Rapid white matter changes in children with conduct problems during a parenting intervention.

Studies report that the microstructural integrity of the uncinate fasciculus (UF; connecting the anterior temporal lobe to the orbitofrontal cortex) is abnormal in adults with psychopathy and children with conduct problems (CP), especially those with high callous-unemotional (CU) traits. However, it is unknown if these abnormalities are 'fixed' or 'reversible'. Therefore, we tested the hypothesis that a reduction in CP symptoms, following a parenting intervention, would be associated with altered microstructural integrity in the UF. Using diffusion tensor imaging tractography we studied microstructural differences (mean diffusivity (MD) and radial diffusivity (RD)) in the UF of 43 typically developing (TD) and 67 boys with CP before and after a 14-week parenting intervention. We also assessed whether clinical response in CP symptoms or CU traits explained changes in microstructure following the intervention. Prior to intervention, measures of MD and RD in the UF were increased in CP compared to TD boys. Following intervention, we found that the CP group had a significant reduction in RD and MD. Further, these microstructural changes were driven by the group of children whose CU traits improved (but not CP symptoms as hypothesized). No significant microstructural changes were observed in the TD group. Our findings suggest, for the first time, that microstructural abnormalities in the brains of children with CP may be reversible following parenting intervention.

Smartphone- and Paper-Based Delivery of Balance Intervention for Older Adults Are Equally Effective, Enjoyable, and of High Fidelity: A Randomized Controlled Trial.

Home-based rehabilitation programs for older adults have demonstrated effectiveness, desirability, and reduced burden. However, the feasibility and effectiveness of balance-intervention training delivered through traditional paper-versus novel smartphone-based methods is unknown. Therefore, the purpose of this study was to evaluate if a home-based balance-intervention program could equally improve balance performance when delivered via smartphone or paper among adults over the age of 65. A total of 31 older adults were randomized into either a paper or phone group and completed a 4-week asynchronous self-guided balance intervention across 12 sessions for approximately 30 min per session. Baseline, 4-week, and 8-week walking and standing balance evaluations were performed, with exercise duration and adherence recorded. Additional self-reported measures were collected regarding the enjoyment, usability, difficulty, and length of the exercise program. Twenty-nine participants completed the balance program and three assessments, with no group differences found for any outcome measure. Older adults demonstrated an approximately 0.06 m/s faster gait velocity and modified balance strategies during walking and standing conditions following the intervention protocol. Participants further self-reported similar enjoyment, difficulty, and exercise effectiveness. Results of this study demonstrated the potential to safely deliver home-based interventions as well as the feasibility and effectiveness of delivering balance intervention through a smartphone-based application.

Selective Amygdala Hypoactivity to Fear in Boys With Persistent Conduct Problems After Parent Training.

BACKGROUND: Parenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person's fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. METHODS: We conducted a prospective, case-control study of boys with CPs and typically developing (TD) boys. Both groups (ages 5-10 years) completed 2 magnetic resonance imaging sessions (18 ± 5.8 weeks apart) with ASB assessed at each visit. Participants included boys with CPs following referral to a parenting intervention group and TD boys recruited from the same schools and geographical regions. Final functional magnetic resonance imaging data were available for 36 TD boys and 57 boys with CPs. Boys with CPs were divided into those whose ASB improved (n = 27) or persisted (n = 30) following the intervention. Functional magnetic resonance imaging data assessing fear reactivity were then analyzed using a longitudinal group (TD/improving CPs/persistent CPs) × time point (pre/post) design. RESULTS: Amygdala hypoactivity to fear was observed only in boys with CPs who had persistent ASB and was absent in those whose ASB improved following intervention. CONCLUSIONS: Our findings suggest that amygdala hypoactivity to fear is a marker for ASB that is resistant to change following a parenting intervention and a putative target for future treatments.

Physical therapist clinical reasoning in home care for walking assistive device prescription: A description of practice.

