What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review

Does community-based health insurance improve access to care in sub-Saharan Africa? A rapid review

In sub-Saharan African countries, out-of-pocket payments can be a major barrier to accessing appropriate healthcare services. Community-based health insurance (CBHI) has emerged as a context-appropriate risk-pooling mechanism to provide some financial protection to populations without access to formal health insurance. The aim of this rapid review was to examine the peer-reviewed literature on the impact of CBHI on the use of healthcare services as well as its capacity to improve equity in the use of healthcare between different socio-economic groups. A systematic search of three electronic databases (Pubmed, Cochrane Library and Littérature en Santé) was performed. Data were extracted on scheme and study characteristics, as well as the impact of the schemes on relevant outcomes. Sixteen publications met the inclusion criteria, studying schemes from seven different countries. They provide strong evidence that community-based health insurance can contribute to improving access to outpatient care and weak evidence that they improve access to inpatient care. There was low evidence on their capacity to improve equity in access to healthcare among insured members. In the absence of sufficient public spending for healthcare, such schemes may be able to provide some valuable benefits for communities with limited access to primary-level care in sub-Saharan Africa. The overall high risk of bias of the studies and the wide existing variety of insurance arrangements suggest caution in generalizing these results. These findings need to be validated and further developed by rigorous studies.

Development of prehospital care quality indicators for the Australian setting: a modified RAND/UCLA appropriateness method

BACKGROUND

Globally, the measurement of quality is an important process that supports the provision of high-quality and safe healthcare services. The requirement for valid quality measurement to gauge improvements and monitor performance is echoed in the Australian prehospital care setting. The aim of this study was to use an evidence-informed expert consensus process to identify valid quality indicators (QIs) for Australian prehospital care provided by ambulance services.

METHODS

A modified RAND/UCLA appropriateness method was conducted with a panel of Australian prehospital care experts from February to May 2019. The proposed QIs stemmed from a scoping review and were systematically prepared within a clinical and non-clinical classification system, and a structure/process/outcome and access/safety/effectiveness taxonomy. Rapid reviews were performed for each QI to produce evidence summaries for consideration by the panellists. QIs were deemed valid if the median score by the panel was 7-9 without disagreement.

RESULTS

Of 117 QIs, the expert panel rated 84 (72%) as valid. This included 26 organisational/system QIs across 7 subdomains and 58 clinical QIs within 10 subdomains.Most QIs were process indicators (n=62; 74%) while QIs describing structural elements and desired outcomes were less common (n=13; 15% and n=9; 11%, respectively). Non-exclusively, 18 (21%) QIs addressed access to healthcare, 21 (25%) described safety aspects and 64 (76%) specified elements contributing to effective services and care. QIs on general time intervals, such as response time, were not considered valid by the panel.

CONCLUSION

This study demonstrates that with consideration of best available evidence a substantial proportion of QIs scoped and synthesised from the international literature are valid for use in the Australian prehospital care context.

Humanitarian Food Security Interventions during the COVID-19 Pandemic in Low- and Middle-Income Countries: A Review of Actions among Non-State Actors

Widespread food insecurity has emerged as a global humanitarian crisis during the coronavirus disease 2019 (COVID-19) pandemic. In response, international non-governmental organizations (INGOs) and United Nations (UN) agencies have mobilized to address the food security needs among different populations. The objective of this review was to identify and describe food security interventions implemented by INGOs and UN agencies during the early stages of the pandemic. Using a rapid review methodology, we reviewed food security interventions implemented by five INGOs and three UN agencies between 31 December 2019 and 31 May 2020. Descriptive statistical and content analyses were used to explore the extent, range, and nature of these interventions. In total, 416 interventions were identified across 107 low- and middle-income countries. Non-state actors have developed new interventions to directly respond to the food security needs created by the pandemic. In addition, these humanitarian organizations have adapted (e.g., new public health protocols, use of technology) and reframed existing initiatives to position their efforts in the context of the pandemic. These findings provide a useful baseline to monitor how non-state actors, in addition to the food security interventions these organizations implement, continue to be influenced by the pandemic. In addition, these findings provide insights into the different ways in which INGOs and UN agencies mobilized resources during the early and uncertain stages of the pandemic.

The Psychological Impact of COVID-19 Pandemic on Women's Mental Health during Pregnancy: A Rapid Evidence Review

BACKGROUND

The perinatal period is a particularly vulnerable period in women's lives that implies significant physiological and psychological changes that can place women at higher risk for depression and anxiety symptoms. In addition, the ongoing pandemic of coronavirus disease 2019 (COVID-19) is likely to increase this vulnerability and the prevalence of mental health problems. This review aimed to investigate the existing literature on the psychological impact of the COVID-19 pandemic on women during pregnancy and the first year postpartum.

METHOD

The literature search was conducted using the following databases: Pubmed, Scopus, WOS-web of science, PsycInfo and Google Scholar. Out of the total of 116 initially selected papers, 17 have been included in the final work, according to the inclusion criteria.

RESULTS

The reviewed contributions report a moderate to severe impact of the COVID-19 outbreak on the mental health of pregnant women, mainly in the form of a significant increase in depression-up to 58% in Spain-and anxiety symptoms-up to 72% in Canada. In addition to the common psychological symptoms, COVID-19-specific worries emerged with respect to its potential effects on pregnancy and the well-being of the unborn child. Social support and being engaged in regular physical activities appear to be protective factors able to buffer against the effects of the pandemic on maternal mental health.

CONCLUSIONS

Despite the limitations of the study design, the evidence suggests that it is essential to provide appropriate psychological support to pregnant women during the emergency in order to protect their mental health and to minimize the risks of long-term effects on child development.

A rapid review exploring nurse-led memory clinics

AIMS

To systematically explore the structures, functions, outcomes, roles and nursing credentials of memory clinics where nurses autonomously lead diagnosis and postdiagnostic care.

DESIGN

A systematic rapid review was conducted.

DATA SOURCES

MEDLINE (Ovid), CINAHL Full-Text (EBSCO) and EMBASE were systematically searched in December 2019 with no timeframe limitations imposed.

REVIEW METHODS

The modified PRISMA checklist was used as a guide to facilitate the review. Articles identified were screened and assessed for inclusion criteria, and screening of reference lists of included studies was also completed.

RESULTS

Six articles, published between 2011-2019, including two case studies, two descriptive reports, one qualitative study and one programme evaluation were included in the review. Nurse-led memory clinics were situated in community centres, on university campuses, hospitals and in general practitioners' offices. The services offered included assessment, diagnosis and treatment/postdiagnostic care. Nurse credentials included advanced practice nurses and a community psychiatric nurse who was a non-medical prescriber. Overall, there was low quantity and quality of evidence to evaluate outcomes.

Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review

BACKGROUND

The COVID-19 pandemic has disrupted surgical practice worldwide. There is widespread concern for surgeon and provider safety, and the implications of hospital lockdown on patient care during epidemics.

METHODS

Medline, EMBASE, CENTRAL, and PubMed were systematically searched from database inception to July 1, 2020 and ongoing monthly surveillance will be conducted. We included studies that assessed postoperative patient outcomes or protection measures for surgical personnel during epidemics.

RESULTS

We included 61 studies relevant to the COVID-19 pandemic and past epidemics. Lockdown measures were noted globally including cancellation of elective surgeries and outpatient clinics. The pooled postoperative complication rate during epidemics was 21.0% among 2095 surgeries. 31 studies followed the health of surgical workers with the majority noting no adverse outcomes with proper safety measures.

