A scoping review of opioid harm reduction interventions for equity-deserving populations.

Background: Morbidity and mortality associated with opioid use has become a North American crisis. Harm reduction is an evidence-based approach to substance use. Targeted harm reduction strategies that consider the needs of specific populations are required. The objective of this scoping review was to document the range of opioid harm reduction interventions across equity-deserving populations including racialized groups, Indigenous peoples, LGBTQIA2S+, people with disabilities, and women. Methods: Ten databases were searched from inception to July 5th, 2021. Terms for harm reduction and opioid use formed the central concepts of the search. We included studies that: (1) assessed the development, implementation, and/or evaluation of harm reduction interventions for opioid use, and (2) reported health-related outcomes or presented perspectives that directly related to experiences receiving or administering harm reduction interventions, (3) were completed within an equity-deserving population and (4) were completed in New Zealand, Australia, Canada or the US. A knowledge map was developed a-priori based on literature outlining different types of harm reduction interventions and supplemented by the expertise of the research team. Findings: 12,958 citations were identified and screened, with 1373 reviewed in full-text screening. Of these, 15 studies were included in the final dataset. The most common harm reduction program was opioid agonist treatment (OAT) (n = 11, 73%). The remaining four studies included: overdose prevention; drug testing equipment; and outreach, peer support, and educational programs for safer use. Nine studies focused on women, primarily pregnant/post-partum women, three focused on Indigenous peoples, and three studies included racialized groups. No studies were identified that provided any information on persons with a disability or members of the LGBTQIA2S+ population. Interpretation: The scant opioid specific harm reduction literature on equity-deserving populations to date has primarily focused on OAT programs and is focused primarily on women. There is a need for more targeted research to address the diverse social experiences of people who use drugs and the spectrum of harm reduction interventions that are needed. There is also a need to acknowledge the history of harm reduction as a drug-user activist movement aimed at challenging bio-medical paradigms of drug use. Further, there is a need to recognize that academic research may be contributing to health inequity by not prioritizing research with this lens. Funding: This research was funded by the Canadian Institutes of Health Research.

Increased Neural Efficiency in Visual Word Recognition: Evidence from Alterations in Event-Related Potentials and Multiscale Entropy.

Visual word recognition is a relatively effortless process, but recent research suggests the system involved is malleable, with evidence of increases in behavioural efficiency after prolonged lexical decision task (LDT) performance. However, the extent of neural changes has yet to be characterized in this context. The neural changes that occur could be related to a shift from initially effortful performance that is supported by control-related processing, to efficient task performance that is supported by domain-specific processing. To investigate this, we replicated the British Lexicon Project, and had participants complete 16 h of LDT over several days. We recorded electroencephalography (EEG) at three intervals to track neural change during LDT performance and assessed event-related potentials and brain signal complexity. We found that response times decreased during LDT performance, and there was evidence of neural change through N170, P200, N400, and late positive component (LPC) amplitudes across the EEG sessions, which suggested a shift from control-related to domain-specific processing. We also found widespread complexity decreases alongside localized increases, suggesting that processing became more efficient with specific increases in processing flexibility. Together, these findings suggest that neural processing becomes more efficient and optimized to support prolonged LDT performance.

Theory of Mind after Pediatric Traumatic Brain Injury: A Scoping Review.

This scoping review aims to synthesize existing literature regarding theory of mind (ToM) outcomes, the neuropathology associated with ToM outcomes, and the relationship between ToM outcomes and social functioning in children and adolescents with traumatic brain injury (TBI). We searched MEDLINE® and PsycINFO databases to identify all literature that examined ToM following pediatric TBI until July 2019. A total of 29 articles met inclusion and exclusion criteria and were included in the results. These articles examined a variety of aspects of ToM, which could be broadly grouped into those focused on cognitive, cognitive-affective, and pragmatic factors. The existing literature suggests that children and adolescents with TBI, compared with their typically developing peers and peers with orthopedic injuries, are more likely to have deficits in ToM. The evidence further shows that the age at which brain injury occurs contributes to ToM disruption. Neuroimaging techniques have offered crucial insights into how TBI may impact ToM performance in children and adolescents. Finally, this review provides evidence that disruption in ToM plays a role in the difficulties in social functioning demonstrated by children and adolescents with TBI. Limitations and gaps in the existing literature warrant future research in this field.

A scoping review of full-spectrum knowledge translation theories, models, and frameworks.

BACKGROUND: Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. METHODS: A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics. RESULTS: Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison. CONCLUSIONS: A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions. TRIAL REGISTRATION: A protocol outlining the methodology of this scoping review was developed and registered with PROSPERO (CRD42018088564).

Effectiveness of Neurostimulation Technologies for the Management of Chronic Pain: A Systematic Review.

OBJECTIVES: To describe the state of the literature for clinical effectiveness of neurostimulation used for the management of chronic pain. METHODS: A systematic review of spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), peripheral nerve field stimulation (PNFS), and supraorbital transcutaneous electrical nerve stimulation in patients with cancer and noncancer chronic pain was conducted. MEDLINE, Embase, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials were searched, using terms like "electrical stimulation therapy" and "pain management." Direction of effect, consistency across studies, and strength of evidence for effects of neurostimulation on chronic pain were narratively synthesized. RESULTS: A total of 15 randomized controlled trials (RCTs) examining SCS, 7 RCTs examining PNS/PNFS, and 1 nonrandomized trial examining supraorbital transcutaneous electrical nerve stimulation (TENS) were included. In nine SCS studies, neurostimulation had positive effects on pain. In three studies, neurostimulation did not significantly reduce pain. For PNS/PNFS, five studies found improvements in pain offered by neurostimulation; pain outcomes were not reported in two studies. In the TENS study, neurostimulation reduced headaches per month and medication consumption. Overall, 21 studies were of low or unclear risk of bias, 4 were high risk of bias, and the TENS study was not appropriate for assessment using the Cochrane Risk of Bias tool. CONCLUSIONS: A robust body of evidence examining SCS and PNS was identified. Only one study for PNFS and TENS was identified; both reported pain reductions. Generally, neurostimulation improved pain control. Future studies should examine the effectiveness of neurostimulation offered early in the trajectory of chronic pain.

Current and Common Definitions of Treatment-Resistant Depression: Findings from a Systematic Review and Qualitative Interviews.

OBJECTIVE: No universal definition for treatment-resistant depression (TRD) exists. This lack of consensus reduces the generalizability of study findings and limits the ability to study TRD. In addition, anecdotally, there may be a difference between the definitions of TRD within research and those applied in practice. Thus, the objective of this work was to identify current common definitions of TRD used in both research and clinical practice. METHOD: A systematic review of published literature was conducted to document TRD definitions. Extracted data were grouped based on patient cohort and method of defining TRD. Validation studies were narratively summarized. Interviews with 6 key informants were conducted to understand how definitions are applied in practice. RESULTS: In total, 155 definitions for TRD were identified in the published literature, and 48.4% of all definitions specified requirement of at least 2 treatment failures. Key informant interviews indicated the concept of TRD is rarely employed in clinical practice. Instead, concepts like "complex needs," "struggling with their disease," and "chronic" are used. When asked directly about how they would define TRD, interview participants said an adequate trial of psychotherapy as well as an adequate trial of at least 2 to 3 antidepressant medications. CONCLUSIONS: There is no universally accepted definition of TRD, and substantial heterogeneity exists. This study indicates discordance between the use of the term in research and clinical practice, with several key informants emphasizing that the terminology is rarely used in their clinical experience. Development of a shared, common definition across practice and research is required.