Talk to the Veterans Crisis Line now
An official website of the United States government
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.
PROSPERO registration number: RD42022347945
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?
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:
Comparator: KQ1: Any comparator (eg, usual care, active comparator, historical controls)
Outcome(s): KQ1:
Process outcomes:
Performance outcomes (eg, time required for supplement administration)
Patient outcomes:
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
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.
PROSPERO registration number: CRD42023438525
The VA Evidence Synthesis Program Coordinating Center is responding to a request from the Offices of Mental Health and Suicide Prevention, Research and Development, and Specialty Care Services for a systematic review of evidence on the effectiveness of syringe service programs. The review will inform development of a plan to support the goals of the National Drug Control Strategy Action Plan, and use of best practices for harm reduction in the VHA.
KQ1: What are the benefits and harms of syringe service programs?
KQ2: Do benefits and harms of syringe service programs vary by exchange model (needs-based versus 1-for-1) or presence/absence of program components?
Population(s): Adults at risk for substance use-related harms.
Interventions: Syringe service programs. Primary intervention should be dispensing of sterile syringes, but programs may also include “wraparound” components such as fentanyl test strip and/or naloxone distribution, rapid HIV and/or hepatitis C (HCV) testing, referral to treatment and/or prevention services, or counseling/training on overdose prevention, safer injection practices, and/or infectious disease prevention (efficacy of components as standalone interventions will not be evaluated).
Comparator: Any or no comparison condition.
Outcome(s): Drug use behaviors (sharing, borrowing, lending, reuse, or unsafe disposal of syringes; amount, speed, or frequency of use); knowledge of overdose risk; naloxone distribution/use; HIV/HCV prevalence or incidence; linkage to treatment for substance use disorder, HIV/HCV, or other medical needs, or to HIV pre-exposure prophylaxis; utilization of referred services; neighborhood crime rates or property values.
Setting: Any, but we may prioritize studies using a best-evidence approach (eg, focusing on studies most relevant to the US/VA setting). Existing systematic reviews may be included to address some outcomes. Studies published before 2000 will be ineligible.
PROSPERO registration number: CRD42023410146
KQ1: Among adults hospitalized for decompensated heart failure, what is the comparative effectiveness of different prescribed sodium intake interventions?
KQ1a: Does effectiveness differ as a function of patient characteristics, including by age, comorbid conditions (kidney function, hypertension, diabetes, stroke, BMI), existing vs. new onset heart failure, preserved vs. reduced ejection fraction or community dietary sodium intake, sex, and race/ethnicity?
Population(s): Adults ≥18 years of age hospitalized for treatment of acute decompensated heart failure which includes exacerbation of a chronic condition or new onset/previously undetected heart failure.
Interventions: Prescribed sodium intake
Comparator: Alternative sodium intake intervention, more sodium intake, normal sodium intake, or less sodium intake.
Outcome(s):
We will conduct literature searches of the bibliographic databases including PubMed (Medline), EMBASE, CINAHL, Cochrane and clinicaltrials.gov (http://clinicaltrials.gov) by utilizing keywords and subject headings for decompensated heart failure, prescribed sodium intake with or without fluid restriction, and inpatient.
There will be no language restriction to the searches nor to the study duration.
We will review the list of references in identified systematic reviews.
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?
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:
Key question 2:
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.
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.
PROSPERO registration number: CRD42023439903
This evidence review of extended reality (XR; including virtual reality [VR], mixed reality, and augmented reality) approaches for addressing chronic pain will be used to inform clinical guidance on use of XR to treat pain within the VA, as well as future research priorities targeted at evidence gaps in this area of work. Chronic pain is common in Veterans, and the prevalence of severe pain is higher in Veterans than in members of the general population. XR approaches may be promising non-pharmacological treatment options for chronic pain. VHA Extended Reality Network has launched several pilots of VR interventions to address pain, including one most recently to treat chronic low back pain. VA HSR&D and PMOP are collaborating with the Network on current and future efforts to implement XR treatments and address evidence gaps.
KQ1: For adults, what are the benefits and harms of extended reality (XR) interventions for treating chronic pain?
KQ2: For adults, what are the benefits and harms of XR interventions for preventing the development of chronic pain?