CONCLUSIONS

This review highlights postoperative patient outcomes during worldwide epidemics including the COVID-19 pandemic and identifies specific safety measures to minimize infection of healthcare workers.

Interventions to increase personal protective behaviours to limit the spread of respiratory viruses: A rapid evidence review and meta-analysis

PURPOSE

Increasing personal protective behaviours is critical for stopping the spread of respiratory viruses, including SARS-CoV-2: We need evidence to inform how to achieve this. We aimed to synthesize evidence on interventions to increase six personal protective behaviours (e.g., hand hygiene, face mask use, maintaining physical distancing) to limit the spread of respiratory viruses.

METHODS

We used best practice for rapid evidence reviews. We searched Ovid MEDLINE and Scopus. Studies conducted in adults or children with active or passive comparators were included. We extracted data on study design, intervention content, mode of delivery, population, setting, mechanism(s) of action, acceptability, practicability, effectiveness, affordability, spill-over effects, and equity impact. Study quality was assessed with Cochrane's risk-of-bias tool. A narrative synthesis and random-effects meta-analyses were conducted.

RESULTS

We identified 39 studies conducted across 15 countries. Interventions targeted hand hygiene (n = 30) and/or face mask use (n = 12) and used two- or three-arm study designs with passive comparators. Interventions were typically delivered face-to-face and included a median of three behaviour change techniques. The quality of included studies was low. Interventions to increase hand hygiene (k = 6) had a medium, positive effect (d = .62, 95% CI = 0.43-0.80, p < .001, I²  = 81.2%). Interventions targeting face mask use (k = 4) had mixed results, with an imprecise pooled estimate (OR = 4.14, 95% CI = 1.24-13.79, p < .001, I²  = 89.67%). Between-study heterogeneity was high.

CONCLUSIONS

We found low-quality evidence for positive effects of interventions targeting hand hygiene, with unclear results for interventions targeting face mask use. There was a lack of evidence for most behaviours of interest within this review.

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

Background

Breast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection.

Methods

We conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank.

Findings

16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis.

Conclusions

Despite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.

Nothing so practical as theory: a rapid review of the use of behaviour change theory in family planning interventions involving men and boys

BACKGROUND

There is growing recognition of the need for interventions that effectively involve men and boys to promote family planning behaviours. Evidence suggests that the most effective behavioural interventions in this field are founded on theoretical principles of behaviour change and gender equality. However, there are few evidence syntheses on how theoretical approaches are applied in this context that might guide best practice in intervention development. This review addresses this gap by examining the application and reporting of theories of behaviour change used by family planning interventions involving men and boys.

METHODS

We adopted a systematic rapid review approach, scoping findings of a previously reported evidence and gap map of intervention reviews (covering 2007-2018) and supplementing this with searches of academic databases and grey literature for reviews and additional studies published between 2007 and 2020. Studies were eligible for inclusion if their title, abstract or keywords referred to a psychosocial or behavioural intervention targeting family planning behaviours, involved males in delivery, and detailed their use of an intervention theory of change.

RESULTS

From 941 non-duplicate records identified, 63 were eligible for inclusion. Most records referenced interventions taking place in low- and middle-income countries (65%). There was a range of intervention theories of change reported, typically targeting individual-level behaviours and sometimes comprising several behaviour change theories and strategies. The most commonly identified theories were Social Cognitive Theory, Social Learning Theory, the Theory of Planned Behaviour, and the Information-Motivation-Behaviour Skills (IMB) Model. A minority of records explicitly detailed gender-informed elements within their theory of change.

CONCLUSION

Our findings highlight the range of prevailing theories of change used for family planning interventions involving men and boys, and the considerable variability in their reporting. Programmers and policy makers would be best served by unified reporting and testing of intervention theories of change. There remains a need for consistent reporting of these to better understand how complex interventions that seek to involve men and boys in family planning may lead to behaviour change.

Alcohol, calories, and obesity: A rapid systematic review and meta-analysis of consumer knowledge, support, and behavioral effects of energy labeling on alcoholic drinks

Mandatory energy (calorie) labeling of alcoholic drinks is a public health measure that could be used to address both alcohol consumption and obesity. We systematically reviewed studies examining consumer knowledge of the energy content of alcoholic drinks, public support for energy labeling, and the effect of energy labeling of alcoholic drinks on consumption behavior. Eighteen studies were included. Among studies examining consumer knowledge of the energy content of alcoholic drinks (N = 8) and support for energy labeling (N = 9), there was moderate evidence that people are unaware of the energy content of alcoholic drinks (pooled estimate: 74% [95% CI: 64%-82%] of participants inaccurate) and support energy labeling (pooled estimate: 64% [95% CI: 53%-73%] of participants support policy). Six studies examined the effect of energy labeling on consumption behavior. In these studies, there was no evidence of a beneficial effect of labeling on alcohol drinking-related outcome measures. However, the majority of studies were of low methodological quality and used proxy outcome measures, and none of the studies were conducted in real-world settings, resulting in a very low level of evidence and high degree of uncertainty. Further research is required to determine whether energy labeling of alcoholic drinks is likely to be an effective public health policy.

Quality-of-Life Discrepancies Among Autistic Adolescents and Adults: A Rapid Review

IMPORTANCE

Quality of life (QoL) is a core outcome of occupational therapy, but it is decreased among autistic adolescents and adults. This is the first review of QoL from an occupational therapy standpoint.

OBJECTIVE

To identify self-reported QoL differences between autistic and nonautistic samples; investigate sex differences in QoL among autistic people; examine consistency in QoL among autistic people across age, intellectual disability (ID), and self- versus proxy-report method; and appraise occupational therapy-related interventions addressing QoL among autistic people.

DATA SOURCES

Articles published in peer-reviewed journals between 2010 and 2020, located through Academic Search Ultimate, PubMed, and OTseeker, along with the American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and Australian Occupational Therapy Journal. Study Selection and Data Collection: Article samples consisted of at least 20% autistic females and used self-reported QoL measures. Qualitative research was excluded, as well as studies with participants younger than age 13 yr. Twenty-seven articles qualified (3 Level 1B, 13 Level 3B, and 11 Level 4).

FINDINGS

Autistic adolescents and adults demonstrated decreased self-reported QoL compared with nonautistic peers across age and ID presence. One article compared sex differences in QoL among autistic people. Interventions improved QoL among autistic people.

CONCLUSIONS AND RELEVANCE

Autistic adolescents and adults demonstrate decreased QoL in comparison with nonautistic peers. Questions remain related to sex differences in QoL among autistic people, an area for future research. Multiple evidence-based approaches to improve QoL in the autistic population are relevant to occupational therapy practice. What This Article Adds: Self-reported QoL among autistic adolescents and adults is clearly lower than among their nonautistic counterparts. This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.

