Fostering Collaborative Teamwork-A Comprehensive Approach to Vascular Graft Infection Following Arterial Reconstructive Surgery.

Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through multidisciplinary collaboration and discuss decision making for challenging presentations. This review will concentrate on VGI that impacts both aneurysms and pseudoaneurysms excluding the ascending thoracic aorta.

Beyond the Heel: Unraveling Sever's Disease and Achilles Tendinitis Through Ultrasound Diagnosis.

Sever's disease, or calcaneal apophysitis, is a common cause of heel pain in physically active children. This case report presents the evaluation, diagnosis, and management of a 10-year-old female patient with persistent left heel pain. Clinical examination and diagnostic ultrasound confirmed the diagnosis of Sever's disease. Treatment involved a comprehensive approach, including medication, immobilization, therapy modalities, and exercises. The patient showed improvement after 10 weeks of therapy. This case emphasizes the significance of early recognition, accurate diagnosis, and multimodal management for successful outcomes in Sever's disease.

Mastering the craft: Creating an insightful and widely-cited literature review.

The art of constructing an insightful literature review manuscript has witnessed an exemplar in the work of Oz et al (2023), wherein concept progression harmoniously merges with figures and tables. Reflecting on retrospective data science, it is evident that well-cited articles can wield a transformative influence on the Journal Citation Reports Impact Factor score, as exemplified by Robert Weinberg's landmark on cancer (Hanahan and Weinberg, 2011). Here, we aim to spotlight a commendable contribution by Tuba Oz, Ajeet Kaushik, and Malgorzata Kujawska in this issue while pivoting towards identifying the hallmarks of a subpar literature review-elements that hinder rather than promote advancement. The hurdles and roadblocks encountered within subpar literature reviews are multifold. Anticipation of emerging trends, identification of challenges, and exploration of solutions remain conspicuously absent. Original Contributions fail to surface amidst the vast sea of pre-existing literature, with noticeable gaps amplified by the lack of illustrative figures and tables. The manuscript, at times, assumes a skeletal form, reflecting an attempt to accommodate an excess of references, leading to convoluted sentences laden with citations. In contrast, a potent solution lies in adopting a comprehensive approach. A nuanced and critical evaluation of sources can culminate in a robust discussion, surpassing the mere summarization of conclusions drawn by others. This approach, often dismissed, holds the potential to elevate clarity, coherence, and logical flow, ultimately inviting engaged readership and coveted citations. The critical necessity of integrating visionary insights is underscored and achieved through a rigorous analysis of pivotal concepts and innovative ideas. Examples can be harnessed to elucidate the application of these solutions. We advocate a paradigm shift, urging literature review writers to embrace the readers' perspective. A literature review's purpose extends beyond providing a comprehensive panorama; it should illuminate avenues for concept development within a specific field of interest. By achieving this balance, literature reviews stand to captivate a devoted readership, paving the way for manuscripts that are both widely read and frequently cited. The pathway forward requires a fusion of astute analysis and visionary insights, shaping the future of literature review composition.

Comprehensive approach to people with type 2 diabetes. Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition.

OBJECTIVE: To provide practical recommendations for the comprehensive approach of people with type 2 diabetes according to evidence-based medicine. PARTICIPANTS: Members of the Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition. METHODS: The recommendations were formulated according to the degrees of evidence of the Standards of Medical Care in Diabetes-2022. After reviewing the available evidence and formulating recommendations by the authors of each section, several rounds of comments were developed incorporating the contributions and voting on controversial points. Finally, the final document was sent to the rest of the members of the area for review and incorporation of contributions, to finally carry out the same process with the members of the Spanish Society of Endocrinology and Nutrition Board of Directors. CONCLUSIONS: The document establishes practical recommendations based on the latest available evidence for the management of people with type 2 diabetes.

Asian Upper Blepharoplasty: A Comprehensive Approach.

Asian upper blepharoplasty is one of the most popular cosmetic procedures for Asians, but less optimal result is still common. The authors' comprehensive approach to Asian upper blepharoplasty includes (1) to determine both the height and length of the upper skin crease; (2) to create more ideal anatomy of the upper eyelid; (3) to reconstruct the desirable anatomic structure of the upper eyelid skin crease; and (4) to add a medial epicanthoplasty if needed to enhance cosmetic results.

Integrated phylogenomic analyses unveil reticulate evolution in Parthenocissus (Vitaceae), highlighting speciation dynamics in the Himalayan-Hengduan Mountains.

Hybridization caused by frequent environmental changes can lead both to species diversification (speciation) and to speciation reversal (despeciation), but the latter has rarely been demonstrated. Parthenocissus, a genus with its trifoliolate lineage in the Himalayan-Hengduan Mountains (HHM) region showing perplexing phylogenetic relationships, provides an opportunity for investigating speciation dynamics based on integrated evidence. We investigated phylogenetic discordance and reticulate evolution in Parthenocissus based on rigorous analyses of plastome and transcriptome data. We focused on reticulations in the trifoliolate lineage in the HHM region using a population-level genome resequencing dataset, incorporating evidence from morphology, distribution, and elevation. Comprehensive analyses confirmed multiple introgressions within Parthenocissus in a robust temporal-spatial framework. Around the HHM region, at least three hybridization hot spots were identified, one of which showed evidence of ongoing speciation reversal. We present a solid case study using an integrative methodological approach to investigate reticulate evolutionary history and its underlying mechanisms in plants. It demonstrates an example of speciation reversal through frequent hybridizations in the HHM region, which provides new perspectives on speciation dynamics in mountainous areas with strong topographic and environmental heterogeneity.

A propósito de un caso: ìntervención psicoterapéutica en trastorno por déficit de tención e hiperactividad y dependencia de cannabis / About a case: psychotherapeutic intervention in tension deficit hyperactivity disorder and cannabis dependence

La intervención en pacientes con TDAH y Trastorno por consumo de cannabis ha adquirido una creciente relevancia en los últimos años debido a sus potenciales implicaciones sobre la clínica y la evolución de la enfermedad. El abordaje integral de ambos trastornos tiene como finalidad optimizar el proceso de recuperación ayudando al paciente a reconstruir sus vidas y evitar recaídas, y se orienta como un enfoque exitoso. A continuación exponemos la gestión de un caso de Trastorno por Déficit de Atención e Hiperactividad y Dependencia de Cannabis implementado en CSMiA Gràcia (AU)

Intervention in patients with ADHD and Cannabis Use Disorder has acquired increasing relevance in recent years due to its potential implications on the clinical and evolution of the disease. The comprehensive approach to both disorders aims to optimize the recovery process by helping the patient to rebuild their lives and avoid relapses, and is oriented as a successful approach. Below we present the management of a case of Attention Deficit Hyperactivity Disorder and Cannabis Dependence implemented at CSMiA Gràcia (AU)

COMPREHENSIVE APPROACH IN CORRECTIONAL WORK WITH OLDER PRESCHOOL CHILDREN WITH SPEECH DISORDERS.

OBJECTIVE: The aim: To investigate the effectiveness of comprehensive approach in correctional work with older preschool children with speech disorders. PATIENTS AND METHODS: Materials and methods: The research was conducted in 2018-2022. The research involved 250 children aged 5-7 years, who were divided into two groups. The experimental group consisted of 150 children with motor alalia (57 girls and 93 boys). The control group consisted of 100 children without speech disorders (48 girls and 52 boys). RESULTS: Results: The analysis of outpatient cards of children with speech disorders of various aetiology was carried out. The main results of a comprehensive medical as well as psychological and pedagogical examination of children with motor alalia are highlighted. The result of the research revealed that organic lesion of the brain affects not only the clinical presentation of nonverbal symptoms, but also psychospeech development, in particular. CONCLUSION: Conclusions: The expediency of using a comprehensive diagnostic methodology was proved, where the medical component consisted in studying the peculiarities of bioelectrical activity of the brain on electroencephalography, which reflects the process of its morphological maturation in ontogenesis.

Integrative prevention and coordinated action toward primary, secondary and tertiary prevention in workplaces: A scoping review.

BACKGROUND: Integrated approaches are valued in several occupational health strategic programmatic orientations. A better understanding of the use of integrative prevention in coordinating measures is needed to develop its use in workplaces. OBJECTIVE: Identify workplace integrative prevention approaches and definitions of prevention (primary, secondary and tertiary) in the literature. METHODS: A scoping review was conducted following Arksey and O'Malley (2005). The literature search was carried out in three databases without date restrictions. In order to be retained, the articles needed to address at least two levels of prevention using an integrative approach in a workplace setting. A qualitative analysis was conducted. RESULTS: The review yielded 16 published articles between 1995 and 2017. The articles addressed mental health, musculoskeletal disorder prevention and comprehensive approaches. Integrative prevention approaches are diverse and are not always named as such. Prevention definitions are not homogenous. CONCLUSIONS: This review identified some of the integrative prevention characteristics aimed at coordinated action for prevention in the workplace and to clarify measures taken at different levels of prevention. Further studies are needed to elaborate on the implementation of integrative prevention in the workplace.

Abordaje integral del niño con parálisis cerebral / Comprehensive approach to children with cerebral palsy

La parálisis cerebral infantil es una de las enfermedades más prevalentes y la causa de discapacidad más frecuente en pediatría. Los niños con parálisis cerebral tienen necesidades de atención médica complejas y a menudo requieren atención por un equipo multidisciplinar, sin embargo, en muchas ocasiones no existe la figura de un pediatra responsable que coordine todo el seguimiento.Realizamos un documento de ayuda en el abordaje de niños con parálisis cerebral dirigido a pediatras que sean coordinadores en la atención de estos pacientes. Nuestra finalidad es la de recopilar de forma ordenada los principales problemas que pueden desarrollar estos pacientes, saber cómo identificarlos y abordarlos en caso necesario, y establecer criterios para la derivación de estos pacientes a otros especialistas. (AU)

Infantile cerebral palsy is one of the most prevalent diseases and the most frequent cause of disability in paediatrics. Children with cerebral palsy have complex health care needs and often require the care of a multidisciplinary team. However, in many cases there is no paediatrician with overall responsibility for coordinating follow-up.We have produced a support document intended for paediatricians coordinating the care of children with cerebral palsy. Our aim is to provide an ordered compilation of the main issues these patients may develop, to know how to identify and address them if necessary, and to establish criteria for referring these patients to other specialists. (AU)

Comprehensive approach to children with cerebral palsy.

Infantile cerebral palsy is one of the most prevalent diseases and the most frequent cause of disability in paediatrics. Children with cerebral palsy have complex health care needs and often require the care of a multidisciplinary team. However, in many cases there is no paediatrician with overall responsibility for coordinating follow-up. We have produced a support document intended for paediatricians coordinating the care of children with cerebral palsy. Our aim is to provide an ordered compilation of the main issues these patients may develop, to know how to identify and address them if necessary, and to establish criteria for referring these patients to other specialists.

[Comprehensive approach to children with cerebral palsy]. / Abordaje integral del niño con parálisis cerebral.

Infantile cerebral palsy is one of the most prevalent diseases and the most frequent cause of disability in paediatrics. Children with cerebral palsy have complex health care needs and often require the care of a multidisciplinary team. However, in many cases there is no paediatrician with overall responsibility for coordinating follow-up. We have produced a support document intended for paediatricians coordinating the care of children with cerebral palsy. Our aim is to provide an ordered compilation of the main issues these patients may develop, to know how to identify and address them if necessary, and to establish criteria for referring these patients to other specialists.

Calidad de atención y mejora continua en el abordaje integral del cáncer de mama: Evaluación de indicadores en una Unidad de Mastología / Quality of care and continous improvement in a comprehensive approach of breast cancer management: evaluation of indicators in a breast center

Introducción: las Unidades de Mastología son organizaciones que tienen por objetivo abordar la patología mamaria de manera multidisciplinaria e integral. A nivel mundial se han implementado programas para evaluar la calidad de atención a través del cumplimiento de indicadores propuestos por Sociedades Científicas u organismos gubernamentales. Algunos de estos han sido propuestos y revisados por la Sociedad Europea de Mastología (EUSOMA). Objetivo: evaluar la calidad de atención de la Unidad de Mastología del Hospital Juan A. Fernández a través del análisis de una serie de indicadores propuestos por EUSOMA como estándares de calidad de atención en centros de patología mamaria. Material y método: estudio descriptivo retrospectivo analizando la base de datos de las pacientes con cáncer de mama estadios 0 a III operadas entre 2015 y 2019. Se analizaron 25 indicadores de procesos propuestos por EUSOMA en 2017. Se registraron las características de la población, y el porcentaje de pacientes en las cuales se cumple la condición de cada uno de los indicadores. Se registró si el indicador alcanza o supera el mínimo estándar, o si alcanza o supera el valor ideal. Resultados: se evaluaron 284 pacientes. Se observó el cumplimiento de la mayoría de los estándares propuestos (18 de 25), alcanzando o superando en el 25% de los indicadores evaluados el valor ideal. Se lograron alcanzar los estándares de calidad de atención relacionados con el diagnóstico clínico y preoperatorio, caracterización anatomopatológica completa en carcinoma invasor, evaluación multidisciplinaria, tratamiento quirúrgico primario en carcinoma invasor e in situ. Se alcanzaron los objetivos tendientes a evitar el sobretratamiento quirúrgico en carcinoma invasor y en cirugía conservadora en carcinoma in situ. En relación a los tratamientos adyuvantes, se alcanzaron los estándares relacionados con radioterapia post cirugía conservadora y post mastectomía, así como también el tratamiento con hormonoterapia y quimioterapia. El seguimiento de los pacientes se realizó en tiempo en tiempo y forma de acuerdo al indicador establecido. Existen 3 indicadores de calidad obligatorios en los que no se alcanzó el estándar mínimo: se observó la necesidad de mejorar la accesibilidad a los tratamientos antiHer2neu en neoadyuvancia, y de reducir los tiempos de espera al inicio del tratamiento. Conclusiones: se observó el cumplimiento de la mayoría de los estándares propuestos. Dado que existen indicadores obligatorios en los que no se alcanzó el estándar mínimo, los esfuerzos primarios deberán centrarse prioritaria e inicialmente en diseñar una planificación que permita alcanzar estos objetivos, así como también mantener en el tiempo los valores positivos ya alcanzados. Se pone de manifiesto la necesidad de implementar políticas a nivel sanitario nacional que permitan mejorar la accesibilidad a medicación oncológica. A su vez, destacamos la importancia de definir indicadores propios con valores ajustados a las características de nuestro país y mantener una evaluación periódica de la calidad de atención a través de los mismos.

Introduction: Breast Units are organizations that manage Breast Cancer in a comprehensive and multidisciplinary approach. Worlwide, programs have been developed in order to evaluate quality of care through the achievement of certain standards of care that have been proposed by scientific organizations, medical associations or government health departments. Some of these indicators have beeb proposed by the European Society of Breast Cancer Specialist (EUSOMA). Objective: to evaluate quality of care in the Breast Unit at Hospital Juan A Fernández (Buenos Aires, Argentina) through the analysis of a series of indicators described by EUSOMA as standard of care in breast centers. Material and method: we performed a descriptive, retrospective analysis of our database including patients with breast cancer stage 0 to III that wer treated between 2015 and 2019. We studied 25 quality of care process indicators proposed by EUSOMA in 2017. We registered population characteristics and the percentage of patients in which each indicator mínimum requirements were achieved. We also studied whether our results achieved or were beyond the ideal targets for each indicator. Results: a total of 284 patients were evaluated. The mínimum standard of care was achieved in most of the evaluated indicators (18 of 25) and in 25% of these, our results achieved or exce3ded the ideal requirements. The indicators in which the mínimum or ideal standard of care was accomplished were regarding clinical and preoperative diagnosis anatomopathological characterisation in invasive breast cancer, multidisciplinary approach, primary surgical management in invasive and in situ breast cancer, avoidanc of overtreatement in invasive breast cancer and breast conserving therapy in carcinoma in situ. Regarding adjuvant treatment, the standard of care was achieved in radiotherapy after breast conserving surgery and after mastectomy, endocrine therapy and chemotherapy. The follow up timing was according to the indicator. There were 3 mandatory indicators in which the mínimum standards were not achieved and were regarding accesibility to anti Her2neu agents in neoadjuvant setting, and timing form diagnosis to firts treatment. Conclusions: we observed that out Breast Unit achieved most of the quality of care indicators described by EUSOMA. However, there 3 mandatory indicators where the results were below the mínimum. This is why future efforts should be focused on designing and planning new measures that will allow these objectives to be accomplished, as well as maintaining what has already been achived. Our results also show the imperious need to implement national public health pólices that would grant a better accesiblility to oncologic medications. We also analysed the importance of defining our own local quality of care indicators in relation to our health policies and current situation, as well as the importance of a continuous evaluation of quality of care through these indicators.

A Comprehensive Approach Is Vital for Diagnosing COVID-19: A Case of False Negative.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading at a rapid pace throughout the world, and the World Health Organization (WHO) declared it as pandemic on March 11, 2020. We present a case of COVID-19 patient whose reverse transcription-polymerase chain reaction (RT-PCR) initially was false negative and later turned positive, which will stress the importance of a comprehensive approach while evaluating a patient with a differential of COVID-19. The clinicians should be aware of the sensitivity and specificities of these tests which can have grave implications on the patient and community if the diagnosis is missed just based on the laboratory tests due to the highly contagious nature of the disease.

A descriptive analysis of assessment measures on the effectiveness of a comprehensive stuttering intervention approach: A single case study.

BACKGROUND: For effective client outcomes, stuttering assessment and intervention approaches need to be aligned. This encompasses using assessment and intervention approaches that address the three multidimensional constructs of stuttering, namely core behaviours, secondary behaviours and negative feelings and attitudes. OBJECTIVE: The study aimed to explore whether multiple assessment measures could be used to describe the effectiveness of a comprehensive stuttering intervention approach, undergirded by the International Classification of Functioning, Disability and Health (ICF) framework. METHOD: A single-subject case design was employed with one male adult who stutters. Data was collected by administering the Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering-Adults (OASES-A) at three testing periods (pre-intervention, immediately post-intervention and 7 months post-intervention), and a semi-structured interview schedule immediately post-intervention. Descriptive statistics was used to analyse the SSI-4 and OASES-A, and thematic analysis was conducted to evaluate the participant's interview schedule responses. RESULTS: The participant's total scores, impact scores and severity ratings of both the SSI-4 and OASES decreased across the three testing periods. The main theme of effectiveness of the comprehensive stuttering intervention to reduce aspects of disability emerged from the participant's responses. CONCLUSION: Evaluation of the results from the assessment measures revealed that the comprehensive stuttering intervention approach was effective in reducing the participant's core behaviours, secondary behaviours and negative feelings and attitudes. Assessment and management of fluency disorders should promote a client-specific multidimensional approach that extends beyond the core behaviours and secondary behaviours, by addressing the underlying social and emotional facets of fluency disorders.

Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled?

Lung cancer remains the leading cause of cancer-related death worldwide. Affected patients frequently experience debilitating disease-related symptoms, including dyspnea, cough, fatigue, anxiety, depression, insomnia, and pain, despite the progresses achieved in term of treatment efficacy. Physical activity and exercise are nonpharmacological interventions that have been shown to improve fatigue, quality of life, cardiorespiratory fitness, pulmonary function, muscle mass and strength, and psychological status in patients with lung cancer. Moreover, physical fitness levels, especially cardiorespiratory endurance and muscular strength, are demonstrated to be independent predictors of survival. Nevertheless, patients with lung cancer frequently present insufficient levels of physical activity and exercise, and these may contribute to quality of life impairment, reduction in functional capacity with skeletal muscle atrophy or weakness, and worsening of symptoms, particularly dyspnea. The molecular bases underlying the potential impact of exercise on the fitness and treatment outcome of patients with lung cancer are still elusive. Counteracting specific cancer cells' acquired capabilities (hallmarks of cancer), together with preventing treatment-induced adverse events, represent main candidate mechanisms. To date, the potential impact of physical activity and exercise in lung cancer remains to be fully appreciated, and no specific exercise guidelines for patients with lung cancer are available. In this article, we perform an in-depth review of the evidence supporting physical activity and exercise in lung cancer and suggest that integrating this kind of intervention within the framework of a global, multidimensional approach, taking into account also nutritional and psychological aspects, might be the most effective strategy. IMPLICATIONS FOR PRACTICE: Although growing evidence supports the safety and efficacy of exercise in lung cancer, both after surgery and during and after medical treatments, most patients are insufficiently active or sedentary. Engaging in exercise programs is particularly arduous for patients with lung cancer, mainly because of a series of physical and psychosocial disease-related barriers (including the smoking stigma). A continuous collaboration among oncologists and cancer exercise specialists is urgently needed in order to develop tailored programs based on patients' needs, preferences, and physical and psychological status. In this regard, benefit of exercise appears to be potentially enhanced when administered as a multidimensional, comprehensive approach to patients' well-being.