Population(s):
KQ1: Adults (≥18 years) with chronic pain:
condition that has chronic pain as a major symptom (eg, arthritis, fibromyalgia, phantom limb pain, diabetic neuropathy) AND/OR assessed pain of ≥ 90 days
KQ2: Adults (≥18 years) with pain
Interventions: Extended reality (ie, augmented, mixed or fully immersive virtual reality) treatments with a primary aim of treating or preventing chronic pain
Comparator: Any
Outcome(s):
Setting:
KQ1: Non-acute care settings (eg, outpatient clinic, home)
KQ2: Any
We will search MEDLINE, Embase, CINHAL, PsycINFO, and Scopus databases, from inception to current.
We will perform citation searching of relevant systematic reviews identified via the searches described above, as well as additional searches of AHRQ EPC and VA ESP reports. We also plan to perform searches of grey literature, including clinical trial registries.
What are the benefits and harms of low-dose radiation therapy for the treatment or prevention of benign hyperproliferative and degenerative skin/epithelial, and musculoskeletal disorders such as keloid scars, hidradenitis suppurativa, Dupuytren’s contracture, Ledderhose disease, Peyronie’s disease, plantar fasciitis, heterotopic ossification, pterygium, or osteoarthritis in adults?
Population(s): Adults ≥18 years of age with keloid scars, hidradenitis suppurativa, Dupuytren’s contracture, Ledderhose disease, Peyronie’s disease, plantar fasciitis, heterotopic ossification, pterygium or osteoarthritis (treatment, recurrence, or prevention).
Comparator: Sham radiation therapy, alternative treatments that do not include radiation, no treatment.
Outcome(s):
Setting: Any
We will conduct literature searches of the bibliographic databases including PubMed (Medline, EMBASE and clinicaltrials.gov (http://clinicaltrials.gov) by utilizing keywords and subject headings for each disease of interest (i.e., keloids, heterotopic ossifications) and radiation therapy.
There will be no restrictions to language of publication for searches.
We will review the list of references in identified systematic reviews.
PROSPERO registration number: CRD42023458540
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?
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):
Setting: We will not place any restrictions on the timing or setting of studies.
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.
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.
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?
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:
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)
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.
PROSPERO registration number: CRD42023465675
An evidence review would inform efforts to standardize the way post-discharge follow-up calls are conducted across VHA facilities, including development of a standard operating procedure and a national documentation template.
KQ1a: Among adults with acute medical hospital admissions, what are the effects of post-discharge contacts on hospital readmission, emergency care use, and patient satisfaction?
KQ1b: Do the effects of post-discharge calls for acute medical hospital admissions vary by intervention characteristics (ie, mode of contact; clinical staff initiating the contact; timing of the contact; assessments used during contact; content of the contact)?
KQ2a: Among adults with acute psychiatric hospital admissions, what are the effects of post-discharge contacts on hospital readmission, emergency care use, and patient satisfaction?
KQ2b: Do the effects of post-discharge calls for acute psychiatric hospital admissions vary by intervention characteristics (ie, mode of contacted; clinical staff initiating the contact; timing of the contact; assessments used during contact)?
Population(s):
KQ1: Adults (≥18 years of age) with an acute medical hospital admission
KQ2: Adults (≥18 years of age) with acute psychiatric hospital admission
If populations are comprised of children and adults and does not include an adult-only subgroup, studies will be included if they have 80% or more adults in the included sample.
Intervention(s)/exposure(s): Post-discharge contact is defined as a bidirectional contact (eg, telephone, video, secure messaging system) from a non-specialist clinical service provider to an adult discharged from inpatient medical or psychiatric hospital that occurs up to 7 days from discharge from a hospitalization and prior to resumption of longitudinal primary care.
A post-discharge contact is intended to improve the post-acute transition from hospital to home and include at least one of the following components:
Comparator(s):
Outcome(s):
Setting: Initiated in the inpatient or outpatient setting, as long as the intent is to provide a post-discharge check-in prior to resumption of longitudinal primary care AND there is at least one contact made after the patient is discharged.
We will conduct a primary search from inception to the current date of MEDLINE (via Ovid), Embase, and CINAHL from inception to May 25th, 2023. 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.