Effective Elements for Workplace Responses to Critical Incidents and Suicide: A Rapid Review

Despite high rates of critical incidents (CIs) in working class occupations, there is a significant gap in our understanding of responses to these events. In this study, we aimed to inform a response training module by synthesising the key elements of pre-, during- and post-incident responses to CIs and suicide in the workplace. A rapid review identified studies on responses to CIs or suicide deaths in the workplace published between January 2015 and June 2020. A systematic search of six databases (Medline, CINAHL, PsycINFO, Sociology Collection, Academic Search and Business Search Complete) and grey literature was performed. Studies were excluded if the focus was on non-colleagues. Two reviewers independently conducted record screening, a review of the full text and assessed study quality. The existing evidence was synthesised and interventions were categorised using Haddon's Matrix. Five studies were included, reporting on CIs across a range of workplace settings, including railways, factories, police and military, along with external critical response units. Overall, study quality was assessed as being poor. Most of the evidence focused on the pre-incident and post-incident stage. There is little evidence on responses to CIs in the workplace. Evidence-based education and training is necessary to establish organisational responses to assist with supporting workers exposed to workplace CIs.

Risk of Transmitting Coronavirus Disease 2019 During Nebulizer Treatment: A Systematic Review

Rationale: There is an urgent need to understand the risk of viral transmission during nebulizer treatment of patients with coronavirus disease 2019 (COVID-19). Objectives: To assess the risk of transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS, Middle East respiratory syndrome (MERS), and influenza with administration of drugs via nebulizer. Methods: We searched multiple electronic databases, including PubMed^®, China National Knowledge Infrastructure, Wanfang, preprint databases, and clinicaltrials.gov through December 1, 2020. Any study design in any language describing the risk of viral transmission with nebulizer treatment was eligible. Data were abstracted by one investigator and verified by a second. Results: We identified 22 articles: 1 systematic review, 7 cohort/case-control studies, 7 case series, and 7 simulation-based studies. Eight individual studies involved patients with SARS, five involved MERS, and one involved SARS-CoV-2. The seven cohort/case-control studies (four high risk of bias [ROB], three unclear ROB) found mixed results (median odds ratio 3.91, range 0.08-20.67) based on very weak data among a small number of health care workers (HCWs) with variable use of personal protective equipment (PPE). Case series had multiple potential contributors to transmission. Simulation studies found evidence for droplet dispersion after saline nebulization and measureable influenza viral particles up to 1.7 m from the source after 10 minutes of nebulization with a patient simulator. Study heterogeneity prevented meta-analysis. Conclusions: Case series raise concern of transmission risk, and simulation studies demonstrate droplet dispersion with virus recovery, but specific evidence that exposure to nebulizer treatment increases transmission of coronaviruses similar to COVID-19 is inconclusive. Tradeoffs balancing HCW safety and patient appropriateness can potentially minimize risk, including choice of delivery method for inhaled medications (e.g., nebulizer vs. metered dose inhaler) and PPE (e.g., N95 vs. surgical mask).

Discrete choice experiment to determine preferences of decision-makers in healthcare for different formats of rapid reviews

BACKGROUND

Time-saving formats of evidence syntheses have been developed to fulfill healthcare policymakers' demands for timely evidence-based information. A discrete choice experiment (DCE) with decision-makers and people involved in the preparation of evidence syntheses was undertaken to elicit preferences for methodological shortcuts in the conduct of abbreviated reviews.

METHODS

D-efficient scenarios, each containing 14 pairwise comparisons, were designed for the DCE: the development of an evidence synthesis in 20 working days (scenario 1) and 12 months (scenario 2), respectively. Six attributes (number of databases, number of reviewers during screening, publication period, number of reviewers during data extraction, full-text analysis, types of HTA domains) with 2 to 3 levels each were defined. These were presented to the target population in an online survey. The relative importance of the individual attributes was determined using logistic regression models.

RESULTS

Scenario 1 was completed by 36 participants and scenario 2 by 26 participants. The linearity assumption was confirmed by the full model. In both scenarios, the linear difference model showed a preference for higher levels for "number of reviewers during data extraction", followed by "number of reviewers during screening" and "full-text analysis". Subgroup analyses showed that preferences were influenced by participation in the preparation of evidence syntheses.

CONCLUSION

The surveyed persons expressed preferences for quality standards in the process of literature screening and data extraction.

Integrated Healthcare and the Dilemma of Public Health Emergencies

Traditional healthcare services have demonstrated structural shortcomings in the delivery of patient care and enforced numerous elements of integration in the delivery of healthcare services. Integrated healthcare aims at providing all healthcare that makes humans healthy. However, with mainly chronically ill people and seniors, typically suffering from numerous comorbidities and diseases, being recruited for care, there is a need for a change in the healthcare service structure beyond direct-patient care to be compatible in peacetime and during public health emergencies. This article’s objective is to discuss the opportunities and obstacles for increasing the effectiveness of healthcare through improved integration. A rapid evidence review approach was used by performing a systematic followed by a non-systematic literature review and content analysis. The results confirmed that integrated healthcare systems play an increasingly important role in healthcare system reforms undertaken in European Union countries. The essence of these changes is the transition from the episodic treatment of acute diseases to the provision of coordinated medical services, focused on chronic cases, prevention, and ensuring patient continuity. However, integrated healthcare, at a level not yet fully defined, will be necessary if we are to both define and attain the integrated practice of both global health and global public health emergencies. This paper attains the necessary global challenges to integrate healthcare effectively at every level of society. There is a need for more knowledge to effectively develop, support, and disseminate initiatives related to coordinated healthcare in the individual healthcare systems.

Emergent gambling advertising; a rapid review of marketing content, delivery and structural features

BACKGROUND

Gambling advertising is well-funded and has become increasingly sophisticated in recent years. As the presence and pervasiveness of gambling advertising increases, there is a corresponding need for empirical understanding of the characteristics and trends associated with emergent gambling advertisements and marketing. However, there is limited data on this rapidly evolving phenomenon.

METHODS

A rapid review was undertaken of the empirical research (2015-2020) that focused upon the content, delivery and structural features incorporated within emerging gambling advertising.

RESULTS

Twenty-five studies were included in the review. The majority of these studies were conducted in either the UK or Australia; two jurisdictions that have unique and particularly liberal gambling environments. The literature suggests that emergent gambling advertising content is targeted, positively framed and in some instances, may overrepresent riskier bets. The sporting and social media spheres are densely populated with such advertisements that involve both direct and indirect marketing strategies. In relation to the online environment, there is evidence to suggest the emergence of more interactive advertisements that prompt user engagement. In addition, financial incentivisation has diversified and is often subject to strict and esoteric conditions. Despite these emergent trends, little provision is devoted to adequately displaying harm reductive or responsible gambling content within gambling advertising.

CONCLUSIONS

Overall, there is a paucity of research and lack of methodological diversity concerning the characteristics of advertising within the literature. The barriers to investigating emerging gambling advertising are discussed alongside future research priorities. It is important for this research area to expand in order to appropriately inform ethical industry marketing and effective harm-reduction strategies. [Pre-registered online via Prospero: CRD42020184349].

A rapid review of gender, sex, and sexual orientation documentation in electronic health records

Objective

The lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM.

Materials and Methods

We searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively.

Results

Thirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research.

Conclusions

The literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.

[Types of evidence syntheses]

This manuscript outlines various types of review articles as forms of evidence synthesis with special regard to their strengths and limitations. Review articles not only present summarised data, but also offer an evaluation of the quality of the individual studies included in it. The validity and the reliability of outcomes of reviews is strongly dependent on the quality of the data included. For this reason, a comprehensive literature selection process is paramount. Fundamental knowledge of bias and literature assessment is also necessary when reading reviews. This article presents selected tools for evidence appraisal and evaluation of bias risk.

