Loss-of-function of EBP50 is a new cause of hereditary peripheral neuropathy: EBP50 functions in peripheral nerve system

Finding causative genetic mutations is important in the diagnosis and treatment of hereditary peripheral neuropathies. This study was conducted to find new genes involved in the pathophysiology of hereditary peripheral neuropathy. We identified a new mutation in the EBP50 gene, which is co-segregated with neuropathic phenotypes, including motor and sensory deficit in a family with Charcot–Marie–Tooth disease. EBP50 is known to be important for the formation of microvilli in epithelial cells, and the discovery of this gene mutation allowed us to study the function of EBP50 in the nervous system. EBP50 was strongly expressed in the nodal and paranodal regions of sciatic nerve fibers, where Schwann cell microvilli contact the axolemma, and at the growth tips of primary Schwann cells. In addition, EBP50 expression was decreased in mouse models of peripheral neuropathy. Knockout mice were used to study EBP50 function in the peripheral nervous system. Interestingly motor function deficit and abnormal histology of nerve fibers were observed in EBP50^+/− heterozygous mice at 12 months of age, but not 3 months. in vitro studies using Schwann cells showed that NRG1-induced AKT activation and migration were significantly reduced in cells overexpressing the I325V mutant of EBP50 or cells with knocked-down EBP50 expression. In conclusion, we show for the first time that loss of function due to EBP50 gene deficiency or mutation can cause peripheral neuropathy.     

Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches

Heavily T2-weighted MR myelography (HT2W-MRM) is emerging as an alternative approach for detection and follow up of CSF leaks. We aimed to assess epidural blood patch (EBP) treatment outcome when using HT2W-MRM as the primary modality for detecting CSF leak and planning EBP placement in routine clinical practice. Since 2018, patients at our institute suspected of having CSF leak, routinely HT2W-MRM instead of CT myelography to determine presence of the leak and identify the EBP target site. Fifty-nine consecutive patients suspected of having a CSF leak underwent HT2W-MRM. After excluding patients with subdural hematoma and poor image quality, 26 (10 men, 16 women; mean age 44.92 ± 12.6 years) patients were included in this study. Patients received EBP on the basis of HT2W-MRM assessments and clinical assessment. Imaging findings and clinical outcome were evaluated. CSF leak was identified in 21 patients (80.8%, 21/26) based HT2W-MRM. Most cases were graded on a confidence scale as CSF leak definitely (n = 13) or probably (n = 3) present. Successful clinical EBP treatment was achieved in 14 of 17 patients (82.4%) after first targeted EBP, and patient symptoms significantly improved after treatment (numerical rating score 6.4 before EBP, 1.3 after EBP, P < 0.001). HT2W-MRM based EBP are the rational and effective choices for CSF leak treatment in routine clinical practice.     

Implementation of Evidence-Based Practices within Treatment-As-Usual and Evidence-Based Practice Initiatives

Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers’ use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs.

     

Furthering Our Understanding of Therapist Knowledge and Attitudinal Measurement in Youth Community Mental Health

Examining therapist evidence-based practice (EBP) knowledge seems an important step for supporting successful implementation. Advances in implementation science suggest a distinction between practice specific (i.e., knowing which practices are derived from the evidence base) and EBP process (i.e., integrating research evidence, clinical experience, client characteristics, and monitoring outcomes) knowledge. An examination of how these knowledge types are measured and relate to attitudes appears warranted. In our sample of 58 youth community therapists, both practice specific and EBP process knowledge accounted for EBP attitude scores, which varied by therapist demographic variables. Implications for measurement of therapist constructs and future research in identifying therapist predictors of EBP use and youth clinical improvement are discussed.     

AACAP 2005 Research Forum: speeding the adoption of evidence-based practice in pediatric psychiatry

OBJECTIVES: At the 2005 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the Academy's Workgroup on Research conducted a Research Forum entitled "Increasing Research Literacy Through the Adoption of Evidence-Based Practice (EBP) in Pediatric Psychiatry." METHOD: Forum participants focused on speeding the adoption of EBP across five areas: EBP as the preferred heuristic for teaching research literacy, use of EBP in training programs, dissemination of EBP in clinical practice, EBP in partnership with industry, and EBP as a framework for developing practice guidelines. RESULTS: EBP provides an easy-to-understand method for accessing and evaluating the research literature and then applying this information to decisions about patient care. Although EBP has been gaining greater visibility in pediatric psychiatry, it is far from the preferred heuristic. To move the field toward fully embracing EBP will require greater understanding of what EBP is (and is not), educating mental health professionals in EBP skills, access to EBP resources, and a commitment to apply EBP to the conceptualization and design of research protocols and practice guidelines. CONCLUSIONS: Pediatric psychiatry would benefit from a principled commitment to follow other areas of medicine in adopting EBP.     

Evaluation on a clinical course of subdural hematoma in patients undergoing epidural blood patch for spontaneous cerebrospinal fluid leak

Objective

Subdural hematoma (SDH) is a frequent complication of spontaneous intracranial hypotension (SIH), in which epidural blood patch (EBP) may be applied as a treatment to stop cerebrospinal fluid (CSF) leak. However, a clinical course of SDH in SIH patients has not been sufficiently evaluated. We retrospectively evaluated the temporal relationships between EBP and SDH in the patients with SIH.

Methods

Twenty-nine consecutive patients, diagnosed as SIH, were studied. Clinical records and images were retrospectively evaluated. When orthostatic headache continued for 2 weeks regardless of conservative treatment, EBP was performed under fluoroscopy.

Results

We detected 13(45%) cases of SDH (mean age 44 years, 8 males and 5 females). In 6 patients, SDHs disappeared after effective EBP, i.e., after the disappearance of orthostatic headache. In 3 patients, SDHs were enlarged or recurred after effective EBP, and in 4 patients, SDHs were first detected after effective EBP.

Conclusion

The knowledge of the presence of these types of SDH (enlarged or recurred or detected after EBP) may deserve clinical attention.     

Bladder and bowel dysfunction following small-volume epidural blood patch for spontaneous intracranial hypotension

Epidural blood patch (EBP) is an effective procedure for the treatment of spontaneous intracranial hypotension (SIH). Neurological compromise following EBP, although rare, is recognized as a serious potential complication. We describe a 33-year-old female patient in whom long-term bladder and bowel dysfunction developed following a small volume (10 mL) EBP to treat SIH. We also discuss the possible pathophysiological mechanisms related to this complication in the postprocedure setting.     

“Change Doesn’t Happen by Itself”: A Thematic Analysis of First-Level Leaders’ Experiences Participating in the Leadership and Organizational Change for Implementation (LOCI) Strategy

The Leadership and Organizational Change for Implementation (LOCI) strategy is a multifaceted implementation strategy that aims to support successful evidence-based practice (EBP) implementation by fostering effective general leadership, implementation leadership, and implementation climate. How implementation strategies are experienced by participants is important for their utilization and effectiveness in supporting EBP implementation. The current study is the first in-depth qualitative study exploring first-level leaders’ experiences of participating in the LOCI strategy. Data were collected as part of a trial where Norwegian child and adult mental health outpatient clinics implemented EBPs for posttraumatic stress disorder (PTSD). Eleven first-level leaders from adult and child clinics participated in semi-structured interviews after completing the LOCI strategy. Data were analyzed through reflexive thematic analysis. The analysis generated four themes related to leaders’ experiences of participating in the LOCI strategy: (1) structuring the EBP implementation, (2) taking responsibility for the EBP implementation, (3) interacting with others about the EBP implementation, and (4) becoming aware of EBP implementation and their own leadership. Most participants experienced the LOCI strategy as beneficial for implementing EBPs for PTSD in their clinic. The strategy succeeded in raising awareness of leadership for EBP implementation, and simultaneously provided participants with tools and support for leading the implementation in their clinic. Two participants experienced LOCI as less beneficial than the others. Our results support the strategy’s potential to engage and empower first-level leaders to get involved in implementation processes and point to important challenges for future research on implementation strategies.

