Recently Published Projects

Objectives: Volunteerism has been explored in terms of the benefits to the health of wellbeing of recipients, but also for the volunteers. However, a synthesis of these findings is needed to explore the psychological, physical and social effects of volunteering on the wellbeing of volunteers, and how these interact with each other and other demographic factors.

Objectives: This review focuses on noninvasive nonpharmacological treatment for chronic pain including exercise, mind-body practices, psychological therapies, multidisciplinary rehabilitation, mindfulness practices, manual therapies, physical modalities, and acupuncture. Many trials have examined the impact of these interventions on outcomes during or immediately after the course of treatment reporting improved function and reduced pain. However, given the persistence of chronic pain, understanding whether the benefits are durable would be very helpful for informing selection of therapies. Therefore, this report focuses on durability of treatment effects, defined as at least 1 month following the end of a course of treatment.

Objectives: Pain affects millions of adults. It impacts physical and mental function and is influenced by multiple factors (e.g., age, sex, comorbidities, and psychosocial factors). Optimal pain management should address biopsychosocial aspects of pain. The U.S. Department of Health and Human Services has been directed to evaluate ways to improve Medicare coverage and payment for pain treatment, particularly through formal pain management programs. Our review assesses the effectiveness and harms of pain management programs that address multiple aspects of pain. The intended audiences for this review are the Centers for Medicare & Medicaid Services (CMS) and other stakeholders including clinicians, policymakers, patients, and their caregivers, and researchers. This review is part of the Dr. Todd Graham Pain Management Study and was sponsored by CMS.

Objectives: The ultimate reason for accurately diagnosing clinical Alzheimer’s-type dementia (CATD) and whether Alzheimer’s disease (AD) is the underlying neuropathological etiology is to inform decision making about drug and nondrug treatments to improve patient and caregiver outcomes. In individuals with suspected cognitive impairment, comprehensive neuropsychological testing may help clinically diagnose dementia and distinguish between dementia subtypes. However, such testing is time consuming and access is limited in some clinical settings. Therefore, we need better understanding in this population with suspected cognitive impairment (case finding) which brief cognitive tests and test combinations most accurately distinguish patients with CATD from those with normal cognition or mild cognitive impairment (MCI), and whether patient characteristics affect test classification accuracy. Additionally, many individuals clinically diagnosed with CATD do not meet neuropathologic (gold standard) criteria for AD on post-mortem brain autopsy. Therefore, we also need better understanding of how accurate pre-mortem brain imaging and cerebrospinal fluid (CSF) biomarkers are for distinguishing patients whose dementia is due to AD from those with non-AD dementia, and whether classification accuracy varies depending on patient characteristics. Finally, although only a few prescription drugs are approved by the U.S. Food and Drug Administration (FDA) for CATD, many supplements are promoted for cognition and function. In addition, many prescription drugs are used off-label for CATD-associated behavioral and psychological symptoms of dementia (BPSD), including antipsychotics despite FDA black box warnings about their increased mortality risk in this population. Less is understood about the beneficial and harmful effects of supplements for CATD-associated BPSD. To guide CATD treatment decisions for cognition, function, BPSD and other outcomes, we need to clarify the benefits and harms of prescription drugs and supplements in this population.

Objectives: Structured Abstract Objective. To understand the evidence base for care interventions, implementation strategies, and between-provider communication tools among children with special healthcare needs (CSHCN) transitioning from pediatric to adult medical care services. Data Sources. We searched Ovid Medline, Ovid Embase, the Cochrane Central trials (CENTRAL) registry, and CINAHL to identify studies through September 10, 2021. We conducted grey literature searches to identify additional resources relevant to contextual questions. Review Methods. Using a mixed-studies review approach, we searched for interventions or implementation strategies for transitioning CSHCN from pediatric to adult services. Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials, quasi-experimental observational, and mixed method studies of CSHCN, their families, caregivers, or healthcare providers. We extracted basic study information from all eligible studies and grouped interventions into categories based on disease conditions. We summarized basic study characteristics for included studies and outcomes for studies assessed as low to medium risk of bias using ROB-2. Results. We identified 9,549 unique references, 440 of which represented empirical research; of these, 154 (16 major disease categories) described or examined a care transition intervention with enough detail to be potentially eligible for inclusion in any of the Key Questions. Of these, 96 studies met comparator criteria to undergo risk of bias assessment; however only nine studies were assessed as low or medium risk of bias and included in our analytic set. Low-strength evidence shows transition clinics may not improve hemoglobin A1C levels either at 12 or 24 months in youth with type 1 diabetes mellitus compared with youth who received usual care. For all other interventions and outcomes, the evidence was insufficient to draw meaningful conclusions because the uncertainty of evidence was too high. Some approaches to address barriers include dedicating time and resources to support transition planning, developing a workforce trained to care for the needs of this population, and creating structured processes and tools to facilitate the transition process. No globally accepted definition for effective transition of care from pediatric to adult services for CSHCN exists; definitions are often drawn from principles for transitions, encompassing a broad set of clinical aspects and other factors that influence care outcomes or promote continuity of care. There is also no single measure or set of measures consistently used to evaluate effectiveness of transitions of care. The literature identifies a limited number of available training and other implementation strategies focused on specific clinical specialties in targeted settings. No eligible studies measured the effectiveness of providing linguistic and culturally competent healthcare care for CSHCN. Identified transition care training, and care interventions to prepare pediatric patients and their families for transitioning CSHCN to adult care, varied considerably. 10 Conclusions. Little rigorous evidence exists to inform care interventions and implementation strategies. Significant barriers impede implementation of interventions, tools, and trainings to transition CSHCN that may be reduced in future intervention development. This review highlights the need for more rigorous studies across the diverse populations of CSHCN in order to provide clearer answers for CSHCN, their families, caregivers, providers, funders, and policymakers.