BACKGROUND: Home care in the United States (US) provides rehabilitative care to people who are homebound after acute hospitalization. Patients with stroke and brain injury (BI) are commonly seen by physical therapists (PTs/PTAs), who often address the loss of walking independence. Clinical reasoning (CR) is required for walking assistive device (WAD) prescription within the home. There has never been a description of the home care PT CR process, which could inform entry-level training and health policy. PURPOSE: To describe the homecare CR process by identifying factors used for prescription of WADs in patients with stroke and BI. Secondly, to describe any practice issues associated with WADs. METHODS: Directors of 7 agencies affiliated with Nazareth College DPT program were recruited to identify PTs/PTAs to complete an online survey between March - July 2017. Quantitative and qualitative data were collected, and analyzed for frequencies or for common themes. RESULTS: A total of 334 PTs/PTAs were enrolled from all agencies and 72 responses were analyzed. The CR process did not differ between stroke and BI. Safety was the primary factor, which was assessed by patient query, observation skills, and objective measures. PTs/PTAs also measured balance, strength, function, cognition, and patient preferences within the context of the home. WADs obtained prior to initiation of home care often weren't used. CONCLUSION: A complex CR process has been described for WAD prescription in home care for patients with stroke and BI. Entry-level training and health policy implications are described.

Experiences of transitioning between settings of care from the perspectives of patients with advanced illness receiving specialist palliative care and their family caregivers: A qualitative interview study.

BACKGROUND: Transitions between care settings (hospice, hospital and community) can be challenging for patients and family caregivers and are often an under-researched area of health care, including palliative care. AIM: To explore the experience of transitions between care settings for those receiving specialist palliative care. DESIGN: Qualitative study using thematic analysis. SETTING/PARTICIPANTS: Semi-structured interviews were conducted with adult patients (n = 15) and family caregivers (n = 11) receiving specialist palliative care, who had undergone at least two transitions. RESULTS: Four themes were identified. (1) Uncertainty about the new care setting. Most participants reported that lack of information about the new setting of care, and difficulties with access and availability of care in the new setting, added to feelings of uncertainty. (2) Biographical disruption. The transition to the new setting often resulted in changes to sense of independence and identity, and maintaining normality was a way to cope with this. (3) Importance of continuity of care. Continuity of care had an impact on feelings of safety in the new setting and influenced decisions about the transition. (4) Need for emotional and practical support. Most participants expressed a greater need for emotional and practical support, when transitioning to a new setting. CONCLUSIONS: Findings provide insights into how clinicians might better negotiate transitions for these patients and family caregivers, as well as improve patient outcomes. The complexity and diversity of transition experiences, particularly among patients and families from different ethnicities and cultural backgrounds, need to be further explored in future research.

Bone fragility related to breast cancer treatment: The pivotal role of nurses in bone health program development, implementation, and testing.

Breast cancer treatment can affect estrogen levels leading to significant bone loss, osteoporosis, and risks for fracture. Although bone care guidelines are published, bone health interventions are often not routinely offered to at-risk individuals. This paper reports on the process of developing and implementing a nurse-led bilingual Breast and Bone Health Program (BBHP) in-person and online at a cancer centre in Montreal, Quebec (www.breastandbonehealth.ca, www.santeseinsetos.ca). The BBHP offers tailored bone health interventions (e.g., risk screening, information, rehabilitation, exercise prescriptions, nutritional counselling, and support for a health-promoting lifestyle). Over a two-year period, women treated for breast cancer (N = 430) took part in the program. Forty percent of surveyed participants (n = 97) initally reported being unaware that some breast cancer treatment could significantly affect bone health. Following the initial informational session with the BBHP nurse, self-reported bone health knowledge significantly increased, with 96% reporting sufficient information to manage their bone health. The BBHP offers both online and in-person risk assessment and bone health promotion activities and tools to both health care professionals and women with breast cancer. Herein, we review the background, BBHP development and implementation as well as preliminary program evaluation.

Is postnatal depression a distinct subtype of major depressive disorder? An exploratory study.

Postnatal depression (PND) has an estimated prevalence of 6.5 to 12.9%. In addition to the direct consequences for women, PND also interferes with the maternal-infant interaction, contributing to long-term cognitive and emotional impairments in exposed offspring. It is unclear how PND differs from major depressive disorder (MDD) more generally, and if PND represents a distinct subtype of depression. We explored whether women with a history of PND have specific differences in brain activation associated with sex hormone changes during the late luteal phase of the menstrual cycle, compared to parous women with either a past history of MDD outside of the postnatal period, or an absent history of MDD ('never depressed'). Thirty mothers (history of PND (n = 10), history of MDD (n = 10), and 'never depressed' (n = 10)) underwent blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) acquisition during an emotional faces task. Amygdala activity was analysed using a region of interest (small volume correction) approach. There was a significant reduction in BOLD response to positive emotional faces in the right amygdala in women with a history of PND compared to women with a history of MDD. A similar but non-significant trend was found in the left amygdala in women with a history of PND compared to 'never depressed' women. Our findings support the hypothesis that women with vulnerability to PND represent a distinct subgroup of women with a differential sensitivity to changes in sex hormones. Further, albeit highly tentative, they provide a putative biomarker that could assist in detection of women at-risk to PND.

