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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.
The VA Evidence Synthesis Program (ESP) Coordinating Center is responding to a request from the VA Offices of Enterprise Integration (OEI) and Planning and Performance Management (OPPM), which has established an Integrated Project Team (IPT) on Homelessness. The IPT has requested a review of known risk factors for homelessness experienced by US Veterans during the pre-service, in-service, and post-service periods. Findings from this report will inform cross-VA efforts to better understand and address homelessness among Veterans.
KQ1: Among Veterans and other adults, what factors during childhood and adolescence are associated with homelessness during adulthood?
KQ2: Among Veterans, what factors during in-service and post-service periods are associated with post-service homelessness?
Population(s):
KQ1: US Veterans (any service era) and other adults experiencing homelessness
KQ2: US Veterans (any service era) experiencing homelessness
Outcome(s): Homelessness (defined as meeting US Department of Housing and Urban Development criteria, use of any specialized VA homeless services, or documented ICD-9 clinical code suggesting homelessness)
To synthesize available evidence on comparative postoperative complication risk associated with tobacco smoking, smoking cessation/reduction, and use of nicotine replacement therapies prior to elective orthopedic surgery.
KQ1: What is the comparative postoperative complication risk/risk reduction associated with continued tobacco smoking, smoking cessation/reduction, and use of nicotine replacement therapies prior to elective orthopedic surgery?
KQ1a: Does comparative complication risk/risk reduction vary by patient age, sex, race/ethnicity, or preexisting comorbidities?
KQ1b: Does complication risk/risk reduction vary by duration of smoking cessation/reduction or use of nicotine replacement therapies prior to elective orthopedic surgery?
Population(s): Adults undergoing elective orthopedic surgery
Interventions: Continued tobacco smoking, smoking cessation/reduction, or use of nicotine replacement therapies prior to elective orthopedic surgery
Comparator: Alternative intervention conditions, or non-smoking status
Outcome(s): Perioperative complications (eg, infection, thromboembolism, prosthetic explantation, extended length of hospital stay, hospital readmission, mortality, etc)
KQ1: What are the comparative efficacy and harms of hypofractionated vs. conventional radiation therapy in definitive treatment of adults with breast, prostate, lung, rectal, head and neck, bladder, pancreas, melanoma, or non-melanoma skin cancer?
KQ2: In the treatment of adults with the above types of cancer, do efficacy and harms of hypofractionation strategies vary by cancer stage, prostate cancer NCCN risk stratification, and other patient characteristics?
Population(s): Adults (18 years of age or older) with one of the identified cancers of interest
Interventions: Hypofractionation: [>220 cGy (2.2 Gy)]
Moderate hypofractionation
Ultrahypofractionation/extreme hypofractionation/stereotactic body radiation therapy (SBRT)/Stereotactic ablative body radiation therapy (SABR)/CyberKnife)
Comparator: Standard of care radiation therapy
Outcome(s): Survival
Toxicity
Quality of Life: Overall and cancer specific
We will search Embase and Medline. Searches will be limited to English language. There will be no limits for geographical origin or time period.
We will supplement our bibliographic database searches with citation searching of relevant systematic reviews identified via the Cochrane and AHRQ databases.
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.
To synthesize available evidence on the accuracy of pulse oximeters among patients of different races/ethnicities and the impact of differential accuracy on treatment delivery and harms. Findings from this report will inform VA policies on the use of pulse oximeters in clinical care.
KQ1: Does detection of hypoxemia by pulse oximetry vary by patient race/ethnicity or skin pigmentation?
KQ2: If present, are racial/ethnic disparities in hypoxemia detection associated with differences in treatment delivery or harms?
Population(s): Adult inpatients or outpatients of different races/ethnicities (self-reported) or skin pigmentation (measured using chromaticity/phototype scales, spectroscopy, or other objective assessment)
Interventions: Concurrent (ie, within 10 minutes) measurement of oxygen saturation in arterial blood gas and by pulse oximetry
Comparator: Not applicable
Outcome(s):
Setting: Any inpatient or outpatient health care setting
PROSPERO registration number: CRD42022363787
KQ1: What protocols have been described to reduce seclusion practices for adult patients in inpatient mental health units?
KQ 1.1: What are the described resource needs (such as personnel and space needs) of these protocols?
KQ2: What are the comparative effects of protocols to reduce seclusion practices on resource use, staff and unit practices, patient experiences, and staff experiences versus usual protocols?