Using Smart Sensors to Monitor Physical Activity and Technical-Tactical Actions in Junior Tennis Players.

The use of smart devices to obtain real-time data has notably increased in the context of training. These technological tools provide data which monitor the external load and technical-tactical actions related to psychological and physical health in junior tennis players. The purpose of this paper is to monitor technical-tactical actions and physical activity during a current tennis competition in the Green stage using a Zepp Tennis Smart Sensor 2. The participants were 20 junior tennis players (under 10 years of age), with an average age of 9.46 years. The total number of strokes (n= 21,477) during 75 matches was analyzed. The study variables were the following aspects: (a) number of strokes, (b) ball impact in the sweet spot; (c) racket speed; (d) ball spin; (e) calories burned; and (f) match time. The current system of competition, based on knockout, does not meet the World Health Organization's recommendations for daily physical activity time. Players mainly used flat forehands with a lack of variability in technical-tactical actions which did not meet the current learning opportunity criteria of comprehensive methodologies. The competition system in under-11 tennis should be adapted to the players' characteristics by improving the variability and quantity of practice.

What are we talking about when we talk about education and Chagas? A systematic review of the issue.

More than 110 years has passed since the first publications on Chagas disease, and it still urges the necessity of understanding it as a complex socioenvironmental issue in which components of diverse nature converge and interact beyond the biomedical and epidemiological aspects. The current scenarios of the issue, both rural and Latin American as urban and global, demand that the education on Chagas disease include all possible contexts: where there are insect vectors and where there are not; inside and outside Latin America; in rural, periurban, and urban areas; in formal and non-formal educational environments. We consider essential the requirement of both an integral approach that overcomes the biomedical aspect to include the multidimensionality of the issue and a dialogical educational perspective that allows individuals and communities to analyze, decide, and lead contextualized prevention and promotion actions regarding their health. In this study, we surveyed, described, and critically analyzed studies approaching the link education-Chagas disease in scientific publications from the last 15 years. We aimed at contributing methodological-theoretical elements to (re)think the development of educational research and experiences that truly help facing this issue. From the electronic search of scientific literature in 6 databases, we found 426 articles, out of which we selected 25. We incorporated 10 articles from other sources to this initial corpus and performed both qualitative and quantitative analyses over the total number [35] to characterize the studied works in general, focusing on the conceptions on the Chagas disease issue and the underlying health education approaches.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report.

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Constructing "Packages" of Evidence-Based Programs to Prevent Youth Violence: Processes and Illustrative Examples From the CDC's Youth Violence Prevention Centers.

This paper describes the strategic efforts of six National Centers of Excellence in Youth Violence Prevention (YVPC), funded by the U.S. Centers for Disease Control and Prevention, to work in partnership with local communities to create comprehensive evidence-based program packages to prevent youth violence. Key components of a comprehensive evidence-based approach are defined and examples are provided from a variety of community settings (rural and urban) across the nation that illustrate attempts to respond to the unique needs of the communities while maintaining a focus on evidence-based programming and practices. At each YVPC site, the process of selecting prevention and intervention programs addressed the following factors: (1) community capacity, (2) researcher and community roles in selecting programs, (3) use of data in decision-making related to program selection, and (4) reach, resources, and dosage. We describe systemic barriers to these efforts, lessons learned, and opportunities for policy and practice. Although adopting an evidence-based comprehensive approach requires significant upfront resources and investment, it offers great potential for preventing youth violence and promoting the successful development of children, families and communities.