Review of Military Casualties in Modern Conflicts-The Re-emergence of Casualties From Armored Warfare

Introduction

The re-emergence of armored warfare in modern conflicts has resulted in a higher number of extremity injuries, burns, and brain injuries. Despite this dramatic increase, little is reported on the type of injuries caused and their management. This review summarizes the publicly available literature and reports on the rate and type of injuries related to armored warfare, their medical outcomes, and management limitations.

Materials and Methods

This rapid evidence review involves a systematic literature search, followed by a non-systematic literature review. The reason for choosing this approach was the inherent lack of quantitative outcome data in the literature to satisfy the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study also used content analysis to study all peer-reviewed articles, focusing on similarities and differences in the findings necessary to formulate tentative results. The electronic search included PubMed, Scopus, and Web of Science, using the following search string: “Armored; Injuries; Mechanized; Morbidity; Mortality; War; Warfare”, alone or in combination.

Results

Modern conflicts are associated with higher number of extremity injuries, burns, and brain injuries among military casualties. Several publications claim that the characteristics of armored warfare and anticipated injuries in this type of warfare might require the far forward deployment of medical support supported by a reliable casualty evacuation chain. Still the quality of the available casualty data is low.

Conclusions

Because of the limited availability of reliable data or military trauma registries, up-to-date military casualty estimation remains a recognized knowledge gap, which needs to be addressed by armed forces worldwide. The future management of modern war casualties requires professional and well-trained staff in all levels, indicating a need for educational initiatives to provide both nurses and medics a greater proportion of medical care and management capabilities and responsibilities than in past conflicts.

Health system foundations for Sláintecare implementation in 2020 and beyond - co-producing a Sláintecare Living Implementation Framework with Evaluation: Learning from the Irish health system's response to COVID-19. A mixed-methods study protocol

All over the world, health systems are responding to the major shock of the COVID-19 pandemic. The virus is causing urgent and fast-paced change in the delivery of health and social care as well as highlighting pre-existing deficiencies and inequalities in the health system and broader society. In Ireland, COVID-19 is occurring during the second full year of Sláintecare’s implementation – Ireland’s 10-year plan for health reform to deliver universal access to timely, integrated care.

This research will coproduce a Living Implementation Framework with Evaluation (LIFE) linking evidence, policy and practice that feeds into real-world Sláintecare implementation. In partnership with senior leadership in the Sláintecare Programme Implementation Office, the Department of Health and the HSE, the researchers will scope, document, measure and analyse the Sláintecare relevant COVID-19 responses using qualitative and quantitative methods.

The LIFE will initially take the form of a live spreadsheet which contains the COVID-19 responses most relevant to Sláintecare. For each response, 3-4 indicators will be collected which enables monitoring overtime. The spreadsheet will be accompanied by a series of rapid reviews, narrative descriptions of multiple case studies, research papers, stakeholder engagement and formative feedback. These collectively make up the ‘LIFE’, informing dialogue with the project partners, which is happening in real time (living), influencing health policy and system decision-making and implementation as the project progresses. The LIFE will inform health system reform in Ireland in the months and years after the emergence of COVID-19 as well as contributing to international health systems and policy research.

Planning the Future Oral Health Workforce: A Rapid Review of Supply, Demand and Need Models, Data Sources and Skill Mix Considerations

Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A limited search was carried out on PubMed and Web of Science for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 countries were included in the review. A majority were from high-income countries (n = 17). Dentists were the sole oral health workforce group modelled in 13 studies; only five studies included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non-availability of the necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.

Methodological Considerations for Auditory Training Interventions for Adults With Hearing Loss: A Rapid Review

Purpose The aim of this study was to evaluate literature on auditory training published since 2013. Method A rapid review or a streamlined approach to systematically identify and summarize relevant studies was performed. Selected health sciences databases were searched using a search strategy developed with the PICO (population, intervention, comparison, and outcome) framework. Studies eligible for inclusion had older adult participants with hearing loss and utilized technology-based auditory training in laboratory or home settings. Results The study quality of most studies was found to be low to moderate, with concentrations between low and moderate. Major issues were related to study design and reporting, such as the need for blinding and a control group, larger sample sizes, and a follow-up for long-term outcomes of auditory training interventions. Wide variability in training approaches, participant backgrounds (e.g., audiograms, hearing aid use), and outcome measures are also noted. Conclusions Evidence on the effectiveness of auditory training is mixed. Future research should include high-quality randomized controlled trials with representative populations; follow-up periods to study long-term effects; and exploration of behavioral, electrophysiological, and self-reported outcome measures. Recommendations for study designs and methodologies are also discussed.

Occupational exposure and post-traumatic stress disorder: A rapid review

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) can result from occupational exposures and poses a considerable burden to workers, their families, workplaces and to society in general.

OBJECTIVE

Our objective was to conduct a rapid review of the literature to answer the question: "Which occupations have exposures that may lead to a PTSD diagnosis?"

METHODS

A rapid review was conducted in six steps: review question development, literature search, study selection (inclusion/exclusion), study characterization, data extraction, and data synthesis.

RESULTS

The search identified 3428 unique references which were reviewed to find 16 relevant studies in 23 articles. The articles revealed associations between PTSD and rescue workers (police, firefighters, etc.), health care professionals, transit drivers, and bank employees which seem well supported by the literature. Some studies also suggest potential associations with PTSD and construction and extraction, electricians, manufacturing, installation, maintenance and repair, transportation and material moving, and clerical workers.

CONCLUSIONS

A rapid review of the peer-reviewed scientific literature of PTSD prevalence or treatment suggests many occupations have exposures that could be associated with PTSD. Occupational traumatic events were most often associated with PTSD diagnosis. More research is needed to better understand the association between occupation and PTSD.

Culturally Competent Gender, Sex, and Sexual Orientation Information Practices and Electronic Health Records: Rapid Review

BACKGROUND

Outdated gender, sex, and sexual orientation (GSSO) information practices in health care contribute to health inequities for sexual and gender minorities (SGMs). Governments, statistics agencies, and health care organizations are developing and implementing modernized practices that support health equity for SGMs. Extending our work, we conducted a rapid review of grey literature to explore information practices that support quality health care for SGMs.

OBJECTIVE

The aim of this rapid review of grey literature was to elucidate modern GSSO information practices from leading agencies for adaptation, adoption, and application by health care providers and organizations seeking to modernize outdated GSSO information practices that contribute to health inequities among SGMs.

METHODS

We searched MEDLINE and Google from 2015 to 2020 with terms related to gender, sex, sexual orientation, and electronic health/medical records for English-language grey literature resources including government and nongovernment organization publications, whitepapers, data standards, toolkits, health care organization and health quality practice and policy guides, conference proceedings, unpublished academic work, and statistical papers. Peer-reviewed journal articles were excluded, as were resources irrelevant to information practices. We also screened the reference sections of included articles for additional resources, and canvassed a working group of international topic experts for additional relevant resources. Duplicates were eliminated. ATLAS.ti was used to support analysis. Themes and codes were developed through an iterative process of writing and discussion with the research team.

RESULTS

Twenty-six grey literature resources met the inclusion criteria. The overarching themes that emerged from the literature were the interrelated behaviors, attitudes, and policies that constitute SGM cultural competence as follows: shared language with unambiguous definitions of GSSO concepts; welcoming and inclusive care environments and affirming practices to reduce barriers to access; health care policy that supports competent health care; and adoption of modernized GSSO information practices and electronic health record design requirements that address invisibility in health data.