Population(s):
KQs 1 and 2:
KQ 2 (additional):
Interventions:
KQs 1 and 2:
Comparator:
KQ 1:
KQ 2:
Outcome(s):
KQ 1:
KQ 1.1:
KQ1 and 2:
KQ 1:
PROSPERO registration number: CRD42022377940
KQ1: Among adults with medically operable stage I non-small cell lung cancer, what are the benefits and harms of stereotactic beam radiotherapy (SBRT) compared to surgery?
KQ2: Do benefits and harms of SBRT compared to surgery differ by patient characteristics (age, comorbidities, performance status), tumor characteristics (size, location, stage), surgery characteristics (type of surgery (minimally invasive vs. open), type of resection (lobectomy, wedge resection, segmental resection, sleeve resection), SBRT characteristics (dose, fractionation)?
KQ3: What are the quantity and characteristics of evidence assessing the comparative effects of ablative therapies as monotherapy or combined with other ablative therapies versus surgical, radiotherapy or ablative therapies for patients with early stage I non-small cell lung cancer, by type of intervention, patient/tumor characteristics, study design, and outcomes?
Population(s):
Adults, 18 years or older, with medically operable (determined based on clinical factors; e.g. patient age, performance status, comorbidities, and cardiopulmonary function) stage I non-small cell lung cancer (KQ1/2)
Adults, 18 years or older, with medically operable or inoperable (determined based on clinical factors; includes patient age, performance status, comorbidities, and cardiopulmonary function) stage I non-small cell lung cancer (KQ3)
Interventions:
KQ1/2
KQ3
Non-surgical ablative treatment modalities
Comparator:
KQ1 and 2:
KQ3:
Outcome(s):
Benefits
Survival (Primary outcome)
Recurrence/Control (Secondary outcome)
Quality of Life (QOL) (Secondary outcome)
Harms
SBRT Toxicity (acute=within 90 days and late=>90days)
Surgery (Short term; <30days)
Surgery (Long term; >30days)
Ablative therapies (short term) (KQ3 Only)
Ablative therapies (long term) (KQ3 Only)
We will search Embase and Medline. Searches will be limited to English language. There will be no limits for geographical origin or time period.
We will supplement our bibliographic database searches with citation searching of relevant systematic reviews identified via the Cochrane and AHRQ databases.
KQ1: Among parents with a history of sexual assault, what are the effects of parenting skills training interventions on key parent, child, and family outcomes?
KQ2: Among parents with a history of serious mental illness, what are the effects of parenting skills training interventions on key parent, child, and family outcomes?
KQ3: Among parents with a history of military service, what are the effects of parenting skills training interventions on key parent, child, and family outcomes?
KQ4: What are intervention characteristics (eg, format, dose, content) of the identified effective parenting skills training interventions?
Population(s):
Community dwelling biological, adoptive, or parent figures/guardian (eg, grandparents as primary caregivers) aged 18 and over of children aged 2 to 17 with histories of
KQ1: Sexual assault (eg, Military Sexual Trauma) or
KQ2: Serious mental illness (SMI) as determined by meeting one of the following criteria:
KQ3: United States military service or other countries armed forces, including those now separated from service (ie, Veterans)
KQ 1-3: Any mixed populations comprised of conditions/exposures listed for K1 – K3 if meeting 75% or more of the overall study population.
Interventions:
Manualized/protocolized parenting skills training interventions that are appropriate for parent figures of any gender identity that are intended to prevent adverse child and family outcomes (eg, disruptive or aggressive behaviors; family conflict) or increase parenting capacity. A parenting skills training program must include modeling, homework, rehearsal/role play, or practice that actively promotes the acquisition of parenting skills (eg, effective communication; increasing use of effective discipline; promoting nurturing behaviors to support positive parent-child interactions; responding sensitively to child’s emotional needs). Parenting skills programs may include enhancements (eg, additional psychoeducation) that aim to address needs of specific parent groups (eg, SPMI, sexual trauma, military service) but must have a focus on acquisition of parenting skills to increase parenting capacity.
Qualifying programs can be delivered:
Comparator: Any comparator (eg, usual care, active comparator, historical controls)
Outcome(s):
KQ1 -KQ 3:
KQ4: Characteristics of effective parenting programs such as
Context:
We will conduct a primary search from inception to the current date of MEDLINE® (via Ovid®), Embase, PsycINFO (via Ovid®) and CINAHL from inception to September 7th 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: CRD42023406164
KQ1: KQ1: What are the benefits and harms of hepatocellular carcinoma (HCC) screening among increased risk adults? Do benefits and harms vary by:
a) Patient or co-existing medical characteristics (eg, age, sex, race/ethnicity; comorbidities)
b) Presence of cirrhosis
c) Liver disease etiology (Hepatitis, B, C, alcohol, metabolic liver disease), “severity” or HCC risk
d) Screening intervals (eg, semi, annual, biennial) or abdominal imaging technique?
