Purpose: An action plan is an agreement between clinician and patient that the patient will make a specific behavior change. The goals of this study are to: determine whether it is feasible for patients to make action plans in the primary care visit; determine whether patients report carrying out their action plans; and describe the action plans patients choose.Methods: Forty-three clinicians in 8 primary care sites were recruited to hold action-plan discussions with patients. Research assistants contacted patients by telephone 3 weeks later to assess whether patients had conducted their action plans.Results: Eighty-three percent of enrolled patients (228) made an action plan during a primary care visit. Of the 79% who recalled making the action plan when interviewed by telephone 3 weeks later, 56% recalled the details of their action plan, and an additional 33% recalled the general nature of the action plan. At least 53% of patients making an action plan reported making a behavior change consistent with that action plan.Conclusions: Most patients reported making a behavior change based on an action plan, suggesting that action plans may be a useful strategy to encourage behavior change for patients seen in primary care. Assisting patients to improve health-related behaviors is an important responsibility of primary care clinicians.1 However, physicians in primary careseldom have time to engage in behavior-change counseling and may be unsure how to discuss behavior change with their patients. 2-4One strategy to encourage behavior change involves a collaborative process in which patients choose a goal and clinicians and patients negotiate a specific action plan to assist in the goal's attainment. For example, the goal may be to lose 10 pounds; an initial action plan may be to substitute water in place of sugar-containing sodas. Patients should have a high level of confidence that they can accomplish the action plan; success increases selfefficacy (a person's confidence that he/she can make positive life changes), and self-efficacy has been associated with healthier behaviors and improved clinical outcomes. 5Several studies suggest that collaborative goal setting and action planning may be more effective in promoting behavior change than traditional clinician-directed advice.6 -8 However, no study offers details on action plans as a specific behavior-change intervention in primary care.We performed a descriptive study of action plans in a diverse sample of primary care patients with coronary heart disease (CHD) risk factors. A companion article 9 discusses the acceptability and feasibility of primary care clinicians engaging their patients in action-plan discussions. In this article, we explore the following questions. 1) To what extent are patients able to make an action plan with their clinician during a routine primary care visit? 2) What types of action plans do patients and clinicians make? 3) What proportion of patients are able to describe, and report carrying out, their action plans after 3 weeks? 4) Are c...

Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies. This article is a resource for understanding the difference between critical appraisal tools and reporting guidelines, and identifying and accessing appropriate tools or guidelines.

Purpose: Collaborative goal-setting-with clinician and patient together deciding on concrete behaviorchange goals-may be more effective in encouraging healthy behaviors than traditional clinician-directed advice. This study explores whether it is feasible for clinicians to engage patients with coronary heart disease (CHD) risk factors in collaborative goal-setting and concrete action planning during the primary care visit.Methods: Primary care clinicians were trained in goal-setting and action planning techniques and asked to conduct action plan discussions with study patients during medical visits. Clinicians' experiences were documented through post-visit surveys and with questionnaires and semistructured interviews at the end of the study.Results: Forty-three clinicians and 274 patients with CHD risk factors participated in the study; 83% of the patient encounters resulted in a behavior-change action plan. Goal-setting discussions lasted an average of 6.9 minutes. Clinicians rated 75% of the discussions as equally or more satisfying than previous behavior-change discussions, and identified time constraints as the most important barrier to adopting the goal-setting process.Conclusions Coronary heart disease (CHD), the leading cause of mortality in the United States, is strongly associated with modifiable behaviors including physical inactivity, poor diet, and tobacco use.1 Seventyseven percent of the US adult population engages in a low level of physical activity, 58% are overweight, 23% use tobacco, 2 and 53% have more than one of these risk factors.3 However, physicians inconsistently provide health behavior-change advice to their patients. From 1992 to 2000, diet and physical activity counseling took place in fewer than 45% and 30%, respectively, of primary care visits by adults with CHD risk factors. 4 Physicians in primary care seldom have time to engage in such discussions and may be unsure how to discuss behavior change with their patients. 5-7The research presented here describes a method for engaging patients in behavior-change discussions within primary care: goal-setting with action planning. This process is based on the emerging collaborative model of patient care. 8 -10 In this paradigm, patients set a goal for a behavior they wish to change, and clinicians engage patients in a discussion of an action plan that can help the patient fulfill the goal. The action plan should be concrete and specific. With nonspecific action plans, eg, to exercise or lose weight, patients cannot evaluate their success and often experience failure. To enhance the likelihood that patients will succeed with their action plan, clinicians ask patients to estimate,

Objective: The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals. Introduction: Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related–care in their office or clinic. Inclusion criteria: Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. Methods: A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools. Results: Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. Conclusions: Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.

The Medical Library Association recently announced its commitment to diversity and inclusion. While this is a positive start, critical librarianship takes the crucial concepts of diversity and inclusion one step further by advocating for social justice action and the dismantling of oppressive institutional structures, including white supremacy, patriarchy, and capitalism. Critical librarianship takes many forms but, at its root, is focused on interrogating and disrupting inequitable systems, including changing racist cataloging rules, creating student-driven information literacy instruction, supporting inclusive and ethical publishing models, and rejecting the notion of libraries as neutral spaces. This article presents examples of the application of critical practice in libraries as well as ideas for applying critical librarianship to the health sciences. This article has been approved for the Medical Library Association’s Independent Reading Program.