     

Implementation of Evidence-based Practice in Child Welfare: Service Provider Perspectives

Implementation of evidence-based practices (EBP) in child welfare is a complex process that is often fraught with unanticipated events, conflicts, and resolutions. To some extent, the nature of the process, problems, and solutions may be dependent on the perspectives and experiences of a given stakeholder group. In order to better understand the implementation process in the child-welfare system, we interviewed comprehensive home-based services (CHBS) case managers who were actively engaged in implementing an EBP to reduce child neglect in a state youth services system. Six primary factors were identified as critical determinants of EBP implementation: (1) Acceptability of the EBP to the caseworker and to the family, (2) Suitability of the EBP to the needs of the family, (3) Caseworker motivations for using the EBP, (4) Experiences with being trained in the EBP, (5) Extent of organizational support for EBP implementation, and (6) Impact of EBP on process and outcome of services. These factors reflect two broader themes of attitudes toward or assessments of the EBP itself and experiences with learning and delivering the EBP. Eventual implementation is viewed as the consequence of perseverance, experience, and flexibility.     

Closing the gap between research and clinical practice

Evidence-based practice and the application of research findings to practice is a major focus of attention in health care today. The quantification of variations in service delivery and the economic implications of these variations contribute to the pressure on clinicians to provide evidence-based care whenever possible. Awareness of the development of evidence-based practice (EBP), the need for EBP, factors that affect EBP, the methods used to translate research into practice, EBP quality indicators, barriers to EBP, and benefits of EBP will assist clinicians in the effective use of evidence-based information in the care of their patients.     

Consumers and families as partners in implementing evidence-based practice.

Evidence-based practices represent an extremely important advance in the mental health system, and NAMI continues its support of efforts to develop and implement these interventions. Moving forward, the authors envision consumers and family members playing a much greater role in developing and promulgating EBP. Individually and corporately, consumers can: facilitate research that will expedite equitable implementation of existing and new EBPs; play a significant role in providing services; play a lead role in promoting policies that support EBP implementation through the development and use of advocacy toolkits; influence provider adaptation of EBP through the broad development and testing of resources that urge EBP consumerism; and, advance through the monitoring of EBP. These consumer-led activities generally have been relegated to a lower level of importance in the current research, policy, and funding environment leading to poorly developed partnerships and "buy in" from the consumer community. It is important that the level of importance of these activities and the role of consumers and families be rethought. Further advancement of EBP will require implementing a three-track program of research, including a much greater focus on action research and the involvement of consumers as research and evaluation partners. This is the fastest and most effective way to achieve breakthrough results in practices for treating people with serious mental illnesses and to address the serious and growing problem of racial and cultural disparities and the disconnect that causes between those individuals and the means to their recovery. The hope of consumers and families rest on the ability to initiate action now.     

Emotional and Behavioral Problems in Children and Adolescents in Central Kenya

Emotional and behavioral problems (EBP) during childhood and adolescence are a common concern for parents and mental health stakeholders. However, little has been documented about their prevalence in Kenyan children and adolescents. This study aimed to close this gap. The study included Child Behavior Checklist reports from 1022 Kenyan parents on their children (ages 6–18 years) and Youth Self-Reports from 533 adolescents (ages 12–18) living in Kenya’s Central Province. EBP in Kenya are highly prevalent compared to multi-cultural standards for parent reports, with 27 and 17% scoring in the borderline and clinical range, respectively. Based on parent reports, younger children scored higher on EBP than older children, and higher on internalizing problems. Based on self-reports girls scored higher than boys, particularly on internalizing problems. The study provides evidence on elevated parent-reported EBP in Kenyan youths. Mental health providers should focus on interventions that reduce EBP in Kenyan youths.     

Identifying common elements of evidence-based psychosocial treatments for children's disruptive behavior problems

ObjectiveAlmost all of the efforts to study and implement evidence-based practice (EBP) have used individual treatments as the unit of analysis. A complementary approach using aggregated common elements of multiple individual evidence-based treatment programs has been introduced. The purpose of this article is to describe a new method for identifying common elements of EBP and to present common elements resulting from a systematic review of interventions for children with disruptive behavior problems and their parents.MethodWe identified eight individual treatment programs with established efficacy for children ages 4 to 13 with disruptive behavior problems, reviewed all of the treatment materials thoroughly, identified core elements of each treatment, and determined which elements were common to at least half of the programs. The validity of these common core elements was confirmed through a survey of national experts using a modified Delphi technique.ResultsWe identified 21 treatment elements that were common to multiple evidence-based treatment programs. These included therapeutic content (e.g., principles of positive reinforcement, problem-solving skills training), treatment techniques (e.g., role-playing, assigning homework), aspects of the working alliance, and other parameters such as treatment duration.ConclusionsIdentification of common core elements of EBP has important implications for efforts to characterize practice, as well as therapist training and implementation of EBP in community-based service settings. Therapist training and ongoing supervision that builds on common elements of EBP could potentially improve the effectiveness of care overall. It could also build a strong foundation for targeted individual treatment implementation efforts by enhancing therapists' skills and attitudes about EBP.     

The efficacy of epidural blood patch in spontaneous CSF leaks.

Of 25 consecutive patients with spontaneous CSF leaks treated with epidural blood patch (EBP), nine patients (36%) responded well to the first EBP. Of 15 patients who received a second EBP, five became asymptomatic (33%). Of eight patients who received three or more EBP (mean 4), four patients (50%) responded well.     

Attitudes towards and organizational support for evidence-based practices: A comparison of education and allied health professionals in autism

BackgroundEvidence-based practices (EBPs) have been developed for clients on the autism spectrum across allied health and education. However, there remains a significant gap between research and practice. We explored the similarities and differences between educators and allied health professionals in two key factors that may link to uptake: individual attitudes and organizational culture support for EBP.MethodAllied health (n = 156) and education professionals (n = 95) completed measures of their individual attitudes and perceived organizational support for EBP.ResultsModerate levels of support for each were found within both groups. Educators however, showed more positive individual attitudes, whereas allied health professionals showed more positive organizational support toward EBP.ConclusionsThese results add to the scant literature comparing professions, highlighting discipline differences in attitudes and organizational support across professionals for EBP in autism. These findings highlight the need for targeted knowledge translation approaches as opposed to development of generic models across contexts and disciplines.     

Predictors of Practitioner Self-reported Use of Evidence-Based Practices: Practitioner Training,Clinical Setting,and Attitudes Toward Research

In light of the recent movement toward evidence-based practice (EBP) in mental health services, practitioner adoption of EBPs in clinical settings has emerged as an important area for study. This paper reports on the results of a national online survey of mental health practitioners in an attempt to identify correlates of self-reported EBP use in practice. The survey consisted of 214 mental health practitioners from 15 states drawn from a diverse set of clinical settings and representing a variety of theoretical orientations. The results indicated that practitioner training (i.e., taking a class in EBPs), the perceived openness of the clinical setting toward EBPs, and the practitioner's attitudes toward treatment research were significant predictors of self-reported EBP use. The relationship between clinical setting and EBP use was partially mediated by attitudes toward treatment research. Negative attitudes toward treatment research partially mediated the relationship between practitioner training and self-reported EBP use. The findings are presented within the context of efforts to increase EBP use in clinical settings and implications for clinical training, treatment research, and EBP dissemination efforts are discussed.