e) Screening modality with or without AFP
Population(s): Adults (≥18 years of age) at increased risk for hepatocellular carcinoma
Interventions: Abdominal imaging (ultrasound, CT, or MRI (full or abbreviated) with or without alpha fetoprotein blood test for HCC screening/surveillance (ie, not a diagnostic or monitoring test for a patient with known or suspected HCC)
Comparator: No HCC screening or compared to another abdominal imaging technique eg, ultrasound vs CT or MRI (full or abbreviated) with or without alpha fetoprotein blood test
HCC screening in patient and liver disease subgroups, at different intervals
Outcome(s): Overall mortality, HCC-specific mortality, HCC specific survival, receipt of curative-intent for HCC, HCC stage at diagnosis, screening-related harms (eg, liver biopsies, false positive and negative tests; financial burden associated with screening adherence, opportunity costs, psychological distress at incorrect diagnosis, overdiagnosis, etc), adherence
Setting: Outpatient clinical
Two reviews assessing screening for HCC in chronic liver disease, Kansagara et al and Singal et al, were conducted in 2014 and 2022. We will evaluate, and include if eligible, all studies included in these 2 reviews and update the Singal review search strategy starting at January 2020 to identify additional articles for inclusion in the review. We will conduct the search in Medline and Embase and supplement this search with review of the AHRQ, Cochrane, and ClinicalTrials.gov databases.
Keywords: screening, surveillance, hepatocellular carcinoma, liver cancer, cirrhosis, hepatitis B, hepatitis C, liver disease
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.
KQ1: What is the effect of health care delivery models or staff-focused interventions designed to manage persistent or recurrent distressed and/or disruptive behaviors among older adults in post-acute health care settings on patient, staff, and utilization outcomes?
KQ2: What is the effect of health care delivery models or staff-focused interventions designed to manage persistent or recurrent distressed and/or disruptive behaviors among older adults during transitions between health care settings on patient, staff, and utilization outcomes?
KQ3: What is the effect of health care delivery models or staff-focused interventions designed to manage persistent or recurrent distressed and/or disruptive behaviors among older adults in the context of inpatient mental health settings on patient, staff, and utilization outcomes?
Population(s): Older adults (aged ≥ 50 years) in residential, or post-acute, health care settings (eg, nursing home, skilled nursing facility) or who are transitioning between hospital to these settings or to home and who are at elevated risk of persistent or recurrent distress and/or disruptive behaviors in healthcare settings associated with underlying conditions such as neurocognitive disorders (eg, dementia), mental health disorders (eg, serious mental illness, psychosis, PTSD, substance use disorders), and/or other chronic medical illnesses
*Eligible studies must include at least 75% of participants aged ≥ 50 years
*Patients could be those identified to be at-risk OR those already displaying disruptive behaviors
*Patients experiencing transient disruptive behaviors due to delirium are not the target population
Interventions: Staff or health care unit-focused approaches to build capacity, knowledge, behaviors, or skills intended to reduce or prevent distress and/or disruptive behaviors among a population of older adults in indicated healthcare settings
*Intervention could involve staff or clinic-facing interventions that focus on optimizing facility staffing, staff training, and education, and/or developing and strengthening staff competencies as they relate to managing disruptive behaviors
*Intervention must primarily target the health care providers or unit (e.g., team, clinical service) or have a significant portion targeted to staff or clinical teams such that a major point of the intervention involved a change in the way care is delivered.
*Interventions must specify a primary intent to reduce disruptive and/or distress behaviors (or have such behaviors as a primary outcome)
*Interventions designed to reduce antipsychotic medication are eligible if otherwise meet criteria outlined above and include measurement of disruptive behaviors as an outcome
*Interventions could include electronic health record components that involve staff interaction or recognition of at-risk patients
Comparator: Any comparator (eg, usual care, active comparator, historical controls)
Outcome(s): Patient outcomes: Measures of disruptive behavior (eg, Cohen-Mansfield agitation inventory), patient harm (eg, injuries, falls), quality of life, use of antipsychotic medications/sedatives
Staff outcomes: provider/staff safety, turnover/burnout, staff competencies/skills, staff self-efficacy/confidence as it relates to handling disruptive behaviors
Utilization outcomes: Length of stay in healthcare settings, timeliness of discharge, hospital re-admissions
Setting: Inpatient medicine, inpatient mental health, residential care/nursing homes, and transitional care, including from hospital or nursing home to community-based or family caregiving.
We will conduct a primary search from inception to December 14th 2022 of MEDLINE® (via Ovid®), Embase (via Elsevier), and PsycINFO (via Ovid®). 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.