CONCLUSIONS

Health equity for SGMs requires systemic change. Binary representation of sex and gender in electronic health records (EHRs) obfuscates natural and cultural diversity and, in the context of health care, places SGM patients at risk of clinical harm because it leads to clinical assumptions. Agencies and agents in health care need to be equipped with the knowledge and tools needed to cultivate modern attitudes, policies, and practices that enable health equity for SGMs. Adopting small but important changes in the language and terminology used in technical and social health care systems is essential for institutionalizing SGM competency. Modern GSSO information practices depend on and reinforce SGM competency in health care.

International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples

Background

Widespread uptake of COVID-19 vaccines will be essential to controlling the COVID-19 pandemic. Vaccines have been developed in unprecedented time and quantifying levels of hesitancy towards vaccination among the general population is of importance.

Methods

Systematic review and meta-analysis of studies using large nationally representative samples (n ≥ 1000) to examine the percentage of the population intending to vaccinate, unsure, or intending to refuse a COVID-19 vaccine when available. Generic inverse meta-analysis and meta-regression were used to pool estimates and examine time trends. PubMed, Scopus and pre-printer servers were searched from January-November 2020. Registered on PROSPERO (CRD42020223132).

Findings

Twenty-eight nationally representative samples (n = 58,656) from 13 countries indicate that as the pandemic has progressed, the percentage of people intending to vaccinate decreased and the percentage of people intending to refuse vaccination increased. Pooled data from surveys conducted during June-October suggest that 60% (95% CI: 49% to 69%) intend to vaccinate and 20% (95% CI: 13% to 29%) intend to refuse vaccination, although intentions vary substantially between samples and countries (I² > 90%). Being female, younger, of lower income or education level and belonging to an ethnic minority group were consistently associated with being less likely to intend to vaccinate. Findings were consistent across higher vs. lower quality studies.

Interpretation

Intentions to be vaccinated when a COVID-19 vaccine becomes available have been declining across countries and there is an urgent need to address social inequalities in vaccine hesitancy and promote widespread uptake of vaccines as they become available.

Funding

N/A.

Meeting support needs for informal caregivers of people with heart failure: a rapid review

Aims 

To explore whether a support-based intervention for informal caregivers of people with heart failure changes their psychosocial and emotional wellbeing. Background Successful self-management of heart failure includes addressing the psychosocial and emotional wellbeing needs of informal caregivers. However, there is limited evidence of how caregivers are supported in this way.

Methods and results 

A rapid review was conducted searching four electronic databases with restrictions to dates January 1996 – September 2019. Specific inclusion and exclusion criteria were applied, and the first author reviewed articles based on title, abstract and then full text, before articles were assessed for conclusions and outcomes. Six studies met the criteria for review. The key caregiver outcomes were burden, depression/anxiety, and quality of life. Significant reductions in caregiver burden were demonstrated in the three studies that measured this outcome. There were mixed results for the outcome measures of depression/anxiety, as well as quality of life, with some interventions demonstrating either significant reductions in depression or anxiety scores, or increases in quality of life scores.

Conclusion 

With only six studies included in this rapid review, it is not possible to make any definitive conclusions regarding the success, or otherwise, of interventions for caregivers of people with heart failure to improve their psychosocial and emotional wellbeing. Whilst some papers would tend to suggest that such interventions can reduce caregiver burden, there is a need to interrogate further interventions in this area to fill the current gap in the literature.

Review: Delivering mental health support within schools and colleges - a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents

BACKGROUND

Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings.

METHODS

Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted.

RESULTS

Two thousand five hundred and sixty-nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school-based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community-level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation.

CONCLUSIONS

Implementing indicated school-based mental health interventions is challenging. Those involved in planning school-based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges.

KEY PRACTITIONER MESSAGE

Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging. Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school-based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment. Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high-quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well-being. Health and education policy should be designed to promote a cross-sector focus on the emotional health of young people. There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak. Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, and Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity. Results: From the 4,621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organizational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training, and resources, were associated with less psychological distress. Conclusions: This review highlights the key factors to the identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to 3 years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

A rapid review of barriers to oral healthcare for people with protected characteristics

Introduction The Equality Act 2010 sets out nine protected characteristics and serves to protect every individual against discrimination. The Act places emphasis on the need to reduce inequalities. An understanding, therefore, of existing barriers to oral healthcare for people with protected characteristics is required to inform policy and the commissioning of services.Aim To conduct a rapid review of current UK literature on barriers to oral healthcare for people with protected characteristics.Methods Electronic searching using Medline via Ovid limited to publications in English from the UK. Publication types included primary and secondary evidence from peer-reviewed journals and reports.Results From a total of 462 citations, 52 articles were included in the final review. Common barriers experienced across the protected characteristic groups were identified in addition to specific barriers experienced by those with protected characteristics.Conclusion This rapid review identified barriers to oral healthcare for people with protected characteristics at individual and organisational levels. Gaps identified in the literature include a lack of information available for barriers experienced by people due to sexual orientation, marital/civil partnership status and gender reassignment. Additionally, there is a gap in the evidence available on policy barriers to oral healthcare for people with protected characteristics.

Mental health of clinical staff working in high-risk epidemic and pandemic health emergencies a rapid review of the evidence and living meta-analysis

PURPOSE

The SARS-CoV-2 / COVID-19 pandemic has raised concerns about the potential mental health impact on frontline clinical staff. However, given that poor mental health is common in acute medical staff, we aimed to estimate the additional burden of work involving high exposure to infected patients.

METHODS

We report a rapid review, meta-analysis, and living meta-analysis of studies using validated measures from outbreaks of COVID-19, Ebola, H1N1 influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS).

RESULTS

A random effects meta-analysis found that high-exposure work is not associated with an increased prevalence of above cut-off scoring (anxiety: RR = 1.30, 95% CI 0.87-1.93, Total N = 12,473; PTSD symptoms: RR = 1.16, 95% CI 0.75-1.78, Total N = 6604; depression: RR = 1.50, 95% CI 0.57-3.95, Total N = 12,224). For continuous scoring, high-exposure work was associated with only a small additional burden of acute mental health problems compared to low-exposure work (anxiety: SMD = 0.16, 95% CI 0.02-0.31, Total N = 6493; PTSD symptoms: SMD = 0.20, 95% CI 0.01-0.40, Total N = 5122; depression: SMD = 0.13, 95% CI -0.04-0.31, Total N = 4022). There was no evidence of publication bias.

CONCLUSION

Although epidemic and pandemic response work may add only a small additional burden, improving mental health through service management and provision of mental health services should be a priority given that baseline rates of poor mental health are already very high. As new studies emerge, they are being added to a living meta-analysis where all analysis code and data have been made freely available: https://osf.io/zs7ne/ .

A rapid review of pre-exposure prophylaxis for HIV in the Asia-Pacific region: recommendations for scale up and future directions

Decline in new HIV infections in the Asia-Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.

