bluuebunny/crossref_metadata_2025_split huggingface dataset:
An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract
Authors: Lopresti Adrian L. , Smith Stephen J. , Malvi Hakeemudin , Kodgule Rahul 
Published: September 2019

Abstract

Background:
Ashwagandha (Withania somnifera (L.) Dunal) is a herb traditionally used to reduce stress and enhance wellbeing. The aim of this study was to investigate its anxiolytic effects on adults with self-reported high stress and to examine potential mechanisms associated with its therapeutic effects.

Methods:
In this 60-day, randomized, double-blind, placebo-controlled study the stress-relieving and pharmacological activity of an ashwagandha extract was investigated in stressed, healthy adults. Sixty adults were randomly allocated to take either a placebo or 240 mg of a standardized ashwagandha extract (Shoden) once daily. Outcomes were measured using the Hamilton Anxiety Rating Scale (HAM-A), Depression, Anxiety, and Stress Scale -21 (DASS-21), and hormonal changes in cortisol, dehydroepiandrosterone-sulphate (DHEA-S), and testosterone.

Results:
All participants completed the trial with no adverse events reported. In comparison with the placebo, ashwagandha supplementation was associated with a statistically significant reduction in the HAM-A (P = .040) and a near-significant reduction in the DASS-21 (P = .096). Ashwagandha intake was also associated with greater reductions in morning cortisol (P < .001), and DHEA-S (P = .004) compared with the placebo. Testosterone levels increased in males (P = .038) but not females (P = .989) over time, although this change was not statistically significant compared with the placebo (P = .158).

Conclusions:
These findings suggest that ashwagandha's stress-relieving effects may occur via its moderating effect on the hypothalamus-pituitary-adrenal axis. However, further investigation utilizing larger sample sizes, diverse clinical and cultural populations, and varying treatment dosages are needed to substantiate these findings.

Trial registration:
Clinical Trials Registry—India (CTRI registration number: CTRI/2017/08/009449; date of registration 22/08/2017)
Research Lifecycle to Increase the Substantial Real-world Impact of Research
Authors: Kilbourne Amy M. , Braganza Melissa Z. , Bowersox Nicholas W. , Goodrich David E. , Miake-Lye Isomi , Floyd Nicole , Garrido Melissa M. , Frakt Austin B. , Bever Christopher T. , Vega Ryan , Ramoni Rachel 
Published: September 2019

Background:
US health care systems face a growing demand to incorporate innovations that improve patient outcomes at a lower cost. Funding agencies increasingly must demonstrate the impact of research investments on public health. The Learning Health System promotes continuous institutional innovation, yet specific processes to develop innovations for further research and implementation into real-world health care settings to maximize health impacts have not been specified.

Objective:
We describe the Research Lifecycle and how it leverages institutional priorities to support the translation of research discoveries to clinical application, serving as a broader operational approach to enhance the Learning Health System.

Methods:
Developed by the US Department of Veterans Affairs Office of Research and Development Research-to-Real-World Workgroup, the Research Lifecycle incorporates frameworks from product development, translational science, and implementation science methods. The Lifecycle is based on Workgroup recommendations to overcome barriers to more direct translation of innovations to clinical application and support practice implementation and sustainability.

Results:
The Research Lifecycle posits 5 phases which support a seamless pathway from discovery to implementation: prioritization (leadership priority alignment), discovery (innovation development), validation (clinical, operational feasibility), scale-up and spread (implementation strategies, performance monitoring), and sustainability (business case, workforce training). An example of how the Research Lifecycle has been applied within a health system is provided.

Conclusions:
The Research Lifecycle aligns research and health system investments to maximize real-world practice impact via a feasible pathway, where priority-driven innovations are adapted for effective clinical use and supported through implementation strategies, leading to continuous improvement in real-world health care.
Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders
Authors: Wilt Timothy J. , Greer Nancy , Duan-Porter Wei 
Published: September 2019

Background:
Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by systematic review groups to navigate common challenges and enhance impacts of systematic review findings.