Every person is an individual: physical therapist clinical reasoning used in inpatient rehabilitation for walking assistive device prescription in patients with stroke and brain injury.

PURPOSE: A complete description of the process of physical therapy clinical reasoning for walking assistive devices in patients with stroke and brain injury has never been undertaken. Describing the clinical reasoning process used in post-acute inpatient rehabilitation is important to shed light on the clinical activities and factors used in practice, prevent device abandonment, and, inform entry-level clinical training. The two purposes were first, to describe the clinical reasoning process used during inpatient rehabilitation for walking assistive devices in patients with stroke and brain injury, and second, to determine whether clinical reasoning differed by two facility types and by diagnosis. METHODS: A mixed methods study of 67 participants in either an online survey or focus groups. RESULTS: A consistent and comprehensive method to determine the need and justification for a walking assistive device regardless of diagnosis or facility type was found. The clinical reasoning process included five primary factors, considered throughout the rehabilitation stay (safety, balance, cognition, strength, and function). The three therapist-related factors (experience/preference, training parameters, and use of objective tools), and seven patient-related factors (experience/preference, fluctuations, fear, age, diagnosis/comorbidities, discharge environment, and payer) individualized care. Definitions of the five primary factors were derived from participants' responses. CONCLUSIONS: Results from this study revealed complexity in the clinical reasoning process used in physical therapy practice to determine the best walking assistive device for patients with stroke and brain injury during inpatient rehabilitation. Information from this study can inform post-acute physical therapy practice and education, and may reduce device abandonment. Implications for rehabilitation Clinical reasoning (CR) is a complex process in which a clinician must consider multiple factors, which requires non-linear and iterative thinking, and involves many people, making it shared among the patient, caregivers, and the healthcare team. Describing the actual CR process used by physiotherapists when prescribing a walking assistive device (WAD) will identify the factors considered, thus more accurately explain the process of care. Such a description could lead to better justification of rehabilitation for patients with stroke and brain injury, and furthermore, determine whether treatments are rendered consistently and when, if ever, divergent approaches occur. Better understanding of the CR process of WAD prescription may also reduce the possibility of device abandonment.

Clinical pathways and outcomes of patients with Barrett's esophagus in tertiary care settings: a prospective longitudinal cohort study in Australia, 2008-2016.

BACKGROUND: Clinical services for Barrett's esophagus have been rising worldwide including Australia, but little is known of the long-term outcomes of such patients. Retrospective studies using data at baseline are prone to both selection and misclassification bias. We investigated the clinical characteristics and outcomes of Barrett's esophagus patients in a prospective cohort. METHODS: We recruited patients diagnosed with Barrett's esophagus in tertiary settings across Australia between 2008 and 2016. We compared baseline and follow-up epidemiological and clinical data between Barrett's patients with and without dysplasia. We calculated age-adjusted incidence rates and estimated minimally and fully adjusted hazard ratios (HR) to identify those clinical factors related to disease progression. RESULTS: The cohort comprised 268 patients with Barrett's esophagus (median follow-up 5 years). At recruitment, 224 (84%) had no dysplasia, 44 (16%) had low-grade or indefinite dysplasia (LGD/IND). The age-adjusted incidence of esophageal adenocarcinoma (EAC) was 0.5% per year in LGD/IND compared with 0.1% per year in those with no dysplasia. Risk of progression to high-grade dysplasia/EAC was associated with prior LGD/IND (fully adjusted HR 6.55, 95% confidence interval [CI] 1.96-21.8) but not long-segment disease (HR 1.03, 95%CI 0.29-3.58). CONCLUSIONS: These prospective data suggest presence of dysplasia is a stronger predictor of progression to cancer than segment length in patients with Barrett's esophagus.

Sex Differences in the Risk of Barrett's Esophagus Associated With the Metabolic Effects of Obesity.