Free Fallin’? The decline in evidence-based decision-making by Canada’s protected areas managers

The conservation of biodiversity requires various forms of evidence to ensure effective outcomes. In this study, we provide an updated assessment of the state of evidence-based decision-making in Canada’s protected areas organizations by examining practitioner perceptions of: ( i) the value and use of various forms of evidence, ( ii) the availability of evidence to support decisions, and ( iii) the extent to which various institutional and behavioural barriers influence the use of evidence. Our results compare national surveys conducted in 2019 and 2013, revealing a significant and concerning decline in the use of all forms of evidence. We found significant declines in the use of peer-reviewed literature, local knowledge, and Indigenous knowledge. Our results correspondingly demonstrate a host of systemic barriers to the effective use of evidence, including a lack of trust, how to deal with uncertainty, and limited training. These challenges persist at a time when the quantity of information is greater than ever, and recognition of the value of Indigenous knowledge is relatively high (and increasing). Leadership is required to cultivate more relevant evidence, to embed scientists and Indigenous Knowledge-Holders in conservation organizations, to (re)establishing knowledge sharing forums, and to establish accountability and reporting measures to support efforts aimed at effectively achieving Canada’s biodiversity conservation goals.

Characteristics of effective online interventions: implications for adolescents with personality disorder during a global pandemic

In recent years, the necessity of providing online interventions for adolescents, as an alternative to face-to-face interventions, has become apparent due to several barriers some adolescents face in accessing treatment. This need has become more critical with the coronavirus disease 2019 (COVID-19) global pandemic impacting the delivery of psychotherapy and limiting accessibility of face-to-face therapy. Whilst it has been established that face-to-face psychotherapy for adolescents with personality disorder can be effective in reducing the impact these complex mental illnesses have on functioning, online interventions for adolescents are rare, and to our knowledge there are no empirically validated online interventions for personality disorder. The development of novel online interventions are therefore necessary. To inform the development of online interventions for adolescents with personality disorder or symptoms of emerging personality disorder, a two-phase rapid review was conducted. Phase one consisted of a search and examination of existing online mental health programs for adolescents with symptoms of personality disorder, to understand how to best use online platforms. Phase two consisted of a rapid review of empirical literature examining online interventions for adolescents experiencing symptoms of personality disorder to identify characteristics that promote efficacy. There were no online programs specific to personality disorder in adolescence. However, 32 online mental health programs and 41 published empirical studies were included for analysis. Common intervention characteristics included timeframes of one to two months, regular confidential therapist contact, simple interactive online components and modules, and the inclusion of homework or workbook activities to practice new skills. There is an urgent need for online interventions targeting personality dysfunction in adolescence. Several characteristics of effective online interventions for adolescents were identified. These characteristics can help inform the development and implementation of novel online treatments to prevent and reduce the burden and impact of personality disorder, or symptoms of emerging personality disorder, in adolescents. This has implications for the COVID-19 pandemic when access to effective online interventions has become more urgent.

The Role of Health Kiosks: A Scoping Review (Preprint)

Background

Health kiosks are publicly accessible computing devices that provide access to services, including health information provision, clinical measurement collection, patient self–check-in, telemonitoring, and teleconsultation. Although the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow.

Objective

We seek to clarify the current and future roles of health kiosks by investigating the settings, roles, and clinical domains in which kiosks are used; whether usability evaluations of health kiosks are being reported, and if so, what methods are being used; and what the barriers and facilitators are for the deployment of kiosks.

Methods

We conducted a scoping review using a bibliographic search of Google Scholar, PubMed, and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers described the implementation as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and querying the key informants. For each article, we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and whether the kiosk included usability testing. We then summarized the data in frequency tables.

Results

A total of 141 articles were included, of which 134 (95%) were primary studies, and 7 (5%) were reviews. Approximately 47% (63/134) of the primary studies described kiosks in secondary care settings. Other settings included community (32/134, 23.9%), primary care (24/134, 17.9%), and pharmacies (8/134, 6%). The most common roles of the health kiosks were providing health information (47/134, 35.1%), taking clinical measurements (28/134, 20.9%), screening (17/134, 12.7%), telehealth (11/134, 8.2%), and patient registration (8/134, 6.0%). The 5 most frequent health domains were multiple conditions (33/134, 24.6%), HIV (10/134, 7.5%), hypertension (10/134, 7.5%), pediatric injuries (7/134, 5.2%), health and well-being (6/134, 4.5%), and drug monitoring (6/134, 4.5%). Kiosks were integrated into the clinical pathway in 70.1% (94/134) of studies, opportunistic kiosks accounted for 23.9% (32/134) of studies, and in 6% (8/134) of studies, kiosks were used in both. Usability evaluations of kiosks were reported in 20.1% (27/134) of papers. Barriers (e.g., use of expensive proprietary software) and enablers (e.g., handling of on-demand consultations) of deploying health kiosks were identified.

Conclusions

Health kiosks still play a vital role in the health care system, including collecting clinical measurements and providing access to web-based health services and information to those with little or no digital literacy skills and others without personal internet access. We identified research gaps, such as training needs for teleconsultations and scant reporting on usability evaluation methods.

A rapid review of variation in the use of dental general anaesthetics in children

Introduction The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue.Aim Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children.Methods Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature.Results From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location.Conclusions This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide.

To stimulate or not to stimulate? A rapid systematic review of repetitive sensory stimulation for the upper-limb following stroke

BACKGROUND

Repetitive sensory stimulation (RSS) is a therapeutic approach which involves repeated electrical stimulation of the skin's surface to improve function. This rapid systematic review aimed to describe the current evidence for repetitive sensory stimulation (RSS) in rehabilitation of the upper-limb for people who have had a stroke.

MAIN TEXT

Methods: Relevant studies were identified in a systematic search of electronic databases and hand-searching in February 2020. The findings of included studies were synthesized to describe: the safety of RSS, in whom and when after stroke it has been used, the doses used and its effectiveness.

RESULTS

Eight studies were included. No serious adverse events were reported. The majority of studies used RSS in participants with mild or moderate impairments and in the chronic stage after stroke. Four studies used RSS in a single treatment session, reporting significant improvements in strength and hand function. Findings from longitudinal studies showed few significant differences between control and experimental groups. Meta-analysis was not possible due to the heterogeneity of included studies.

CONCLUSIONS

This review suggests that there is insufficient evidence to support the use of RSS for the upper-limb after stroke in clinical practice. However, this review highlights several clear research priorities including establishing the mechanism and in whom RSS may work, its safety and optimal treatment parameters to improve function of the upper-limb after stroke.

Rapid reviews: A critical perspective

BACKGROUND

The high scientific uncertainty of many far-reaching and serious political decisions during the "coronavirus crisis" underpins the enormous importance of having evidence syntheses that are quickly available and at the same time reliable. As these requirements can only be insufficiently fulfilled by systematic reviews due to the high amount of time required, abbreviated evidence syntheses in the form of rapid reviews are becoming increasingly popular.

PURPOSE

This commentary aims to enhance methodological and methodical discussions and research about abbreviated evidence syntheses.

METHODS

A selective literature search and evaluation focussing on research dealing with rapid reviews.

RESULTS

In rapid reviews, a wide variety of methods can be used to speed up the process of literature search and evaluation, while at the same time maintaining the principles of methodological quality and transparent reporting. But do rapid reviews currently keep what they promise? We discuss the increasing trend towards rapid reviews, giving the currently available evidence on the topic some critical reflection. Following this discussion, we will finally derive demands that go beyond the topic of rapid reviews alone.

Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review

Objectives

Infectious disease outbreaks can be distressing for everyone, especially those deemed to be particularly vulnerable such as pregnant women, who have been named a high-risk group in the current COVID-19 pandemic. This paper aimed to summarise existing literature on the psychological impact of infectious disease outbreaks on women who were pregnant at the time of the outbreak.

Study design

The design of this study is a rapid review.