Objectives:
Describe pragmatic approaches taken by Department of Veterans Affairs Evidence Synthesis Programs (VA ESP) in conducting systematic reviews of effectiveness and implementation barriers and facilitators for complex interventions to provide VA stakeholders with evidence to guide national health care practice and policy.

Results:
We describe 3 systematic reviews conducted by VA ESP teams to evaluate the evidence for complex health care interventions. We summarize key findings, implications for future research needs and policy, dissemination of findings, and approaches taken to address common challenges. The VA ESP experience adds to existing systematic review methods and provides a perspective on generating rigorous and relevant reviews of complex interventions.

Conclusions:
Reviews of complex interventions often encounter challenges related to sources of variability in many dimensions, and lack of clarity and information in reporting of intervention elements, local context, and implementation factors. Evidence synthesis teams should work closely with stakeholders to understand their needs, synthesize and interpret results in meaningful ways, and explore implications that are most relevant for day-to-day clinical practice and operational decisions of learning health care systems. More evaluation of the impact of systematic reviews may improve uptake of findings from future reviews and enhance translation of evidence into practice and policy.
“It Would’ve Been Nice if They Interpreted the Data a Little Bit. It Didn’t Really Say Much, and It Didn’t Really Help Us.”
Authors: Christensen Vivian , Floyd Nicole , Anderson Johanna 
Published: September 2019

Background:
Patient health outcomes improve when learning health care systems use evidence to implement promising services and allocate resources effectively. Here, we examine the unique environment in which Veterans Health Administration (VHA) leadership use evidence and the facilitators and barriers to using evidence synthesis products in decision-making. We end by describing the steps researchers can take to better support the needs of health system leadership.

Methods:
We conducted 20 semistructured phone interviews with individuals in VHA leadership positions. We used an inductive approach to identify themes observed across key informant interviews.

Results:
Key informants identified several factors that fostered the use of evidence including, timeliness, lack of bias, flexible approaches, and concise reports with a clear bottom line. Barriers included lack of relevant evidence and lack of information on how to translate evidence into practice, resistance to change among providers and within the larger health system, and political pressures to implement therapies or technologies with little evidence or uncertainty. Researchers can foster evidence uptake by developing a review scope and key questions that are important to multiple stakeholders, including frontline clinicians and health system leadership.

Conclusions:
The VHA’s evidence needs resemble other health systems, but evidence synthesis products should include a translational component to enhance implementation. Resistance to change and political pressures can further hinder the uptake of evidence within VHA.
Establishing an Evidence Synthesis Capability For Psychological Health Topics in the Military Health System
Authors: Belsher Bradley E. , Beech Erin H. , Kelber Marija S. , Hempel Susanne , Evatt Daniel P. , Smolenski Derek J. , Campbell Marjorie S. , Otto Jean L. , Morgan Maria A. , Workman Don E. , Stewart Lindsay , Morgan Rebecca L. , Khusid Marina , Edwards-Stewart Amanda , O’Gallagher Kevin , Bush Nigel 
Published: September 2019

Background:
To promote evidence-based health care, clinical providers and decision makers rely on scientific evidence to inform best practices. Evidence synthesis (ES) is a key component of this process that serves to inform health care decisions by integrating and contextualizing research findings across studies.

Objective:
This paper describes the process of establishing an ES capability in the Military Health System dedicated to psychological health topics.

Research Designs:
The goal of establishing the current ES capability was to facilitate evidence-based decision-making among clinicians, clinic managers, research funders, and policymakers, through the production and dissemination of trustworthy ES reports. We describe how we developed this capability, provide an overview of the types of evidence syntheses products we use to respond to different stakeholders, and detail the procedures established for selecting and prioritizing synthesis topics.

Results:
We report on the productivity, acceptability, and impact of our efforts. Our reports were used by a variety of stakeholders and working groups, briefed to major committees, included in official reports and policies, and cited in clinical practice guidelines and the peer-reviewed literature.