GOAL: The goal of this study was to determine if there is an association between the insulin-insulin-like growth factor axis, the metabolic syndrome (MetS), type 2 diabetes mellitus and risk of Barrett's esophagus (BE), and if these associations are modified by sex. BACKGROUND: BE is more common in males. Gastroesophageal reflux disease, the major risk factor for BE occurs at similar frequencies in both sexes, suggesting that sex-related factors such as the metabolic effects of abdominal obesity may be important in the causation of BE. MATERIALS AND METHODS: A structured interview, anthropometric measures, and fasting blood were collected within a population-based case-control study. We recruited 227 BE cases (70% male) and 241 population controls, frequency matched by age and sex. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for association with BE using multivariable logistic regression models. RESULTS: Hyperinsulinemia (highest vs. lowest tertile, OR=1.9; 95% CI: 1.2-3.1), Homeostatic Model Assessment of Insulin Resistance (OR=1.9; 95% CI: 1.2-3.1) and the MetS (OR=1.8; 95% CI: 1.2-2.6) were independently associated with an increased risk of BE. With each additional MetS criterion, there was a 20% increased risk of BE (OR=1.2; 95% CI: 1.0-1.4). When stratified by sex, these associations were found in males but not females. We found no association with serum measures of insulin-like growth factors or interleukin-6 and risk of BE. CONCLUSION: Hyperinsulinemia, insulin resistance, and the MetS are associated with the risk of BE in males but not females, suggesting these factors may contribute to the higher prevalence of BE in males.

Trends and Factors Associated With Concordance Between International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification Codes and Stroke Clinical Diagnoses.

Background and Purpose- International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) codes are often used for disease surveillance. We examined changes in concordance between ICD-CM codes and clinical diagnoses before and after the transition to ICD-10-CM in the United States (October 1, 2015), and determined if there were systematic variations in concordance by patient and hospital characteristics. Methods- We included Paul Coverdell National Acute Stroke Program patient discharges from 2014 to 2017. Concordance between ICD-CM codes and the clinical diagnosis documented by the physician (assumed as accurate) was calculated for each diagnosis category: ischemic stroke, transient ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage. Results- In total, 314 857 patient records were included in the analysis (n=280 hospitals), 55.9% of which were obtained after the transition to ICD-10-CM. While concordance was generally high, a small, and temporary decline occurred from the last calendar quarter of ICD-9-CM (average unadjusted concordance =92.8%) to the first quarter of ICD-10-CM use (91.0%). Concordance differed by diagnosis category and was generally highest for ischemic stroke. In the analysis of ICD-10-CM records, disagreements often occurred between ischemic stroke and transient ischemic attack records and between subarachnoid and intracerebral hemorrhage records. Compared with the smallest hospitals (≤200 beds), larger hospitals had significantly higher odds of concordance (ischemic stroke adjusted odds ratio for ≥400 beds, 1.7; 95% CI, 1.5-1.9). Conclusions- This study identified a small and transient decline in concordance between ICD-CM codes and stroke clinical diagnoses during the coding transition, indicating no substantial impact on the overall identification of stroke patients. Researchers and policymakers should remain aware of potential changes in ICD-CM code accuracy over time, which may affect disease surveillance. Systematic variations in the accuracy of codes by hospital and patient characteristics have implications for quality-of-care studies and hospital comparative assessments.

Establishing key criteria to define and compare models of specialist palliative care: A mixed-methods study using qualitative interviews and Delphi survey.

BACKGROUND: Specialist palliative care services have various configurations of staff, processes and interventions, which determine how care is delivered. Currently, there is no consistent way to define and distinguish these different models of care. AIM: To identify the core components that characterise and differentiate existing models of specialist palliative care in the United Kingdom. DESIGN: Mixed-methods study: (1) semi-structured interviews to identify criteria, (2) two-round Delphi study to rank/refine criteria, and (3) structured interviews to test/refine criteria. SETTING/PARTICIPANTS: Specialist palliative care stakeholders from hospice inpatient, hospital advisory, and community settings. RESULTS: (1) Semi-structured interviews with 14 clinical leads, from eight UK organisations (five hospice inpatient units, two hospital advisory teams, five community teams), provided 34 preliminary criteria. (2) Delphi study: Round 1 (54 participants): thirty-four criteria presented, seven removed and seven added. Round 2 (30 participants): these 34 criteria were ranked with the 15 highest ranked criteria, including setting, type of care, size of service, diagnoses, disciplines, mode of care, types of interventions, 'out-of-hours' components (referrals, times, disciplines, mode of care, type of care), external education, use of measures, bereavement follow-up and complex grief provision. (3) Structured interviews with 21 UK service leads (six hospice inpatients, four hospital advisory and nine community teams) refined the criteria from (1) and (2), and provided four further contextual criteria (team purpose, funding, self-referral acceptance and discharge). CONCLUSION: In this innovative study, we derive 20 criteria to characterise and differentiate models of specialist palliative care - a major paradigm shift to enable accurate reporting and comparison in practice and research.