Methods

Five databases were searched for relevant literature, and main findings were extracted.

Results

Thirteen articles were included in the review. The following themes were identified: negative emotional states; living with uncertainty; concerns about infection; concerns about and uptake of prophylaxis or treatment; disrupted routines; non-pharmaceutical protective behaviours; social support; financial and occupational concerns; disrupted expectations of birth, prenatal care and postnatal care and sources of information.

Conclusions

Pregnant women have unique needs during infectious disease outbreaks and could benefit from up-to-date, consistent information and guidance; appropriate support and advice from healthcare professionals, particularly with regards to the risks and benefits of prophylaxis and treatment; virtual support groups and designating locations or staff specifically for pregnant women.

•

Pregnant women may be particularly susceptible to distress during pandemics.

•

Infection fears and prophylaxis concerns may exacerbate distress.

•

Disrupted routines, financial concerns and uncertainty are also stressors.

•

Disrupted expectations of birth and related healthcare may be distressing.

•

Pregnant women may benefit from clear information/guidance and support groups.

A "Rapid Best-Fit" model for framework synthesis: Using research objectives to structure analysis within a rapid review of qualitative evidence

The short time frame associated with rapid reviews can be challenging for researchers conducting qualitative evidence synthesis. In these circumstances a Best-Fit Framework Synthesis, drawing upon existing theory and/or research, may be conducted to rapidly make sense of qualitative evidence. This article discusses a "Rapid Best-Fit" approach to conducting Framework Synthesis within an 6-week rapid systematic review of qualitative evidence. In the absence of a suitable theoretical model to inform the synthesis, we drew upon our research objectives to structure a framework, and to identify the studies which contained the most relevant data. Themes from these studies were used to revise the initial framework before inductive thematic synthesis finalized theme content. This "Rapid Best-Fit" approach yielded results aligned with the needs of the commissioners of the review and is a useful addition to qualitative synthesis methods, allowing for the incorporation of diverse views and experiences into fast-paced decision making scenarios.

Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings : A Living Rapid Review

BACKGROUND

Recommendations on masks for preventing coronavirus disease 2019 (COVID-19) vary.

PURPOSE

To examine the effectiveness of N95, surgical, and cloth masks in community and health care settings for preventing respiratory virus infections, and effects of reuse or extended use of N95 masks.

DATA SOURCES

Multiple electronic databases, including the World Health Organization COVID-19 database and medRxiv preprint server (2003 through 14 April 2020; surveillance through 2 June 2020), and reference lists.

STUDY SELECTION

Randomized trials of masks and risk for respiratory virus infection, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and observational studies of mask use and coronavirus infection risk were included. New evidence will be incorporated by using living review methods.

DATA EXTRACTION

One reviewer abstracted data and assessed methodological limitations; a second reviewer provided verification.

DATA SYNTHESIS

39 studies (18 randomized controlled trials and 21 observational studies; 33 867 participants) were included. No study evaluated reuse or extended use of N95 masks. Evidence on SARS-CoV-2 was limited to 2 observational studies with serious limitations. Community mask use was possibly associated with decreased risk for SARS-CoV-1 infection in observational studies. In high- or moderate-risk health care settings, observational studies found that risk for infection with SARS-CoV-1 and Middle East respiratory syndrome coronavirus probably decreased with mask use versus nonuse and possibly decreased with N95 versus surgical mask use. Randomized trials in community settings found possibly no difference between N95 versus surgical masks and probably no difference between surgical versus no mask in risk for influenza or influenza-like illness, but compliance was low. In health care settings, N95 and surgical masks were probably associated with similar risks for influenza-like illness and laboratory-confirmed viral infection; clinical respiratory illness had inconsistency. Bothersome symptoms were common.

LIMITATIONS

There were few SARS-CoV-2 studies, observational studies have methodological limitations, and the review was done by using streamlined methods.

CONCLUSION

Evidence on mask effectiveness for respiratory infection prevention is stronger in health care than community settings. N95 respirators might reduce SARS-CoV-1 risk versus surgical masks in health care settings, but applicability to SARS-CoV-2 is uncertain.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

Home Modification Assessments for Accessibility and Aesthetics: A Rapid Review

PURPOSE

The purpose of this study was to identify assessments used to evaluate the homes of people with disabilities in terms of accessibility, usability, activities, comfort/satisfaction, and aesthetics.

BACKGROUND

The home is increasingly becoming an environment for healthcare as more people desire to age in place. Research indicates home environmental modifications to be beneficial to promote a better person-environment fit, especially when using a standardized assessment approach. There is not a comprehensive list of assessments that address home modifications, adaptations, or interior designs for people with disabilities.

METHOD

Researchers conducted a rapid review of articles, with data collection scales, instruments, and procedures for home modifications published between 2000 and 2017.

RESULTS

A total of 26 articles met the inclusion criteria, resulting in the identification of 33 distinct assessments, including 18 assessments evaluating the accessibility of home modifications, 3 assessments examining usability, 15 assessments addressing activities of daily living or functional activities, and 5 assessments addressing comfort and/or satisfaction. No assessments for aesthetics were located.

CONCLUSION

Researchers developed a list of assessments that could be used for research or practice. Further research is needed to address the lack of assessments focusing on the aesthetics or attractiveness of home modifications, as well as more assessments tailored to specific diagnoses and population groups.

Advancing methodology for scoping reviews: recommendations arising from a scoping literature review (SLR) to inform transformation of Children and Adolescent Mental Health Services

BACKGROUND

There is consensus that health services commissioning and clinical practice should be driven by scientific evidence. However, workload pressures, accessibility of peer reviewed publications and skills to find, appraise, and synthesise relevant evidence are often cited as barriers to uptake of research evidence by practitioners and commissioners alike. In recent years a growing requirement for rapid evidence synthesis to inform commissioning decisions about healthcare service delivery and provision of care contributed to an increasing popularity of scoping literature reviews (SLRs). Yet, comprehensive guidelines for conducting and reporting SLRs are still relatively scarce.

METHODS

The exemplar review used as a worked example aimed to provide a readily available, comprehensive, and user-friendly repository of research evidence for local commissioners to help them make evidence-informed decisions about redesigning East of England Children and Adolescent Mental Health Services. In conducting the review, we were broadly guided by Arksey and O'Malley's framework, however some modifications were made at different stages to better reflect the largely pragmatic objective of this review. This paper compares the methodology used with existing methodological frameworks for scoping studies, to add to the existing knowledge base.

RESULTS

We proposed the following advancements to the existing SLR frameworks: (i) Assemble a research team with complementary skills and expertise; (ii); Draw on expertise of external partners, particularly practitioners, decision-makers and commissioners who will be translating findings into practice; (iii) Pre-register the review protocol. Keep a detailed record of all steps and decisions and consider how they would impact on generalisability and utility of review findings; (iv) Use systematic procedures for literature searchers, selection of studies, data extraction and analysis; (v) If feasible, appraise the quality of included evidence; (vi) Be transparent about limitations of findings.

CONCLUSIONS

Despite some methodological limitations, scoping literature reviews are a useful method of rapidly synthesising a large body of evidence to inform commissioning and transformation of CAMHS. SLRs allow researchers to start with a broader questions, to explore the issue from different perspectives and perhaps find more comprehensive solutions that are not only effective, but also accounted for their feasibility and acceptability to key stakeholders.

Improving the precision of search strategies for guideline surveillance

INTRODUCTION AND AIM

NICE guideline surveillance determines whether previously published guidelines need updating. The surveillance process must balance time constraints with methodological rigor. It includes a rapid review to identify new evidence to contradict, reinforce or clarify guideline recommendations. Despite this approach, the screening burden can still be high. Applying additional search techniques may increase the precision of the database searches.

METHODS

A retrospective analysis was conducted on five surveillance reviews with less than 2% of the studies included after screening. Modified searches were run in MEDLINE, Embase and PsycINFO (where appropriate) to test the impact of additional search techniques: focused subject headings, subheadings, frequency operators and title only searches. Modified searches were compared to original search results to determine: the retrieval of included studies, the precision of the search and the number needed to read. Studies not retrieved by the modified search were checked to determine if the surveillance decision would have been affected.

RESULTS

The additional search techniques tested indicated that a combination of focused subject headings and frequency operators could improve the precision of surveillance searches. The modified search retrieved all the original studies included in the surveillance review for three of the reviews tested. Some of the original included studies were not retrieved for two reviews but the missing studies would not have affected the surveillance decision.

CONCLUSIONS

Combining focused subject headings and frequency operators is a viable option for improving the precision of surveillance searches without compromising recall and without impacting the surveillance decision.

Assessing how information is packaged in rapid reviews for policy-makers and other stakeholders: a cross-sectional study

Background

Rapid reviews (RRs) are useful products to healthcare policy-makers and other stakeholders, who require timely evidence. Therefore, it is important to assess how well RRs convey useful information in a format that is easy to understand so that decision-makers can make best use of evidence to inform policy and practice.

Methods

We assessed a diverse sample of 103 RRs against the BRIDGE criteria, originally developed for communicating clearly to support healthcare policy-making. We modified the criteria to increase assessability and to align with RRs. We identified RRs from key database searches and through searching organisations known to produce RRs. We assessed each RR on 26 factors (e.g. organisation of information, lay language use). Results were descriptively analysed. Further, we explored differences between RRs published in journals and those published elsewhere.

Results

Certain criteria were well covered across the RRs (e.g. all aimed to synthesise research evidence and all provided references of included studies). Further, most RRs provided detail on the problem or issue (96%; n = 99) and described methods to conduct the RR (91%; n = 94), while several addressed political or health systems contexts (61%; n = 63). Many RRs targeted policy-makers and key stakeholders as the intended audience (66%; n = 68), yet only 32% (n = 33) involved their tacit knowledge, while fewer (27%; n = 28) directly involved them reviewing the content of the RR. Only six RRs involved patient partners in the process. Only 23% (n = 24) of RRs were prepared in a format considered to make information easy to absorb (i.e. graded entry) and 25% (n = 26) provided specific key messages. Readability assessment indicated that the text of key RR sections would be hard to understand for an average reader (i.e. would require post-secondary education) and would take 42 (± 36) minutes to read.

Conclusions

Overall, conformity of the RRs with the modified BRIDGE criteria was modest. By assessing RRs against these criteria, we now understand possible ways in which they could be improved to better meet the information needs of healthcare decision-makers and their potential for innovation as an information-packaging mechanism. The utility and validity of these items should be further explored.

Protocol availability

The protocol, published on the Open Science Framework, is available at: osf.io/68tj7

Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review

Objectives:

To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease.

Methods:

Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties.

Results:

84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported.

Discussion:

The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.

Risk factors for gambling and problem gambling: a protocol for a rapid umbrella review of systematic reviews and meta-analyses

BACKGROUND

Gambling and problem gambling are increasingly being viewed as a public health issue. European surveys have reported a high prevalence of gambling, and according to the Gambling Commission, in 2018, almost half of the general population aged 16 and over in England had participated in gambling in the 4 weeks prior to being surveyed. The potential harms associated with gambling and problem are broad, including harms to individuals, their friends and family, and society. There is a need to better understand the nature of this issue, including its risk factors. The purpose of this study is to identify and examine the risk factors associated with gambling and problem gambling.

METHODS

An umbrella review will be conducted, where systematic approaches will be used to identify, appraise and synthesise systematic reviews and meta-analyses of risk factors for gambling and problem gambling. The review will include systematic reviews and meta-analyses published between 2005 and 2019, in English language, focused on any population and any risk factor, and of quantitative or qualitative studies. Electronic searches will be conducted in Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, NICE Evidence and SocIndex via EBSCO, and a range of websites will be searched for grey literature. Reference lists will be scanned for additional papers and experts will be contacted. Screening, quality assessment and data extraction will be conducted in duplicate, and quality assessment will be conducted using AMSTAR-2. A narrative synthesis will be used to summarise the results.

DISCUSSION

The results of this review will provide a comprehensive and up-to-date understanding of the risk factors associated with gambling and problem gambling. It will be used by Public Health England as part of a broader evidence review of gambling-related harms.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019151520.

Assessing the format and content of journal published and non-journal published rapid review reports: A comparative study

BACKGROUND

As production of rapid reviews (RRs) increases in healthcare, knowing how to efficiently convey RR evidence to various end-users is important given they are often intended to directly inform decision-making. Little is known about how often RRs are produced in the published or unpublished domains, and what and how information is structured.

OBJECTIVES

To compare and contrast report format and content features of journal-published (JP) and non-journal published (NJP) RRs.

METHODS

JP RRs were identified from key databases, and NJP RRs were identified from a grey literature search of 148 RR producing organizations and were sampled proportionate to cluster size by organization and product type to match the JP RR group. We extracted and formally compared 'how' (i.e., visual arrangement) and 'what' information was presented.

RESULTS

We identified 103 RRs (52 JP and 51 NJP) from 2016. A higher percentage of certain features were observed in JP RRs compared to NJP RRs (e.g., reporting authors; use of a traditional journal article structure; section headers including abstract, methods, discussion, conclusions, acknowledgments, conflict of interests, and author contributions; and use of figures (e.g., Study Flow Diagram) in the main document). For NJP RRs, a higher percentage of features were observed (e.g., use non-traditional report structures; bannering of executive summary sections and appendices; use of typographic cues; and including outcome tables). NJP RRs were more than double in length versus JP RRs. Including key messages was uncommon in both groups.

CONCLUSIONS

This comparative study highlights differences between JP and NJP RRs. Both groups may benefit from better use of plain language, and more clear and concise design. Alternative innovative formats and end-user preferences for content and layout should be studied further with thought given to other considerations to ensure better packaging of RR results to facilitate uptake into policy and practice.

STUDY REGISTRATION

The full protocol is available at: https://osf.io/29xvk/.

Rapid Review of SARS-CoV-1 and SARS-CoV-2 Viability, Susceptibility to Treatment, and the Disinfection and Reuse of PPE, Particularly Filtering Facepiece Respirators

In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are often stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), particularly N95-type filtering facepiece respirators (FFRs), which are paramount to protect frontline medical/nursing staff, and to minimize further spread of the virus. We carried out a rapid review to summarize the existing literature on the viability of SARS-CoV-2, the efficacy of key potential disinfection procedures against the virus (specifically ultraviolet light and heat), and the impact of these procedures on FFR performance, material integrity, and/or fit. In light of the recent discovery of SARS-CoV-2 and limited associated research, our review also focused on the closely related SARS-CoV-1. We propose a possible whole-of-PPE disinfection solution for potential reuse that could be rapidly instituted in many health care settings, without significant investments in equipment.