Conclusions:
Our experiences thus far suggest that the current ES capability offers a needed service within our health system. Our framework may help inform other agencies interested in developing or sponsoring a similar capability.
Prioritizing Evidence-based Interventions for Dissemination and Implementation Investments
Authors: Huppert Jill S. , Fournier Alaina K. , Bihm Jasmine L. , Chang Christine S. , Miller Therese L. , Nourjah Parivash , Chang Stephanie M. , Bierman Arlene S. 
Published: September 2019

Background:
The Agency for Healthcare Research and Quality (AHRQ) is mandated to implement patient-centered outcomes research (PCOR) to promote safer, higher quality care. With this goal, we developed a process to identify which evidence-based PCOR interventions merit investment in implementation. We present our process and experience to date.

Materials and Methods:
AHRQ developed and applied a systematic, transparent, and stakeholder-driven process to identify, evaluate, and prioritize PCOR interventions for broad dissemination and implementation. AHRQ encouraged public nominations, and assessed them against criteria for quality of evidence, potential impact, and feasibility of successful implementation. Nominations with sufficient evidence, impact, and feasibility were considered for funding.

Results:
Between June 2016 and June 2018, AHRQ received 35 nominations from researchers, nonprofit corporations, and federal agencies. Topics covered diverse settings, populations, and clinical areas. Twenty-eight unique PCOR interventions met minimum criteria; 16 of those had moderate to high evidence/impact and were assessed for feasibility. Fourteen topics either duplicated other efforts or lacked evidence on implementation feasibility. Two topics were prioritized for funding (cardiac rehabilitation after myocardial infarction and screening/treatment for unhealthy alcohol use).

Conclusions:
AHRQ developed replicable criteria, and a transparent and stakeholder-driven framework that attracted a diverse array of nominations. We identified 2 evidence-based practice interventions to improve care with sufficient evidence, impact, and feasibility to justify an AHRQ investment to scale up practice. Other funders, health systems or institutions could use or modify this process to guide prioritization for implementation.
Patients and Caregivers Rate the PAINReportIt Wireless Internet-Enabled Tablet as a Method for Reporting Pain During End-of-Life Cancer Care
Authors: Schoppee Tasha M. , Dyal Brenda W. , Scarton Lisa , Ezenwa Miriam O. , Singh Prashant , Yao Yingwei , Suarez Marie L. , Wang Zaijie J. , Molokie Robert E. , Wilkie Diana J. 
Published: September 2019

Background
In several studies, investigators have successfully used an internet-enabled PAINReportIt tablet to allow patients to report their pain to clinicians in real-time, but it is unknown how acceptable this technology is to patients and caregivers when used in their homes.

Objective
The aims of this study were to examine computer use acceptability scores of patients with end-stage cancer in hospice and their caregivers and to compare the scores for differences by age, gender, race, and computer use experience.

Intervention/Methods
Immediately after using the tablet, 234 hospice patients and 231 caregivers independently completed the Computer Acceptability Scale (maximum scores of 14 for patients and 9 for caregivers).

Results
The mean (SD) Computer Acceptability score was 12.2 (1.9) for patients and 8.5 (0.9) for caregivers. Computer Acceptability scores were significantly associated with age and with previous computer use for both patients and caregivers.

Conclusions
This technology was highly acceptable to patients and caregivers for reporting pain in real time to their hospice nurses.

Implications for Practice
Findings provide encouraging results that are worthy of serious consideration for patients who are in end stages of illness, including older persons and those with minimal computer experience. Increasing availability of technology can provide innovative methods for improving care provided to patients facing significant cancer-related pain even at the end of life.
Quality of Life in Patients With Breast Cancer
Authors: An Yuanyuan , Fu Gan , Yuan Guangzhe 
Published: September 2019

AbstractPrevious research showed that family caregiver's perception of burden can influence patient's report on their quality of life (QoL). The present study investigated the relationship between the two variables by considering the role of patient's anxiety and depression. A total of 382 dyads of Chinese breast cancer patients and their family caregivers participated in this study. The results showed that the mediation model fitted the data well (χ2= 49.859;df= 16; χ2/df= 3.116; RMSEA = 0.05; TLI = 0.928; CFI = 0.959). It indicated that family caregiver's burden influenced patient's QoL negatively, and this relationship was partially mediated by patient's anxiety and depression.
Doctor-Diagnosed Arthritis and Self-Reported Physical Health Function Among Middle-Aged and Older Adults With Serious Mental Illness
Authors: Brooks Jessica M. , Umucu Emre , Sánchez Jennifer , Seehusen Carol , Fortuna Karen L. , Chiu Chungyi , Bartels Stephen J. 
Published: September 2019

