutrition

General Search Strategy

We will conduct a primary search from inception to the current date of MEDLINE (via Ovid), Embase, and CINAHL from inception to January 16, 2022. We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert medical librarian. We will hand-search previous systematic reviews conducted on this or a related topic for potential inclusion.

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Nurse Transition to Practice Programs

Key Questions

KQ1: Are transition to practice programs for newly graduated, entry-to-practice registered nurses (RNs) effective for improving organizational, nurse, and patient outcomes?

KQ2: What are the components and implementation characteristics of effective transition to practice programs for newly graduated, entry-to-practice RNs?

PICOTS

Population(s): Newly graduated, entry-to-practice RNs in the first 12 months of employment following graduation and/or licensure for entry to practice

Interventions: Transition to practice or nurse residency programs specifically designed for newly graduated, 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: Any comparator (eg, usual care, active comparator, historical controls)

Outcome(s):

Key question 1:

  • Organizational outcomes (eg, retention/attrition, quality of care),
  • Nurse outcomes (eg, confidence, competence, practice-readiness, satisfaction),
  • Patient outcomes (eg, patient satisfaction, adverse events),

Key question 2:

  • Components (eg, preceptorships, simulations),
  • Implementation characteristics (eg, duration, recruitment strategies, settings, utilization, uptake, barriers/facilitators, collaboration with academic partners)

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

General Search Strategy

We will conduct searches from 1/1/10 to the current date of PubMed/MEDLINE and CINAHL Plus. We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts (eg, “Education, Nursing, Graduate”, “graduate nurse transition”, “transition to practice”). To ensure completeness, search strategies will be developed in consultation with an expert medical librarian. We will hand search references from previous, relevant systematic reviews for potential inclusion.

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Classification of Cancer Cachexia

PROSPERO registration number: CRD42023458540

Key Questions

KQ1:
1a. What cancer cachexia classification systems have been described/what criteria have been used?
1b. What are their performance characteristics?

KQ2: What are the short- and long-term outcomes for patients following cachexia classification with the tools identified in KQ1?

PICOTS

Population(s): This review will focus on adults with any type of cancer at risk for cachexia or with cachexia. We will exclude studies focusing on non-cancer populations, those conducted in pediatric populations, and those using non-human subjects.

Interventions/exposures: For KQ1, the exposures of interest will include cancer cachexia diagnostic strategies, screening, and classification/severity scoring tools (including modified tools, algorithms) (herein referred to as classification strategies).

For KQ2, the exposure of interest in cachexia stage. We will exclude studies that do not define the classification strategy used for cachexia.

Comparator(s): Comparators for KQ1 may include a reference standard for classification, an alternate classification strategy, or no comparator. Comparators for KQ2 may include other cachexia stages or those without cachexia.

Outcome(s):For KQ1, outcomes will include parameter for classification and data on performance measures of the identified classification strategies (eg, diagnostic accuracy, predicative ability, etc).

For KQ2, outcomes of interest include clinical and patient-important outcomes (eg, treatment response, overall survival, nutritional outcomes, functionality, quality of life):

  • Survival (overall, cancer specific, etc)
  • Recurrence
  • Cachexia symptom burden/severity (anorexia, fatigue, change in taste, etc)
  • QOL
  • Functional levels (ECOG, KPS, ADLs, measures of mobility, exercise tolerance, etc)
  • Hospitalizations
  • Cancer treatment compliance/tolerance
  • Feeding tube placement
  • Cachexia progression
  • Cancer progression
  • Need for TPN
  • Response to nutritional supplementation
  • Development of malnutrition
  • Long-term steroid use
  • Other medication use (eg, orexigenics, antipsychotics)
  • Physical activity/exercise recommendation and compliance

Setting: We will not place any restrictions on the timing or setting of studies.

General Search Strategy

We will conduct literature searches of the bibliographic databases including PubMed (Medline), EMBASE, Cochrane and clinicaltrials.gov (http://clinicaltrials.gov) by utilizing keywords and subject headings relating to cancer cachexia, and severity assessment and diagnostic tools.

No restrictions will be placed on language or date of publication.

We will review the list of references in identified systematic reviews.

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Occurrence of Psychiatric Conditions or Symptoms after Military Service-related Environmental and Chemical Toxic Exposures

Background/Objectives of Review

An evidence map on the association between toxic exposures during military service and mental, behavioral, and neuropsychiatric health issues (ie., psychiatric conditions or symptoms). The Sergeant First Class (SFC) Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act expands and extends VA health care eligibility for Veterans with conditions presumed to be caused by toxic exposure that occurred during military service. An evidence map on this topic will be used to assist clinical teams in providing evidence-informed care to Veterans with psychiatric concerns that arise during toxic exposure screenings and to develop national guidance for approaches to screening, assessment, and treatment related to these concerns.

Key Questions

KQ1: For which military service-related environmental and chemical toxic exposures has the co-occurrence of psychiatric conditions or symptoms been evaluated?

KQ2: What is the prevalence, incidence, or association of co-occurring psychiatric conditions or symptoms among individuals with a history of military-service related environmental and/or chemical toxic exposures?

PICOTS

Population(s): Active-duty military personnel, national guard, reservists, or Veterans from the US or other countries.

For studies with mixed populations, 80% (and at least 100 individuals in total) of the analytic sample must be compromised of individuals meeting the above definition.

Intervention(s)/exposure(s): Exposure to environmental (eg, burn pits, radiation) and/or chemical (eg, asbestos, agent orange) toxins during military service inclusive of:

  • Exposures that may have occurred during deployment or when not deployed
  • Exposures that may be self-reported or objectively verified

Comparator(s): No history of toxic exposure or no comparator

Outcome(s):Psychiatric symptoms and conditions, inclusive of related diagnoses (eg, MDD, GAD, PTSD, Mild or Major Neurocognitive Disorder, substance use disorder) and symptoms (eg, executive functioning, difficulty concentrating, memory, processing speed, suicidal behavior/ideation, sleep disturbance, aggression)

General Search Strategy

We will conduct a primary search from 1946 to July 27th 2023 of MEDLINE (via Ovid), Embase (via Elsevier), APA PsycINFO (via Ovid), and PTSDpubs (via ProQuest). We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert medical librarian and peer-reviewed by another librarian. We will hand search selected systematic reviews conducted on this or related topics for potential inclusion.

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Clinical and At-Home Resources for PTSD

PROSPERO registration number: CRD42023471333

Key Questions

KQ1: Are internet-based and mobile interventions with asynchronous therapist-guided or self-guided content and resources designed to improve PTSD symptom severity and/or self-management effective for improving PTSD symptoms and other mental health symptoms among adults with a diagnosis of PTSD?

KQ2: Are internet-based and mobile interventions with asynchronous therapist-guided or self-guided content and resources designed to enhance coping and symptom management skills for family members and caregivers of adults with PTSD effective for improving stress, mental health symptoms, and coping skills?

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An Evidence Map of Women Veterans’ Health Literature (2016–2023)

Key Question

What is the scope and breadth of the literature on women Veteran’s health published since 2015?

Participants/population: Individuals who identify as women or who have female reproductive or sexual anatomy

AND, who have served in the armed forces including national guard and reserves

(Note: Women Veterans (WV) must comprise >75% of study population OR study must report results separately for WV as sub-group analysis or otherwise report results separately for women; total n must be at least 50 unless is a qualitative study or methods development)

OR, health care team members who provide care to women Veterans if focus of article is on provision of care to women Veteran population

Intervention(s)/exposure(s): Any or none

Comparator(s): Any or none

Outcome(s): Any

Context: Health care and health conditions relevant to women Veterans, including social determinants of health

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Shared Decision-Making for Lung Cancer Screening

PROSPERO registration number: CRD42024511257

Key Questions

KQ1: What communication strategies, tools, and/or approaches used for shared decision making (SDM) in lung cancer screening are reported in the literature?

KQ2: What is the effectiveness and comparative effectiveness of communication strategies, tools, and or approaches used to enhance SDM for lung cancer screening?

b. Does effectiveness vary by patient (i) or clinical setting (ii) characteristics:

i. ie, age, race/ethnicity, comorbidities, current smoking status, socioeconomic status (SES)/education, residency: geographic region, rural/urban
ii. Primary care, smoking cessation, prevention clinics, public forums

KQ3: What are the harms of the communication strategies, tools, and or approaches used to enhance SDM for lung cancer screening?

KQ4: What are the barriers and facilitators of implementing different communication strategies, tools, and/or approaches for lung cancer screening SDM?

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Adult ADHD Among Veterans

PROSPERO registration number: CRD42024517093

Key Questions

KQ1: Among adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and prescribed psychostimulant medications, what is the incidence of misuse of the prescribed medications, the incidence of diversion of the prescribed medications, and the incidence of substance use disorders (SUD) in this population?

KQ2: Among adults diagnosed with ADHD with a co-occurring substance use disorder (SUD), what are the benefits and harms of non-stimulant ADHD pharmacological and/or nonpharmacological treatment of ADHD compared to ADHD psychostimulant medications?

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Moral Injury Evidence Assist

Key Questions

KQ1: What are the characteristics of published research studies on moral injury in adults?

KQ2: How has published literature on moral injury changed over time?

KQ3: How many studies include moral injury as an outcome measure?

Population: KQ1&KQ2: Adults with or at risk for moral injury; KQ3: Any

Intervention: Any or none

Comparator: Any or none

Outcomes: KQ1&KQ2: Any; KQ3: Moral injury

Study Design: KQ1&KQ3: Research studies; KQ2: Any publication type

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AI in Clinical Care Evidence Assist

Key Question

KQ: What recent research has investigated applications of AI-based tools and approaches to improve clinical care?

Population: Adult patients in any clinical care setting

Intervention: Prospectively implemented AI-based tool or approach intended to improve direct patient care or healthcare administration (eg, use of large language model to summarize clinical notes from community provider)

Comparator: Non-AI-based approach (eg, manual summarization and entry of clinical notes from community provider)

Outcomes: Performance/accuracy (area under receiver operating characteristic curve, agreement or error rates, efficiency, etc)

Healthcare quality/safety (healthcare-acquired infection rate, complication rate, patient satisfaction, etc)

Implementation outcomes (barriers and facilitators, uptake, healthcare staff satisfaction, etc)

Study Design: Comparative studies (multiple-group or before-after designs) published 2017–present

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Dextrose Prolotherapy for Musculoskeletal Pain

Key Questions

KQ1: What are the benefits and harms of dextrose prolotherapy for acute and chronic musculoskeletal pain?

KQ2: Do benefits and harms of dextrose prolotherapy vary by:

  • Patient characteristics
  • Pain condition characteristics
  • Treatment history
  • Treatment parameters (eg, concentration, number of injections, use of imaging, setting of treatment)

KQ3: What are the costs of dextrose prolotherapy for healthcare systems and patients?

Participants/population: Adults (≥ 18 years) with acute or chronic musculoskeletal pain

Intervention(s)/exposure(s): Dextrose prolotherapy (hypertonic, >5%)

Comparator(s): Any

Outcome(s):

  • Pain-related functioning or interference
  • Physical performance (eg, range of motion, timed up & go)
  • Adverse events
  • Health-related quality of life
  • Pain intensity or severity
  • Costs, resource use, access to care
  • Treatment burden (patients & caregivers)

Context: Outpatient settings only

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