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BackgroundTwo-thirds of older adults have two or more medical conditions that often take precedence over depression in primary care.ObjectiveWe evaluated whether evidence-based depression care management would improve the long-term mortality risk among older adults with increasing levels of medical comorbidity.DesignLongitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Twenty primary care practices randomized to intervention or usual care.PatientsThe sample included 1204 older primary care patients completing the Charlson Comorbidity Index (CCI) and other interview questions at baseline.InterventionFor 2 years, a depression care manager worked with primary care physicians to provide algorithm-based care for depression, offering psychotherapy, increasing the antidepressant dose if indicated, and monitoring symptoms, medication adverse effects, and treatment adherence.Main MeasuresDepression status based on clinical interview, CCI to evaluate medical comorbidity, and vital status at 8 years (National Death Index).Key ResultsIn the usual care condition, patients with the highest levels of medical comorbidity and depression were at increased risk of mortality over the course of the follow-up compared to depressed patients with minimal medical comorbidity [hazard ratio 3.02 (95 % CI, 1.32 to 8.72)]. In contrast, in intervention practices, patients with the highest level of medical comorbidity and depression compared to depressed patients with minimal medical comorbidity were not at significantly increased risk [hazard ratio 1.73 (95 % CI, 0.86 to 3.96)]. Nondepressed patients in intervention and usual care practices had similar mortality risk.ConclusionsDepression management mitigated the combined effect of multimorbidity and depression on mortality. Depression management should be integral to optimal patient care, not a secondary focus.

The gap between discovery of public health knowledge and application in practice settings and policy development is due in part to ineffective dissemination. This article describes (1) lessons related to dissemination from related disciplines (eg, communication, agriculture, social marketing, political science), (2) current practices among researchers, (3) key audience characteristics, (4) available tools for dissemination, and (5) measures of impact. Dissemination efforts need to take into account the message, source, audience, and channel. Practitioners and policy makers can be more effectively reached via news media, social media, issue or policy briefs, one-on-one meetings, and workshops and seminars. Numerous “upstream” and “midstream” indicators of impact include changes in public perception or awareness, greater use of evidence-based interventions, and changes in policy. By employing ideas outlined in this article, scientific discoveries are more likely to be applied in public health agencies and policy-making bodies.

Nonalcoholic fatty liver disease (NAFLD) has become a serious public health issue not only in Western countries but also in Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease that often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma (HCC). While a definite diagnosis of NASH requires liver biopsy to confirm the presence of hepatocyte ballooning, hepatic fibrosis is the most important prognostic factor in NAFLD. With so many NAFLD patients, it is essential to have an effective screening method for NAFLD with hepatic fibrosis. As HCC with non-viral liver disease has increased markedly in Japan, effective screening and surveillance of HCC are also urgently needed. The most common death etiology in NAFLD patients is cardiovascular disease (CVD) event. Gastroenterologists must, therefore, pay close attention to CVD when examining NAFLD patients. In the updated guidelines, we propose screening and follow-up methods for hepatic fibrosis, HCC, and CVD in NAFLD patients. Several drug trials are ongoing for NAFLD/NASH therapy, however, there is currently no specific drug therapy for NAFLD/NASH. In addition to vitamin E and thiazolidinedione derivatives, recent trials have focused on sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) analogues, and effective therapies are expected to be developed. These practical guidelines for NAFLD/NASH were established by the Japanese Society of Gastroenterology in conjunction with the Japan Society of Hepatology. Clinical evidence reported internationally between 1983 and October 2018 was collected, and each clinical and background question was evaluated using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. This English summary provides the core essentials of these clinical practice guidelines, which include the definition and concept, screening systems for hepatic fibrosis, HCC and CVD, and current therapies for NAFLD/NASH in Japan.

Due to the increasing amount of available published evidence and the continual need to apply and update evidence in practice, we propose a shift in the way evidence generated by learning health systems can be integrated into more traditional evidence reviews. This paper discusses two main mechanisms to close the evidence-to-practice gap: (1) integrating Learning Health System (LHS) results with existing systematic review evidence and (2) providing this combined evidence in a standardized, computable data format. We believe these efforts will better inform practice, thereby improving individual and population health.

A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.

To examine the current application of Evidence-Based Practice (EBP) among radiology professionals, including radiologists and radiographers, in Saudi Arabia and to identify challenges in order to propose suitable future improvement strategies if it is required. A mixed-method design was used in this study. A survey consisting of 23 questions addressing research activities and EBP within radiology departments was sent to radiology personnel. The sample size of the quantitative phase of the study was determined using a formula specific for an infinite or unknown population. The formula used was n = P(1-P)Z2/d2, which resulted in a required sample size of 384 participants. A total of 345 participants; however, 45 did not fully complete the questionnaire and were therefore excluded. The data were analyzed using SPSS version 27. Inferential statistics, including non-parametric tests such as the Mann-Whitney U Test and the Kruskal-Wallis Test, were used to assess the influence of demographic factors on perceptions and challenges related to the adoption of evidence-based practice (EBP) in research within Saudi Arabia. Additionally, 20 semi-structured interviews were conducted with radiology personnel across the country. The sampling technique for the qualitative phase of the study was guided by the study's objectives and the unique characteristics of the research group. The participants were purposively sampled in order to include radiologists and radiographers who work in different types of hospitals (public, semi-public, private) in Saudi Arabia. Responses from the interviews were coded, and key themes were identified following Miles and Huberman's framework. The findings revealed a positive attitude towards research and EBP among Saudi radiology personnel. Over half of the participants (74.3%) strongly agreed that they understood and were familiar with EBP. They also felt confident in their ability to conduct scientific research in radiology (Mean = 4.27) and believed that they should actively initiate projects (Mean = 4.10). Radiologists reported a higher level of agreement compared to radiographers regarding their familiarity with EBP and their ability to critically evaluate the quality of research (P-value = <0.05). However, participants indicated lower level of agreement about their ability to develop their current practice based on EBP and engage in discussions with colleagues about research evidence. Key challenges identified include a lack of training, insufficient support and limited autonomy, which may hinder EBP implementation. This study underscores the need for comprehensive education, ongoing training and a supportive organisational culture to enhance EBP adaption.

Systematic reviews have transformed medicine, but a more cost-effective means of appraisal is needed for fields in which data are sparse and patchy, argue William J. Sutherland and Claire F. R. Wordley. Systematic reviews have transformed medicine, but a more cost-effective means of appraisal is needed for fields in which data are sparse and patchy.

AI, with its ramifications in machine learning (ML) and natural language processing (NLP), provides techniques capable of processing and analyzing colossal volumes of data, including the vast scientific literature. Data collection, a traditionally laborious step in review research, also benefits from the power of AI. Human curation, critical validation of results and accurate interpretation of conclusions generated by AI are non-negotiable pillars to guarantee evidence reliability and applicability(2).

Clinicians and neuroscientists must work together to understand and improve psychological treatments, urge Emily A. Holmes, Michelle G. Craske and Ann M. Graybiel.

To explore the knowledge, use, attitudes towards Evidence-based Medicine, also known as Evidence-based Practice (EBP), and perceived barriers to its dissemination among physiotherapists. Cross-sectional study. Members of the Italian Association of Physiotherapists (n=2000) were invited to participate in an online survey about EBP knowledge and use. The survey questionnaire comprised four sections: (1) respondent characteristics; (2) knowledge of EBP principles; (3) attitude, use and perceived effectiveness of EBP; (4) perceived barriers to implementing EBP in clinical practice. Out of 2000 physiotherapists, 1289 participated in the survey (64.5% response rate). Overall, 90% perceived EBP as useful and necessary for their clinical practice. More than 85% stated that they were familiar with the principles of EBP, 75% reported that they were able to search online databases for relevant information and 60% reported that they were able to understand statistical analyses. However, 56% believed that patient preferences and 39% that clinical expertise are not part of the EBP model. Half stated that they understood and could explain the term 'meta-analysis' but only 17% knew what a forest plot is and just 20% correctly judged the finding of a given meta-analysis. Lack of time was reported as the main barrier to EBP. The majority of Italian physiotherapists overrated their knowledge about EBP, demonstrating a gap between perceived and actual knowledge of EBP in this population.