AbstractArthritis is one of the most common chronic conditions in aging adults, with both physical and mental health issues and consequences. However, there is insufficient arthritis research among aging adults with serious mental illness (SMI). This study examined rates of doctor-diagnosed arthritis and its cross-sectional associations with self-reported physical health function among adults aged 50 years and older with SMI. Community-based mental health center participants (n= 176) reported clinical and sociodemographic data (e.g., physical health function, sex), whereas diagnostic information (i.e., arthritis, psychiatric, and medical diagnoses) was retrieved from medical records. Arthritis prevalence was high (43.8%) and had an independent, negative association with physical health function. Findings suggest that arthritis evaluations and intervention services need to be prioritized in middle-aged and older adults with SMI. Future research should focus on further testing arthritis self-management programs and other nonpharmacological psychosocial approaches for arthritis in aging adults with SMI.
Interindividual Balance Adaptations in Response to Perturbation Treadmill Training in Persons With Parkinson Disease
Authors: Klamroth Sarah , Gaßner Heiko , Winkler Jürgen , Eskofier Björn , Klucken Jochen , Pfeifer Klaus , Steib Simon 
Published: September 2019

Background and Purpose:
Perturbation training is a promising approach to reduce fall incidence in persons with Parkinson disease (PwPD). This study aimed to evaluate interindividual differences in balance adaptations in response to perturbation treadmill training (PTT) and identify potential outcome predictors.

Methods:
PwPD (n = 43, Hoehn & Yahr stage 1-3.5) were randomly assigned to either 8 weeks of PTT or conventional treadmill training (CTT) without perturbations. At baseline and following intervention, data from 4 domains of balance function (reactive, anticipatory, dynamic postural control, and quiet stance) were collected. Using responder analysis we investigated interindividual differences (responder rates and magnitude of change) and potential predictive factors.

Results:
PTT showed a significantly higher responder rate in the Mini Balance Evaluation Systems Test (Mini-BESTest) subscore reactive postural control, compared with CTT (PTT = 44%; CTT = 10%; risk ratio = 4.22, confidence interval = 1.03-17.28). Additionally, while between-groups differences were not significant, the proportion of responders in the measures of dynamic postural control was higher for PTT compared with CTT (PTT: 22%-39%; CTT: 5%-10%). The magnitude of change in responders and nonresponders was similar in both groups. PTT responders showed significantly lower initial balance performance (4/8 measures) and cognitive function (3/8 measures), and were older and at a more advanced disease stage, based on descriptive evaluation.

Discussion and Conclusions:
Our findings suggest that PTT is beneficial to improve reactive balance in PwPD. Further, PTT appeared to be effective only for a part of PwPD, especially for those with lower balance and cognitive function, which needs further attention.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A1).
Transgender Women Have Higher Human Papillomavirus Prevalence Than Men Who Have Sex With Men—Two U.S. Cities, 2012–2014
Authors: Singh Vidisha , Gratzer Beau , Gorbach Pamina M. , Crosby Richard A. , Panicker Gitika , Steinau Martin , Amiling Raiza , Unger Elizabeth R. , Markowitz Lauri E. , Meites Elissa 
Published: September 2019

BackgroundHuman papillomavirus (HPV) prevalence is high among men who have sex with men (MSM), yet little is known about HPV among transgender women (TGW). We assessed HPV prevalence and knowledge among TGW compared with MSM.MethodsWe enrolled TGW and MSM aged 18 to 26 years from clinics in Chicago and Los Angeles during 2012 to 2014. Participants self-reported gender identity, HIV status, HPV knowledge, and vaccination status. Self-collected anal and oral specimens were tested for HPV DNA (37 types); serum was tested for HPV antibodies (4 vaccine types). Prevalence among unvaccinated TGW and MSM was compared using prevalence ratios (PRs) and 95% confidence intervals (CIs). Participants without DNA or serologic evidence of HPV were considered naïve.ResultsAmong 1033 participants, 49 were TGW. Among 44 TGW and 855 MSM who were unvaccinated, any HPV DNA was detected in anal specimens from 39 (88.6%) TGW and 606 (70.9%) MSM (PR, 1.3; 95% CI, 1.1–1.4), and oral specimens from 4 (9.1%) TGW and 81 (9.5%) MSM (PR, 1.0; 95% CI, 0.4–2.5). Antibodies were detected among 37 (84.1%) TGW and 467 (54.6%) MSM (PR, 1.5; 95% CI, 1.3–1.8). Most participants were naïve to 1 or more HPV vaccine type/s, including 29 (65.9%) TGW and 775 (90.6%) MSM (PR, 0.7; 95% CI, 0.6–0.9). Most TGW (55.1%) had never heard of HPV vaccine.ConclusionsAmong TGW, HPV prevalence was high and knowledge was low. Most were still naïve to 1 or more HPV vaccine type. Although vaccination ideally occurs prior to exposure, findings support existing national recommendations to vaccinate TGW and MSM, and suggest additional outreach might increase vaccination.
A Co-Located Continuity Clinic Model to Address Healthcare Needs of Women Living Unhoused With Opioid Use Disorder, Who Engage in Transactional Sex in North Seattle
Authors: Stewart Jenell , Stadeli Kathryn M. , Green Margaret L. , Etter-Carlson Lisa , Dahl Elizabeth , Davidson Giana H. , Golden Matthew , Dhanireddy Shireesha 
Published: September 2019

Abstract
This is a review of the first 50 patients attending a colocated continuity clinic with harm reduction services to women experiencing homelessness in north Seattle. Among those tested, patients had high rates of curable sexually transmitted infections (44%), injection opioid use (36%), transactional sex (69%), unintended pregnancy (10%), and human immunodeficiency virus infections (10%).
Oropharyngeal and Genital Gonorrhea Infections Among Women and Heterosexual Men Reporting Sexual Contact With Partners With Gonorrhea: Implication for Oropharyngeal Testing of Heterosexual Gonorrhea Contacts
Authors: Chow Eric P.F. , Chen Marcus Y. , Williamson Deborah A. , Bradshaw Catriona S. , Vodstrcil Lenka A. , Trumpour Sabrina , Howden Benjamin P. , Fairley Christopher K. 
Published: September 2019

Background
There have been very limited studies of oropharyngeal gonorrhea in heterosexuals. Routine screening of oropharyngeal gonorrhea is not recommended in heterosexual contacts of gonorrhea. This study aimed to examine oropharyngeal gonorrhea positivity among heterosexuals reporting contact with a partner with gonorrhea.

Methods
At the Melbourne Sexual Health Centre (MSHC), all heterosexual individuals reporting contact with sexual partners with gonorrhea are tested for genital gonorrhea. In May 2017, MSHC also included screening for oropharyngeal gonorrhea in heterosexual contacts of gonorrhea. All contacts of gonorrhea among women and heterosexual men between May 2017 and November 2018 were reviewed. Site-specific gonorrhea positivity was also calculated.

Results
One hundred ninety-one gonorrhea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 (interquartile range, 24–33) years. The gonorrhea positivity in males was significantly higher at the oropharynx compared with urethra (18%; 95% confidence interval [CI], 11% to 26% vs 2%; 95% CI, 0% to 7%; P < 0.001); and higher at the oropharynx compared with cervicovaginal site in women (46%; 95% CI, 35% to 57% vs 36%; 95% CI, 26% to 47%; P = 0.056). Of the 100 men who did not have genital gonorrhea, 17 (18%; 95% CI, 10% to 26%) tested positive at the oropharynx. Of the 55 women who did not have genital gonorrhea, 21 (24%; 95% CI, 15% to 34%) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of gonorrhea in heterosexual men and women were only in the oropharynx, respectively.

Conclusions
Oropharyngeal gonorrhea testing among heterosexual contacts of gonorrhea may be indicated given a substantial proportion of gonorrhea contacts are only infected at this site.