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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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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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Physical Therapy in Primary Care

Key Questions

KQ1: What are the effects of integrated physical therapy (PT) in primary care on patient satisfaction, staff satisfaction, access to care, and health care utilization for adults with musculoskeletal disorders and/or mobility impairments?

KQ2: Do the effects of integrated PT in primary care vary by clinic, staff, or patient characteristics?

KQ3: For studies of integrated PT in primary care identified for KQ1 & 2:

  • KQ3A: Which tools or measures have been used to assess implementation?
  • KQ3B: Which tools or measures have been used to assess team integration?
  • KQ3C: What were differences between implementation strategies or adaptations for rural vs. urban clinics (if any)?
  • KQ3D: What were differences in facilitators or barriers for implementation or sustainability for rural vs. urban clinics (if any)?

Participants/population: Adults presenting to primary care clinics with following conditions for which outpatient PT is indicated:

  • musculoskeletal disorders (eg, chronic low back pain or shoulder pain)
  • mobility impairments or history of falls

Intervention(s)/exposure(s): Integrated primary care PT (ie, evaluation by a physical therapist integrated with the primary care team). We will exclude PT referral models that solely allow a patient to schedule a PT visit directly (without interaction with primary care).

Comparator(s): Any

Context: Outpatient primary care health care settings

Outcome(s):

KQ1 & 2:

  • Patient satisfaction
  • Staff satisfaction, self-efficacy and knowledge
  • Access to care (eg, wait time for PT evaluation, wait time for primary care appointment, no show rate for PT)
  • Health care utilization (eg, outpatient PT, imaging, specialty referral)

KQ3:

  • Measures for implementation outcomes staff satisfaction, self-efficacy and knowledge
  • Measures for team integration health care utilization (eg, outpatient PT, imaging, specialty referral)
  • Implementation strategies for rural versus urban
  • Barriers and facilitators to implementation for rural versus urban

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Music Interventions for Reducing Aggression in Long-Term Care Residents

Key Questions

KQ1: Among residents of nursing homes and VA Community Living Centers, are music exposure activities or therapeutic interventions effective for management of behavioral symptoms, stratifying by cognitive impairment?

Participants/population: Adult residents of nursing homes and VA Community Living Centers

Intervention(s)/exposure(s): Music exposure activities or therapeutic interventions (eg, listening to music, singing, playing instruments, “rhythmic exercise”, etc, in a group or individual setting). We will include music interventions regardless of the primary aim of the intervention. Interventions must be regular and structured (2 sessions and monthly)

Exclusions: Interventions where music is one of multiple components and the effect of the music component cannot be isolated, including music and movement intervention; studies where participants self-select or are selected into a music intervention from a menu of possible interventions based on patient characteristics/ preferences. 

Comparator(s): Any

Context: Nursing homes and VA Community Living Centers

Excluded: Assisted living facilities

Outcome(s):

Required, measured using standardized tools or counts:

  • Aggression
  • Agitation
  • Behavioral symptoms of dementia

Additionally, if reported:

  • Cost
  • QOL (both patient and caregiver)

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