Development and Validation of the False Disorder Score: The Focal Scale of the Inventory of Problems.

This article introduces the Inventory of Problems (IOP)-a new, computerized, 181-item tool designed to discriminate bona fide from feigned mental illness and cognitive impairment-and presents the development and validation of its focal, feigning scale, the False Disorder Score (IOP-FDS). The initial sample included (a) 211 patients and 64 offenders who took the IOP under standard conditions, and (b) 210 community volunteers and 64 offenders who feigned mental illness. We split this sample into three subsamples. The first (n = 301) was used to select the variables to generate the IOP-FDS; the second (n = 148) scaled the IOP-FDS into a probability score; and the third (n = 100) tested its validity with an independent data set. In this third subsample, the IOP-FDS had sensitivity = .90, specificity = .80, and a greater area under the curve (AUC = .95) than the IOP-29 (.91). For 40 participants, the Personality Assessment Inventory (PAI) was available, too. Within this subgroup, the IOP-FDS outperformed the selected PAI validity scales (AUC = .99 vs. AUC ≤ .85).

Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol.

INTRODUCTION: Provision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision. METHODS AND ANALYSIS: Phase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set. ETHICS AND DISSEMINATION: The study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public. TRIAL REGISTRATION NUMBER: ISRCTN90752212.

Association Between Therapy Intensity and Discharge Outcomes in Aged Medicare Skilled Nursing Facilities Admissions.

OBJECTIVES: To determine the association between therapy intensity and discharge outcomes for aged Medicare skilled nursing facilities (SNFs) fee-for-service beneficiaries and to determine the association between therapy intensity and time to community discharge. DESIGN: Retrospective observational design. SETTING: SNFs. PARTICIPANTS: Aged Medicare fee-for-service beneficiaries (N=311,338) in 3605 SNFs. INTERVENTIONS: The total minutes of physical therapy, occupational therapy, and speech therapy per day were divided into intensity groups: high (≥60min); medium-high (45-<60min); medium-low (30-<45min); and low (<30min). MAIN OUTCOME MEASURES: Four discharge outcomes-community, hospitalization, permanent placement, and death-were examined using a multivariate competing hazards model. For those associated with community discharge, a Poisson multivariate model was used to determine whether length of stay differed by intensity. RESULTS: High intensity therapy was associated with more community discharges in comparison to the remaining intensity groups (hazard ratio, .84, .68, and .433 for medium-high, medium-low, and low intensity groups, respectively). More hospitalizations and deaths were found as therapy intensity decreased. Only high intensity therapy was associated with a 2-day shorter length of stay (incident rate ratio, .95). CONCLUSIONS: High intensity therapy was associated with desirable discharge outcomes and may shorten SNF length of stay. Despite growing reimbursements to SNFs for rehabilitation services, there may be desirable benefits to beneficiaries who receive high intensity therapy.

Meaningful Functional Change Achieved from Physical Therapy Provided in a Student-Run Pro Bono Clinic.

OBJECTIVE: This study investigated whether patients with chronic neurologic diagnoses who attended a student-run pro bono physical therapy (PT) clinic achieved the minimum detectable change (MDC) on functional measures and the factors associated with such change. METHODS: Retrospective chart review included 71 patients with a primary diagnosis of stroke, traumatic brain injury, or multiple sclerosis from 2010 to 2014. The sample was 45% female, with a mean age of 62 yrs (SD 12.6) and mean 7.9 yrs (10.1) postdiagnosis. Second-year DPT students provided supervised weekly sessions. Meaningful functional change was defined as the achievement of the MDC on one functional outcome measure. Multivariate logistic regression, controlled for semester, was used to analyze factors associated with achievement of MDC. RESULTS: MDC was achieved in approximately 70% of cases. Factors associated with MDC achievement were number of visits (OR 1.04, p<0.02) and the Charlson Comorbidity Index (OR 1.06, p<0.02). Factors not associated were age, sex, diagnosis, years post-diagnosis, number of medications, admission functional status, and distance to the clinic. CONCLUSIONS: Weekly 60-min PT sessions provided in a student-run neurologic clinic were associated with achieving the MDC on functional measures. Such clinics may be a safety net.

A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance.

CONTEXT: End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. OBJECTIVES: To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. METHODS: Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. RESULTS: From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: <30% were controlled, <15% randomized participants. Over half (n = 85) relied on staff self-reported outcomes to assess effectiveness, and 49% did not cite psychometrically validated measures. Key information (e.g., training duration, participant flow) was poorly reported. CONCLUSIONS: Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing.