Time to challenge the spurious hierarchy of systematic over narrative reviews?

Rural perinatal nursing in Canada: A hermeneutic literature review

Background

Nurses working in rural and remote settings are central to the delivery of perinatal services, often as the initial providers to assess and manage patients. Although policies and guidelines dictate nurses' responsibilities, little research focuses on rural perinatal nursing practice. Articulation of nurses' actual and significant involvement in rural perinatal care is needed as increasingly sustaining rural perinatal services is in jeopardy.

Objective

The study aimed to answer the question, "How are nurses understood to be involved in the delivery of rural perinatal care?"

Design

A hermeneutic literature review.

Setting

Rural and remote Canada.

Methods

A hermeneutic literature review was conducted through a two-phase, interpretive process of evaluation and deliberation for relevance and meaning carried out through dialogue and questioning with the selected texts and among members of the research team. This process provided deepened understanding of rural perinatal nursing practice and the contexts in which it takes place, highlighting not only what was evident in the texts, but also what was missing regarding nurses' involvement in the provision of perinatal care.

Results

Seven of 38 grey literature documents, and 25 research articles out of 800 were selected as relevant to the research question. Rural nurses' perinatal practice was found to be largely invisible in the literature. Only a few studies focused on nurses, demonstrating their autonomy and agency to benefit patients, other providers, and system functioning, despite many contextual and health system constraints. Rural nurses' experiences and insights were found rarely to be represented in perinatal policy and guidelines.

Conclusions

Rural nurses voices and practices are rarely represented in the research and grey literature relevant to rural perinatal services. Nurses' insights and experiences are essential to ensure that policies and practices in healthcare organizations foster the sustainability of rural perinatal care for rural/remote childbearing families and the retention of nurses in rural practice.

Tweetable abstract

Canadian rural perinatal nurses' practices are largely invisible in research and grey literature. Their voices and recognition of their contributions to care are needed to sustain rural maternity services.

Making Healthcare Decisions on Behalf of People in a Disorder of Consciousness. A "Risk-Making" Theory of Decisional Practices

Healthcare decisions evaluate treatment risks and benefits, using a shared decision-making process between patient and clinician. Healthcare workers (HCWs) offer treatments based on condition specific evidence and expert knowledge. The patient evaluates treatment choices from their individual perception of how helpful or harmful treatment might be. This is a "risk-taking" decision. Those in a disorder of consciousness (DOC) have unreliable or absent awareness. They cannot participate in the risk-taking decisional process outlined above. Instead, family members and HCWs evaluate the options and determine how much risk is acceptable. We propose this is a distinctly different decisional process called "risk-making," and that for those in a DOC it is influenced by multiple poorly understood factors. The different ways that decisions are made on their behalf may be negatively impacting their healthcare and creating a distributive justice need. A "risk-making" theory of DOC healthcare decision-making was developed via narrative literature review. It aims to explicate the realities of DOC decision-making practices, and surface rarely discussed assumptions and social factors possibly impacting DOC healthcare for discussion and future exploration.

Health-Promoting Effects of Black Tea: A Narrative Review of Clinical Trials

Black tea, a popular beverage, is rich in polyphenols. However, thorough analyses of clinical trial evidence supporting its health benefits are lacking. This narrative review is aimed at addressing this knowledge gap by synthesizing findings across pivotal clinical domains and identifying critical areas for further investigation. A comprehensive search of PubMed/MEDLINE, PubMed Central, Scopus, Web of Science, and Google Scholar was performed for English-language papers from January 1990 to July 2024, focusing on cardiovascular and metabolic health, as well as cognitive function. Findings from clinical trials indicated that consuming black tea regularly enhances endothelial and vascular health, notably by improving flow-mediated vasodilation. These advantages are largely due to the tea's antioxidant, anti-inflammatory, and gut microbiota-modulating effects, including the promotion of beneficial bacterial species such as Flavonifractor plautii. Effects on metabolic health, such as lipid profiles and glucose metabolism, were inconsistent. However, black tea was linked to improved cognitive function, especially attention and alertness, likely due to caffeine and L-theanine. Despite these promising results, further research is needed to overcome limitations like small sample sizes and short study durations. Future studies should be aimed at standardizing black tea preparations to optimize health benefits.

Policy analysis in sport: a review of mainstream meso-level frameworks and developing more sustainable policy for grassroots sport

This paper reviews some mainstream meso-level policy analysis frameworks widely applied in sport. There is, however, an absence of consensus for an established framework for analysing sport policy in general and, instead, techniques emanating from other fields of study have been relied upon. The resultant approach to sport policy analysis is inconsistent, multidimensional, and lacks unanimity, leading to calls for a sport-specific framework. This research outlines how meso-level frameworks have been applied in sport policy and issues linked to sustainability from a grassroots policy perspective. A narrative literature review provides an overview of prevalent approaches, namely Institutional Analysis, the Multiple Streams Framework, Policy Network Theory, and the Advocacy Coalition Framework. Aspects of applying these models to sport policy-including some key advantages and disadvantages-are outlined, especially the issue of conventional top-policy processes, the impact on policy implementers at grassroots level, and the potential for bottom-up policy influence. The article examines the four frameworks in the context of praxes in sport, noting the overall importance of a meso-level approach to sport policy analysis and that arriving at an holistic and inclusive accord has merit.

Systematic reviews of the literature: an introduction to current methods

Systematic reviews are a type of evidence synthesis in which authors develop explicit eligibility criteria, collect all the available studies that meet these criteria, and summarize results using reproducible methods that minimize biases and errors. Systematic reviews serve different purposes and use a different methodology than other types of evidence synthesis such as narrative reviews, scoping reviews, and overviews of reviews. Systematic reviews can address questions regarding effects of interventions or exposures, diagnostic properties of tests, and prevalence or prognosis of diseases. All rigorous systematic reviews have common processes that include (1) determining the question and eligibility criteria, including a priori specification of subgroup hypotheses, (2) searching for evidence and selecting studies, (3) abstracting data and assessing risk of bias of the included studies, (4) summarizing the data for each outcome of interest, whenever possible using meta-analyses, and (5) assessing the certainty of the evidence and drawing conclusions. There are several tools that can guide and facilitate the systematic review process, but methodological and content expertise are always necessary.

The usability of rollators as part of the human-centred quality of mobility devices: a systematic narrative literature review

Purpose: The aim of this literature review was to identify and summarize aspects of the usability of rollators from the currently available research literature. Further objectives were the exploration of rollator requirements and the search for possible disciplinary differences in the consideration or elaboration of usability aspects.

Materials and Methods: Following the PRISMA guidelines, the databases CINAHL, Pubmed and Academic Search Elite were examined in the period from April - May 2023. For the synthesis of the quantitative and qualitative data and the identification of prominent themes in this work, a theory driven thematic analysis approach was used.

Results: A total of 45 publications were included (25 quantitative, 14 mixed methods, 6 qualitative) from various disciplines, the majority belonging to physiotherapy 42%, followed by engineering 16% and health sciences 16%. Aspects of usability were extracted using a deductive code catalogue based on QUEST 2.0. The categories "easy to use" (28/126), "comfort" (20/126), and "safety" (14/126) were most frequently assigned. While "repairs & servicing" (5/126), "service delivery" (4/126), and "durability" (3/126) were coded least frequently.

Conclusion: So far, no specific publications on the usability of rollators has been published, which made it necessary to summarize individual usability aspects using a deductive code catalogue. The results obtained, therefore, do not allow any generalized statement about the usability of rollators. However, this initiates discussions about the usability of rollators that should be studied in the future in a participatory and user-centred manner and, placing satisfaction more in the focus of usability engineering and evaluation of rollators.

Perceptions of care homes as practice learning environments for pre-registration nursing students: A systematic-narrative hybrid literature review

BACKGROUND

The ageing population is increasing demand for skilled nurses in long-term care settings, such as care homes. However, attracting qualified nurses remains challenging. Pre-qualification experience could enhance skills, recruitment and retention, but requires greater understanding and support of care homes as learning environments.

AIM

To identify and synthesise research evidence related to care homes as learning environments, and to investigate factors influencing learning within such settings.

DESIGN

Systematic-narrative hybrid review.

DATA SOURCES

CINAHL, PubMed, Medline, Scopus, Web of Science, Nursing and Allied Health and Google Scholar were searched for research articles published between January 2014 and October 2023 which sought to explore the learning opportunities of nursing students in care homes. Studies published in English were considered.

REVIEW METHODS

Retrieved articles were assessed for suitability, quality and inclusion through title and abstract examination facilitated by the use of an appropriate critical appraisal tool (PICO). Articles were read, and re-read, evidence extracted, tabulated, and then synthesised using a thematic approach. Reporting is consistent with PRISMA guidelines for reporting systematic reviews.

RESULTS

4203 articles were screened, 31 studies matched the inclusion criteria. Three key themes were developed through thematic synthesis: (i) Positive but challenging experiences (ii) Barriers to learning include lack of registered nurses, time pressure and high workload, and lack of financial investment (iii) Facilitators of learning in care homes include positive supervisory relationship, effective orientation and reception, and partnership and collaboration between educational institutions and care home settings.

CONCLUSION

This review reveals the potential of care homes as settings that offer valuable learning opportunities for nursing students, as well as a sector that support the future needs of an ageing population. Advocating for policies that specifically address the support of nurse education and nurses in this environment is warranted.

Cancer Survivorship and the Significance of an Integrated Diachronic Life Course Perspective

Standardised health care is primarily focused on remediation and delivered episodically through costly and fragmented health-care systems. Such an approach is untenable, given the diversity and complexity of peoples' health-care needs, increasing prevalence of chronic disease and existing heath inequities. A life course perspective fundamentally challenges our current understanding of health care and has great potential to promote innovation in health-care practice, systems and policy. However, the way that health develops and manifests across the life course is a highly complex process underpinned by a plethora of causal antecedents, consequences and interdependencies that have yet to be adequately captured and articulated in current life course frameworks. The field of cancer survivorship and its recent rise to prominence provides a highly relevant and compelling case example to inform development and refinement of existing life course frameworks. Cancer survivorship exemplifies what can be described as an integrated diachronic life course perspective, which serves as a conceptual framework to enhance our understanding of health development across the life course and guide health-care practice, systems and policy to meet the increasingly complex health-care needs of current and future generations.

Understanding literature reviews: a guide for enhancing nursing practice globally

BACKGROUND

Literature reviews are essential in nursing for integrating research into practice, informing clinical guidelines and shaping health policy. They comprehensively synthesise the available evidence, supporting nurses in making informed decisions that improve patient care. It is therefore crucial when researchers are selecting the method most appropriate for investigating their clinical questions that they understand the different types of literature review.

AIM

To explore the characteristics, strengths and limitations of narrative, systematic and scoping reviews, as well as highlight their significance in nursing practice globally.

DISCUSSION

Narrative reviews provide broad, flexible overviews of topics; however, they lack methodological rigour, which can potentially result in bias. Systematic reviews provide high-quality, reliable evidence by using a structured approach to synthesising data from multiple studies; this makes them valuable for clinical decision-making and the development of guidelines. Scoping reviews map the scope of research onto emerging topics, identifying gaps and future research priorities, though they do not typically assess the quality of included studies.

CONCLUSION

Literature reviews are vital tools for nurses worldwide. Understanding the differences between types of literature review enables nurses to effectively use the one most appropriate to their needs. This is essential for evidence-based practice, informs clinical and policy decisions, and supports high-quality patient care, as well as contributing to nurses' professional development.

IMPLICATIONS FOR PRACTICE

Nurses who engage with literature reviews can stay informed about the latest research, improve patient outcomes and participate in the advancement of nursing knowledge globally.

Physiology mechanisms of exercise for PTSD: a narrative review

In at-risk societies, the population of post-traumatic stress disorder (PTSD) incidence is gradually expanding from veterans to the general public. In the face of the high incidence of PTSD, exercise therapy, as an economical and maneuverable treatment, has not received the attention it deserves. In this paper, the literature on PTSD symptom improvement through comb-climbing exercise interventions found that performing long-term exercise can achieve significant improvement in PTSD symptoms by modulating the central nervous system, autonomic nervous system, and immune system at the physiological level. Aerobic exercise (running, walking) is beneficial to the central nervous system and immune system; anaerobic exercise positively affects the autonomic nervous system, including resistance or strength endurance training; yoga, which focuses on flexibility and balance training, has a positive effect on the immune system. Future research should explore the neutral and negative effects and mechanisms of exercise on PTSD interventions. Expand more empirical studies in special occupational populations. And implement longitudinal intervention studies with PTSD patients to gain an in-depth understanding of PTSD intervention effects.

A systematic-narrative hybrid review of evidence: Exploring how corporate social responsibility initiatives impact population health

Corporate Social Responsibility (CSR) refers to initiatives undertaken by corporations that aim to make a positive impact on society. It is unclear to what extent these aims are achieved in relation to population health. We explored the evidence for mechanisms by which CSR has positive or negative effects on population health through a systematic-narrative hybrid review of 97 relevant articles. We found few examples overall that could trace a CSR initiative through to verifiable impacts on the population. Our review found that generally the evidence for the impacts of CSR on population health was patchy, highly heterogenous and of varying quality. We found some potential positive impacts of CSR on health; including on poverty alleviation, development, health care, the environment and the health and wellbeing of workers. Some CSR initiatives were rebranding of core functions, such as HR practices and employee wellbeing strategies, or were a partial redressing of the problems the corporation itself is creating, such as CSR initiatives that sought to improve workplace safety, reduce corporate environmental footprints or relocate people displaced by mining activities. We situate these impacts in relation to the role and intent of CSR, and argue that meaningful progress on CSR can only be made with greater transparency and reporting of initiatives to more fulsomely evaluate their impacts - as well as the political economy in which these sit. It is further critical to strengthen government regulation and oversight to maximise any public good that can come from CSR, and minimise the negative consequences reported in research literature.

Appetite and childhood malnutrition: A narrative review identifying evidence gaps between clinical practice and research

Severe Acute Malnutrition (SAM) is a critical global health issue, contributing to approximately one-half of all child mortality worldwide. SAM management guidelines recommend the use of appetite assessment determined by an "appetite test" to distinguish between complicated and uncomplicated SAM, subsequently guiding clinical decisions regarding outpatient versus inpatient care and discharge from hospital. Despite the widespread utilization of this recommendation, its validity lacks substantial evidence within the existing literature. Hence, the aims of this narrative review were to provide an overview of the SAM diagnostic and management guideline recommendations concerning the use of appetite assessment; to review the existing knowledge base supporting this clinical practice. The review identified gaps between the clinical use of appetite assessment in SAM management and the available supporting scientific evidence. Additionally, both the opportunities and challenges associated with appetite assessment methods used in clinical practice were highlighted and discussed in relation to existing literature. Further studies with more rigorous methods are needed to bridge these gaps and formulate evidence-based clinical practice. There is also a need to adapt and validate the existing appetite assessment tools to ensure they are tailored to the specific population, setting, and primary purpose of assessing appetite in children who have already developed SAM.

Will psychology ever 'join hands' with disability studies? Opportunities and challenges in working towards structurally competent and disability-affirmative psychotherapy for energy limiting conditions

Despite sustained efforts among critically informed scholars to integrate thinking from disability studies into psychology, the psy disciplines continue to largely neglect the lived experience of disabled people and overlook disability as a form of social inequity and valued culture. In this article, I make a renewed case for integrating thinking from disability studies into psy, in particular within the psychotherapy professions and in the case of 'energy limiting conditions', a grass-roots concept that includes clinically and socially marginalised chronic illness such as Long COVID. Drawing on my experience as a disabled practitioner, and situating this within extant literature on disability and psy, I take an autoethnographic approach to exploring opportunities and challenges in bridging the interdisciplinary divide. I argue that unacknowledged institutional ableism within psy reproduces and is reinforced by physical and attitudinal barriers for disabled practitioners and service users, engendering under-representation of disability in psychotherapy professions and lacunae in disability-affirmative conceptual resources. Additionally, I propose that hermeneutical lacunae are bolstered by documented defensive clinical practices pertaining to disability. After discussing a wealth of opportunities for integration offered by disability studies, and noting the institutional failure within psy to embrace disability-related demographic and epistemic diversity, I question whether ongoing epistemic and social exclusions within the psy disciplines constitute a case of 'willful epistemic ableism'. Drawing on theorising vis-à-vis epistemic injustice and epistemologies of ignorance, I signal a form of systematic, actively maintained and structurally incentivised (motivated) non-knowing that results in collective failure among dominant groups to recognise established hermeneutical resources of the disabled community and allies. I conclude with suggestions of how this form of epistemic injustice might be mitigated.

What helps or hinders the communication of poor prognosis between secondary and primary care? A systematic review with narrative synthesis

BACKGROUND

The communication of poor prognosis from secondary to primary care helps to ensure that patients with life-limiting illness receive appropriate coordinated care in line with their preferences. However, little is known about this information-sharing process.

AIM

To determine how poor prognosis is communicated from secondary care to primary care.

DESIGN AND SETTING

This was an international systematic review and narrative synthesis of studies published in English.

METHOD

Four electronic databases were searched from 1 January 2000 to 17 May 2021, supplemented by hand-searching of key journals. One-quarter of titles and abstracts were independently screened by a second reviewer. Two reviewers undertook data extraction and quality appraisal, independently using the Mixed Methods Appraisal Tool. Data were analysed using narrative synthesis. Reporting follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.

RESULTS

Searches identified 23 853 unique studies of which 30 met the inclusion criteria. Few studies had a focus on the interprofessional communication of poor prognosis. Information about prognosis was not commonly communicated from secondary to primary care and was more likely to occur if death was imminent. Lack of identification of poor prognosis by secondary care teams was a barrier. Facilitators included shared electronic records and direct clinician-clinician contact. GPs welcomed this information from secondary care and felt it was vital for continuity of care.

CONCLUSION

Although the communication of poor prognosis from secondary to primary care is highly valued it is rare and associated with cultural and systemic challenges. Further research is necessary to understand the information needs of GPs and to explore the challenges facing secondary care clinicians initiating this communication.

Improving the evaluation of clinical competence in undergraduate students, evidence and technology: An integrative review

BACKGROUND

Assessment of clinical practice is integral to determining nursing students' knowledge, critical thinking, and overall clinical competency to ensure patients are receiving quality care. There are no best practice approaches to evaluating competency in undergraduate nursing students despite the necessity to attest to how students are meeting regulatory standards upon graduation. The use of technology in healthcare and post-secondary institutions has increased, however, within nursing education, technology use for clinical evaluation remains largely underused.

PURPOSE

This integrative narrative review aimed to synthesize literature on evaluating undergraduate nursing students' clinical competence and the role of technology in enhancing the assessment process.

METHODS

An integrative review was conducted to inform quality improvement projects relative to the assessment of students' clinical performance in an undergraduate nursing program in Canada. Authors searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database for articles relating to competency, clinical performance evaluation, clinical evaluation tools, formative and summative evaluation, and technology in clinical evaluation. The main questions guiding this review were: How is competence assessed in relation to undergraduate students' clinical performance? And, how can technology enhance the assessment of students' clinical performance?

RESULTS

A total of 34 articles were included in this review. Current clinical evaluation processes use a combination of methods and tools to evaluate students' competence, however, there remains room for ongoing advancements. Adopting technology into the evaluation process can help students better understand competencies and learning outcomes, receive near real-time feedback from clinical instructors, and promote critical self-reflection. Technology has also reduced student and faculty workload with a more efficient and streamlined process. Further research is needed to understand how technology can best be incorporated into clinical evaluation processes.

CONCLUSION

Though under-researched, technology has been shown to be a valuable tool in the clinical evaluation process to promote student engagement in the assessment of clinical performance. In addition, considering factors such as the student and faculty relationship, preferences for feedback, and overall workload in the design of clinical evaluation processes is necessary.

Experiences of Complicated Grief - A Synthesis of Qualitative Studies

Objective: Synthesize research findings and provide insight into firsthand experiences of complicated grief. Methods: We systematically searched qualitative studies in English in four databases (PsycInfo, PubMed, CINAHL and Web of Science). We included 5 studies and applied meta-ethnography to identify and translate across studies. Results: This review illuminates the firsthand experiences of complicated grief. Three key themes were identified: 'ambivalence', 'misrecognition', and 'self-sacrifice'. These concepts reflect the synthesis of available qualitative research on the experience of complicated grief. The findings suggest that complicated grief is experienced as intrusive and unhelpful, providing a distressful state with lack of recognition from the perspective of the bereaved. Conclusions: The synthesis provides an empirically founded interpretation and contribution to the challenge of distinguishing between normal, complicated, and pathological grief reactions. As bereavement increasingly becomes a clinical concern, these findings highlight the necessity for further phenomenological research and the detailed profiling of disordered grief.

Everyday technology and assistive technology supporting everyday life activities in adults living with COPD - a narrative literature review

Introduction: People living with chronic obstructive pulmonary disease (COPD) encounter challenges in everyday life activities due to symptoms like breathlessness and fatigue. Compensatory strategies, such as using everyday technology (mechanical, electronic and digital equipment and functions encountered daily) and assistive technology (products, instruments, or equipment adapted or designed to improve functioning of people with disabilities), are crucial for supporting everyday life activities; thus, it is essential to explore therapeutic potentials of these technologies. The present review aims to synthesise research literature concerning the use of everyday technology and assistive technology to support everyday activities among persons living with COPD.

Methods: A narrative review was conducted with a systematic search in five bibliographic databases. Three sets of search terms were used: (i) everyday technology, assistive technology, and related terms, (ii) everyday life activities and related terms, and (iii) chronic obstructive pulmonary disease and related terms.

Results: Screening resulted in 26 included articles.Following the American Occupational Therapy Association framework, the identified articles show six categories of everyday life activities supported by everyday technologies and assistive technologies: health management, social participation, activities of daily living, instrumental activities of daily living, leisure, and rest and sleep.

Conclusion: Most articles focus on everyday technology for health management; however, everyday technology may hold unexpected potential to support a broader array of everyday life activities. Little is known about assistive technology to support everyday life activities for people with COPD, though it is described as crucial for independence and energy conservation.

A Meta-analysis of Cognitive Functioning in Intimate Partner Violence Perpetrators

Numerous psychologists have shown interest in applying neuropsychological tests to study intimate partner violence (IPV) perpetrators and gain a further understanding of the underlying nature of this type of violence. However, up until now, no meta-analysis has drawn on all the available scientific literature to calculate whether consistent differences exist between the neuropsychological performance of IPV perpetrators and other samples of men (non-violent men, IPV perpetrators with drug misuse, and other men with criminal history). The aim of this study was to carry out this calculation and also measure whether neuropsychological performance explained IPV perpetration. We conducted a meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. After initially identifying 7243 sources, we eventually included a total of 25 publications. The number of studies included for effect size calculation in each cognitive domain ranged from two to nine. Taking solely into account studies comparing IPV perpetrators with non-violent men, our findings indicate that both IPV perpetrators who misuse drugs and those who do not exhibit worse neuropsychological functioning compared to non-violent men. These differences range from moderate to large for working memory, switching attention, cognitive flexibility, planning abilities, and phonemic fluency. However, while low functioning in response IQ was only observed in IPV perpetrators without drug misuse, continuous attention performance only differed in IPV perpetrators with drug misuse. It should be noted that most conclusions were consistent. In addition, the comparison between IPV perpetrator subsamples and other types of criminal convictions only revealed differences in switching attention, with IPV perpetrators presenting worse abilities than the rest of the subsamples. Finally, we also found some support for significant associations between neuropsychological performance and both physical and psychological IPV perpetration. This meta-analysis is a significant contribution that will help inform future clinical strategies for the early detection of cognitive needs. It will also guide the implementation of new or complementary intervention programs.

How Does the Proportion of Child-Specific Content of Pre-Registration Nursing Programmes in Higher Education Institutions Impact Upon Newly Qualified Registered Nurses' Perceptions of Preparedness to Care for Children, Young People, and Their Families? A Narrative Review Protocol

This paper presents a narrative review protocol to explore how the proportion of child-specific content of pre-registration programmes in universities impact upon newly qualified nurses' perceptions of preparedness to care for children, young people (CYP), and their families. The preparation and education to become a nurse who cares for children and young people differs from country to country. Providers of pre-registration nurse education offer routes into nursing from diploma to degree and in some countries post-graduate routes. The United Kingdom offers pre-registration programmes leading to qualifying as a children's nurse whereas programmes in countries such as the USA and Canada lead to a professional registration as a registered nurse with postgraduate study to specialize in areas such as pediatrics. The role of pre-registration nursing programmes is to facilitate preparedness for practice. Preparation for practice can include theoretical teaching and practice learning through simulation and face-to-face experience with countries requiring different numbers of practice hours to be completed. Although practice hours are central to nursing education, there is limited evidence on the impact and portion of child-specific content, including clinical learning in preparation of newly qualified nurses to care for CYP and their families. A preliminary search of Prospero, CINAHL, Medline and Cochrane Database indicates that there are no current or in progress reviews identified. The Population of interest, Exposure of interest, and Outcome framework were used to define the research question and inform the eligibility criteria. The review will consider different research designs if related to the research question. The search strategy will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for systematic reviews. Two independent reviewers will be involved in the screening progress to determine the final studies for inclusion. Eligible studies will be assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Extraction of study characteristics and data related to the research question will be extracted into a predefined table. Data synthesis will be conducted using a descriptive analytical approach to summarize extracted data.

The Use of Arts-Based Methods to Enhance Patient Engagement in Health Research

INTRODUCTION

Patient and care partner engagement in research (PER) is important in generating knowledge to improve healthcare. Arts-based methods (ABM) use art in the research process to share aesthetic knowledge, which is knowledge that may be too complex to share only verbally. Together, PER and ABM are potentially synergistic, as both are participatory, problem-focused, dialogic, and collaborative; yet little is known of the utility of ABM for PER.

METHODS

A narrative review was performed to identify, collate, and summarize the ways ABM has been used with PER and share the impacts of ABM on PER. The databases CINAHL, Scopus, and PubMed were searched, and 15 articles were included.

RESULTS

A wide variety of ABM were used for PER, with some studies using multiple ABMs. The use of ABM for PER was reported to be decolonizing, shifted power from researchers to people with lived experience, and reduced tokenism. People with lived experience shared their knowledge directly through their art, deepening the understanding of their emotions, feelings, and relationships.

CONCLUSION

Researchers should consider the benefits of the participatory nature of ABM and explore how to engage people with lived experience in their work beyond data collection. Researchers engaging people with lived experience should consider using ABM as a way to operationalize PER to elicit aesthetic knowledge and strengthen power equalization.

PATIENT OR PUBLIC CONTRIBUTION

No patients or members of the public contributed to this review due to a lack of funding to support their meaningful involvement.

How auditory processing influences the autistic profile: A review

We need to combine sensory data from various sources to make sense of the world around us. This sensory data helps us understand our surroundings, influencing our experiences and interactions within our everyday environments. Recent interest in sensory-focused approaches to supporting autistic people has fixed on auditory processing-the sense of hearing and the act of listening-and its crucial role in language, communications, and social domains, as well as non-social autism-specific attributes, to understand better how sensory processing might differ in autistic people. In this narrative review, we synthesize published research into auditory processing in autistic people and the relationship between auditory processing and autistic attributes in a contextually novel way. The purpose is to understand the relationship between these domains more fully, drawing on evidence gleaned from experiential perspectives through to neurological investigations. We also examine the relationship between auditory processing and diagnosable auditory conditions, such as hyperacusis, misophonia, phonophobia, and intolerance to loud sounds, as well as its relation to sleep, anxiety, and sensory overload. Through reviewing experiential, behavioral and neurological literature, we demonstrate that auditory processes interact with and shape the broader autistic profile-something not previously considered. Through a better understanding of the potential impact of auditory experiences, our review aims to inform future research on investigating the relationship between auditory processing and autistic traits through quantitative measures or using qualitative experiential inquiry to examine this relationship more holistically.

Revitalizing faith: an inquiry into political Sufism and religious continuity in contemporary Kazakhstan

The article embarks upon a study of political Sufism in contemporary Kazakhstan and patterns of religious continuity through an examination of Islamic manifestations that stretch back centuries, juxtaposed with the current state religious policy. It examines the role of the Muftiate's "official Islam" in shaping the life of religious communities, exploring the intricate interplay between religious identity, secularism, and public perception in the post-Soviet landscape. The author employed a multi-faceted research approach, integrating historical analysis, policy examination, and an ethnographic study of contemporary religious dynamics in the country. The historical analysis provides a foundation of the religious landscape, while policy analysis examines the state's contemporary role in shaping religious practices. Ethnography, focusing on groups such as the Jahriyya, Naqshbandiyya, and the Suhba, involves respondents from diverse regions of Kazakhstan, offering firsthand insights into the experiences and perceptions of Sufi communities at the grassroots level, which enriches the study with a contextual perspective. Notably, fieldwork surveys, where the author engaged with respondents, provide valuable insights into the diverse experiences shaping the dynamics of political Sufism and religious continuity. They involved a diverse group of respondents, including religious leaders, community members, and secular intellectuals, from multiple regions of Kazakhstan at both urban and rural levels. The article is of scientific and practical significance as it enhances understanding of religious dynamics in the country, offering policymakers, scholars, and practitioners valuable perspectives for informed decision-making and policy development. The research's limitations include its focus on specific Sufi groups within Kazakhstan, which may not represent the full spectrum of Islamic practices across the region. The recommendations emphasize the need for further analysis of how prioritizing doctrinal adherence over individual freedoms contributes to the erosion of authentic religious institutions and the politicization of Islam. It also recommends to investigate the roles of Sufi groups in filling spiritual and social vacuums, their potential for politicization, and how this interplay affects religious freedom and national identity in Kazakhstan. This is particularly significant given the state's efforts to appropriate Islamic traditions for ideological purposes, which has led to a separation between Islamic doctrine and its lived expressions. Finally, it emphasizes the need for further comparative research on Sufi movements across Central Asia to better understand how different state policies impact religious communities.

A Narrative Review of Ethical Issues in the Use of Artificial Intelligence Enabled Diagnostics for Diabetic Retinopathy

INTRODUCTION

Diabetic retinopathy is one of the leading causes of avoidable blindness among adults globally, and screening programmes can enable early diagnosis and prevention of progression. Artificial intelligence (AI) diagnostic solutions have been developed to diagnose diabetic retinopathy. The aim of this review is to identify ethical concerns related to AI-enabled diabetic retinopathy diagnostics and enable future research to explore these issues further.

METHODS

This is a narrative review that uses thematic analysis methods to develop key findings. We searched two databases, PubMed and Scopus, for papers focused on the intersection of AI, diagnostics, ethics, and diabetic retinopathy and conducted a citation search. Primary research articles published in English between 1 January 2013 and 14 June 2024 were included. From the 1878 papers that were screened, nine papers met inclusion and exclusion criteria and were selected for analysis.

RESULTS

We found that existing literature highlights ensuring patient data has appropriate protection and ownership, that bias in algorithm training data is minimised, informed patient decision-making is encouraged, and negative consequences in the context of clinical practice are mitigated.

CONCLUSIONS

While the technical developments in AI-enabled diabetic retinopathy diagnostics receive the bulk of the research focus, we found that insufficient attention is paid to how this technology is accessed equitably in different settings and which safeguards are needed against exploitative practices. Such ethical issues merit additional exploration and practical problem-solving through primary research. AI-enabled diabetic retinopathy screening has the potential to enable screening at a scale that was previously not possible and could contribute to reducing preventable blindness. It will only achieve this if ethical issues are emphasised, understood, and addressed throughout the translation of this technology to clinical practice.

What is Indigenous cultural health and wellbeing? A narrative review

Indigenous cultural health is an emerging field of research and reflects the unique connections Indigenous peoples have with their Country, culture, and knowledge systems. This narrative review explores the concept of cultural health focusing on the interplay between culture, health, and wellbeing within settler colonial contexts. The review is mostly focused on Australian research, despite its international scope. A narrative review methodology was employed, search terms were compiled, and a title and abstract search was executed across two databases (Scopus, PubMed), confined to English language papers, with a focus on Australia. Three key themes were identified: Country; culture, and Indigenous knowledges. Country is vital to health. Culture practices offer frameworks for healing nurturing the relationship between people, Country and culture. Privileging Indigenous knowledges is a means to achieving health and wellbeing. Indigenous cultural health encompasses the interconnectedness of Country, people and culture, demanding a holistic approach that integrates Indigenous knowledges and practices. In Australia, these core components of cultural health must be situated in a contemporary context of ongoing colonisation. This narrative review underscores the importance of culturally centred approaches in addressing health inequities and enhancing the wellbeing of Indigenous peoples.

Funding

This study was funded by the Australian Government's Medical Research Future Fund (MRF2009522 & MRF2025330).

Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review

Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.

Narrative reanalysis: A methodological framework for a new brand of reviews

In response to the evolving needs of knowledge synthesis, this manuscript introduces the concept of narrative reanalysis, a method that refines data from initial reviews, such as systematic and reviews, to focus on specific sub-phenomena. Unlike traditional narrative reviews, which lack the methodological rigor of systematic reviews and are broader in scope, our methodological framework for narrative reanalysis applies a structured, systematic framework to the interpretation of existing data. This approach enables a focused investigation of nuanced topics within a broader dataset, enhancing understanding and generating new insights. We detail a five-stage methodological framework that guides the narrative reanalysis process: (1) retrieval of an initial review, (2) identification and justification of a sub-phenomenon, (3) expanded search, selection, and extraction of data, (4) reanalyzing the sub-phenomenon, and (5) writing the report. The proposed framework aims to standardize narrative reanalysis, advocating for its use in academic and research settings to foster more rigorous and insightful literature reviews. This approach bridges the methodological gap between narrative and systematic reviews, offering a valuable tool for researchers to explore detailed aspects of broader topics without the extensive resources required for systematic reviews.

Design, Implementation, and Analysis of an Assessment and Accreditation Model to Evaluate a Digital Competence Framework for Health Professionals: Mixed Methods Study

BACKGROUND

Although digital health is essential for improving health care, its adoption remains slow due to the lack of literacy in this area. Therefore, it is crucial for health professionals to acquire digital skills and for a digital competence assessment and accreditation model to be implemented to make advances in this field.

OBJECTIVE

This study had two objectives: (1) to create a specific map of digital competences for health professionals and (2) to define and test a digital competence assessment and accreditation model for health professionals.

METHODS

We took an iterative mixed methods approach, which included a review of the gray literature and consultation with local experts. We used the arithmetic mean and SD in descriptive statistics, P values in hypothesis testing and subgroup comparisons, the greatest lower bound in test diagnosis, and the discrimination index in study instrument analysis.

RESULTS

The assessment model designed in accordance with the competence content defined in the map of digital competences and based on scenarios had excellent internal consistency overall (greatest lower bound=0.91). Although most study participants (110/122, 90.2%) reported an intermediate self-perceived digital competence level, we found that the vast majority would not attain a level-2 Accreditation of Competence in Information and Communication Technologies.

CONCLUSIONS

Knowing the digital competence level of health professionals based on a defined competence framework should enable such professionals to be trained and updated to meet real needs in their specific professional contexts and, consequently, take full advantage of the potential of digital technologies. These results have informed the Health Plan for Catalonia 2021-2025, thus laying the foundations for creating and offering specific training to assess and certify the digital competence of such professionals.

Salutogenic Environmental Health Model-proposing an integrative and interdisciplinary lens on the genesis of health

Introduction

The maintenance of health is a central objective of public health initiatives. Within the salutogenic paradigm, health promotion is focused on understanding the mechanisms of health development. Models serve as indispensable tools. One of the leading paradigms in the health sciences is the Salutogenic Model developed by Aaron Antonovsky. However, it lacks sufficient specification to reflect the complexity of the environmental dimensions that have emerged from research in environmental health science. The interactions and impact pathways between these dimensions on health status are not adequately distinguished. The objective of this study is to address this gap by extending Antonovsky's model to encompass environmental dimensions, that is, the interactions between humans and their environment. Furthermore, the study will integrate examples of models and theories from various disciplines to illustrate how a more comprehensive and holistic explanation of health development can be provided from an interdisciplinary environmental public health perspective.

Methodology

As part of a three-step approach, a Basic Model was first developed that integrates the five environmental dimensions-Natural, Built-Material, Socio-Cultural, Psycho-Social, and Individual-into the Salutogenic Model. Subsequently, narrative non-exhaustive literature research was used to identify interdisciplinary example models. The models were used to identify gaps in the Basic Model through a critical lens and to synthesize them into a more holistic model.

Results

The synthesis of fifteen interdisciplinary models resulted in the development of an integrative Salutogenic Environmental Health Model (SEHM), which comprises twelve principal components of health development and their interactions and pathways. Links to the original models permit the user to refer back to them.

Discussion

This integrative approach offers a comprehensive understanding of the development of health by synthesizing disparate explanatory models and theories from various disciplines through theoretical analysis. The various environmental dimensions and the determinants of health contained therein, as well as their mental and physical processing and the associated components of health development and their interactions, are summarized in this new model. The SEHM thus enables a differentiated analysis of health determinants and serves as an operational framework for health promotion and pathways to well-being in contemporary research contexts.

Lost in translation: a narrative review and synthesis of the published international literature on mental health research and translation priorities (2011-2023)

BACKGROUND

Priority setting in mental health research is arguably lost in translation. Decades of effort has led to persistent repetition in what the research priorities of people with lived-experience of mental ill-health are.

AIM

This was a narrative review and synthesis of published literature reporting mental health research priorities (2011-2023).

METHODS

A narrative framework was established with the questions: (1) who has been involved in priority setting? With whom have priorities been set? Which priorities have been established and for whom? What progress has been made? And, whose priorities are being progressed?

RESULTS

Seven papers were identified. Two were Australian, one Welsh, one English, one was from Chile and another Brazilian and one reported on a European exercise across 28 countries (ROAMER). Hundreds of priorities were listed in all exercises. Prioritisation mostly occured from survey rankings and/or workshops (using dots, or post-it note voting). Most were dominated by clinicians, academics and government rather than people with lived-experience of mental ill-health and carer, family and kinship group members.

CONCLUSION

One lived-experience research led survey was identified. Few studies reported lived-experience design and development involvement. Five of the seven papers reported responses, but no further progress on priorities being met was reported.

Considerations when asking about "disability" in disability inclusive research

PURPOSE

There are several ways to include "disability" in research studies, which can be confusing or overwhelming for researchers, community members, and students. The aim of this paper is to share conceptualizations of disability and how to ask about "disability" in research studies. The paper provides a general introduction and brief analysis of the methodological approaches which can be used.

METHODS

We used reviews of the literature and extensive discussions to identify key articles, books, websites, and reports that provide guidance and examples of asking about disability in research.

RESULTS

Four primary approaches to asking study participants about disability were identified. For each of these, we provide background information, key points about the ways to use the approach including tools that have been developed, and example studies. A comparison table provides a high-level overview of similarities and differences in approaches. Other approaches and tools were also identified and are briefly described.

CONCLUSION

Researchers involved in disability and rehabilitation research should be aware that there is not one best or singular way to ask about disability when conducting research. The approach or approaches chosen for a particular study need to match the purpose of the study. It is important that researchers take time to carefully consider their options and choose the best fit for their study.

Metformin: Beyond Type 2 Diabetes Mellitus

Metformin was developed from an offshoot of Guanidine. It is known to be the first-line medication for type 2 diabetes mellitus, polycystic ovarian syndrome, and weight reduction. Metformin has also been shown to have effectiveness in the management of non-alcoholic fatty liver disease (NAFLD), liver cirrhosis, and various carcinomas like hepatocellular, colorectal, prostate, breast, urinary bladder, blood, melanoma, bone, skin, lung and so on. This narrative review focuses on the effect of metformin on non-alcoholic fatty liver disease, liver cirrhosis, and hepatocellular carcinoma. The search platforms for the topic were PubMed, Scopus, and Google search engine. Critical words for searching included 'Metformin,' AND 'Indications of Metformin,' AND 'Non-Alcoholic Fatty Liver Disease,' AND 'Metformin mechanism of action,' AND 'NAFLD management,' AND 'NAFLD and inflammation,' AND 'Metformin and insulin,' AND 'Metformin and inflammation,' AND 'Liver cirrhosis,' AND 'Hepatocellular carcinoma.' Lifestyle modification and the use of hypoglycemic agents can help improve liver conditions. Metformin has several mechanisms that enhance liver health, including reducing reactive oxygen species, nuclear factor kappa beta (NF-κB), liver enzymes, improving insulin sensitivity, and improving hepatic cell lipophagy. Long-term use of metformin may cause some adverse effects like lactic acidosis and gastrointestinal disturbance. Metformin long-term overdose may lead to a rise in hydrogen sulfide in liver cells, which calls for pharmacovigilance. Drug regulating authorities should provide approval for further research, and national and international guidelines need to be developed for liver diseases, perhaps with the inclusion of metformin as part of the management regime.

Balancing the load: A narrative review with methodological implications of compensatory training strategies for non-starting soccer players

New training approaches have emerged advocating for the implementation of compensatory physical training. This approach aims to provide additional training that balances the load typically experienced by non-starters during a match. This may help maintain their readiness and ensures that their physical fitness is not compromised by the reduced exposure to match loads. Thus, this narrative review aims to describe the differences in external loads between starting and non-starting players and describe the studies conducted in compensatory training. Studies examining external load metrics such as total distances covered, high-speed running, and sprinting suggest that, adjusted for playing time, values are often higher in non-starting players. Although not standardized, there is an obvious decrease in exposure for these critical variables in non-starters. Additionally, internal load parameters such as perceived exertion and heart rate tend to be higher in starting players. Regarding the physical fitness impacts, evidence suggests differences observed between starters and non-starters in some aspects of physical performance, although the extent and significance of these differences can vary. The studies on compensatory training are limited, and the typical approach usually centres on running-based exercises and small-sided games, offering differing approaches to address the physical needs. The gap in research underscores the necessity for improved study designs that can shed light on the real impact of compensatory training. Presently, the practice of compensatory training has been adopted, yet a definitive understanding of its genuine influence, particularly in terms of enhancing physical fitness and mitigating injury risks, remains elusive.

Overview of Ethiopian Public Higher Education: Trends, System, Challenges, and Quality Issues

Education is a pillar of the socio-economic development of a nation. Higher education (HE) is an engine for national development through producing the required skilled manpower, technology, innovations, research, and training services. The purpose of this study is to highlight the functioning, challenges, and emerging initiatives in public universities in Ethiopia. It employs a narrative review method for the synthesis of the findings. A total of 2004 published articles were searched using Boolean syntax from Scopus, ProQuest, ScienceDirect, and Web of Sciences databases, and 40 articles were maintained for analysis. Thus, the Ministry of Education (MoE) oversees the overall system of higher education. Public universities have shown relatively rapid expansion in the last three decades compared to the 1950s, followed by an increase in gross enrollment rate (GER). However, concerns were raised about the sustainability of these changes due to low investment in the educational sector. Various reforms have been introduced into the higher education system like differentiation, curriculum changes, national comprehensive exit exams for undergraduates, and admission tests for postgraduate programs. The higher education system is struggling with persistent challenges such as quality concerns, inadequate educational inputs, rigid structure, poor working environments, unemployment, and professional skill gaps. Due emphasis should be given to strengthening leadership, supplying adequate educational resources, sustainable financing, staff development, improving service delivery, and quality education.

Non-invasive approaches to hydration assessment: a literature review

Traditional hydration assessment methods, while accurate, are often invasive and impractical for routine monitoring. In response, innovative non-invasive techniques such as bioelectrical impedance analysis (BIA), electrodermal activity (EDA), electrocardiogram (ECG) monitoring, and urine color charts have emerged, offering greater comfort and accessibility for patients. These methods use various types of sensors to capture a range of bio-signals, followed by machine learning-based classification or regression methods, providing real-time feedback on hydration status, which is crucial for effective management and prevention of urinary stones. This review explores the principles, applications, and efficacy of these non-invasive techniques, highlighting their potential to transform hydration monitoring in clinical and everyday settings. By facilitating improved patient compliance and enabling proactive hydration management, these approaches align with contemporary trends in personalized healthcare. This article presents a literature review on non-invasive approaches to hydration assessment, focusing on their significance in preventing kidney stone disease and enhancing kidney health.

Effective Nature-Based Outdoor Play and Learning Environments for below-3 Children: A Literature-Based Summary

Early childhood (0-8 years) is a time of rapid brain development supported by spontaneous and informal learning from the surrounding environment. Meaningful contact with nature (a dynamic and varied source of informal learning) during the early years of life sets up rich scopes for such spontaneous learning-especially in the first three years, a period in life that determines all future learning, behavior, and health. Besides its learning affordances, nature-based environments provide numerous health and developmental benefits. Considering that more than 13 million children under 5 years of age in the US spend most of their waking hours in care facilities, the potential benefits of having a nature-based outdoor area in their primary care environments are immense. However, guidelines and assessment standards for designing nature-based outdoor environments for below-three children (infants and toddlers) are almost non-existent. This three-phase research holds the promise of addressing this issue. Phase 1 reviews the available limited literature on below-three children's outdoor play and learning environments and summarizes their design implications. Phase 2 extracts effective design guidelines and identifies assessment indicators from the Phase 1 studies. In Phase 3, empirical data (environmental assessment data) are collected to compare the existing and proposed design environment conditions of below-3 outdoor play and learning environments in a selected childcare facility. This phase highlights evidence-based assumptions of new criteria, guidelines, and indicators to assess any below-3 nature-based childcare outdoor environments. This research provides new information and insights for designing nature-based outdoor play and learning environments for below-3 children to increase their meaningful connections with natural elements while attending a care facility.

Air quality and mental illness: role of bioaerosols, causal mechanisms and research priorities

BACKGROUND

Poor air quality can both trigger and aggravate lung and heart conditions, as well as affecting child development. It can even lead to neurological and mental health problems. However, the precise mechanisms by which air pollution affect human health are not well understood.

AIMS

To promote interdisciplinary dialogue and better research based on a critical summary of evidence on air quality and health, with an emphasis on mental health, and to do so with a special focus on bioaerosols as a common but neglected air constituent.

METHOD

A rapid narrative review and interdisciplinary expert consultation, as is recommended for a complex and rapidly changing field of research.

RESULTS

The research methods used to assess exposures and outcomes vary across different fields of study, resulting in a disconnect in bioaerosol and health research. We make recommendations to enhance the evidence base by standardising measures of exposure to both particulate matter in general and bioaerosols specifically. We present methods for assessing mental health and ideal designs. There is less research on bioaerosols, and we provide specific ways of measuring exposure to these. We suggest research designs for investigating causal mechanisms as important intermediate steps before undertaking larger-scale and definitive studies.

CONCLUSIONS

We propose methods for exposure and outcome measurement, as well as optimal research designs to inform the development of standards for undertaking and reporting research and for future policy.

Livestreaming clinical experience to remotely located learners: A critical narrative review

CONTEXT

Medical education relies on real patient learning (RPL) to provide medical students with essential clinical experience. However, growing demand for clinical placements continues to be a challenge in providing sufficient RPL opportunities. The COVID-19 pandemic forced academic institutions to rethink the delivery of traditional clinical training and innovations in online clinical learning experiences, specifically livestreamed clinical experiences, have emerged which show promise in addressing the capacity limitations of traditional placements. Although previous reviews have explored the use of livestreamed clinical experiences during the pandemic, there is a lack of rigorous theoretical framing to support these innovations.

OBJECTIVES

The aim of this review is two-fold: to examine the effectiveness of livestreamed clinical experiences through an experience-based learning (ExBL) theory perspective and to provide practical recommendations to optimise and implement these innovations.

METHODS

A review of literature was conducted to identify journal articles published between September 2019 and January 2023 reporting on innovations relating to livestreamed clinical experiences. The search focused on undergraduate and postgraduate medical education but relevant evidence from other healthcare professions were also included due to a limited evidence base. Strengths and weaknesses were derived from the literature and analysed in relation to ExBL components.

RESULTS

Principal strengths of livestreamed clinical experiences included expanded access to RPL opportunities and medical specialties, enhanced standardisation of learning experiences and positive perceptions from students regarding convenience. Clinical educators found these innovations enabled teaching at scale. Patients did not perceive such innovations to negatively impact their standard of care. Limitations included the inability to practice physical examination skills, challenges in ensuring learner engagement and connectivity issues.

CONCLUSION

Livestreamed clinical experiences have the potential to effectively expand placement capacity and provide high-quality educational experiences for medical students. Although certain limitations exist, technological and pedagogical adaptations can help overcome these challenges. The application of theoretical frameworks to future online innovations will be fundamental to ensure effective clinical learning.

Logic modelling as hermeneutic praxis: Bringing knowledge systems into view during comprehensive primary health care planning for homelessness in Australia

Logic modelling is used widely in health promotion planning for complex health and social problems. It is often undertaken collaboratively with stakeholders across sectors that hold and enact different institutional approaches. We use hermeneutic philosophy to explore how knowledge is 'lived' by - and unfolds differently for - cross-sectoral stakeholders during comprehensive primary healthcare service planning. An Organisational Action Research partnership was established with a non-government organisation designing comprehensive primary health care for individuals experiencing homelessness in Adelaide, Australia. Grey literature, stakeholder input, academic feedback, a targeted literature review and evidence synthesis were integrated in iterative cycles to inform and refine the logic model. Diverse knowledge systems are active when cross-sectoral stakeholders collaborate on logic models for comprehensive primary health care planning. Considering logic modelling as a hermeneutic praxis helps to foreground and explore these differences. In our case, divergent ideas emerged in how health/wellbeing and trust were conceptualised; language had different meanings across sectors; and the outcomes and data sought were nuanced for various collaborators. We explicate these methodological insights and also contribute our evidence-informed, collaboratively-derived model for design of a comprehensive primary health care service with populations experiencing homelessness. We outline the value of considering cross-sectoral logic modelling as hermeneutic praxis. Engaging with points of difference in cross-sectoral knowledge systems can strengthen logic modelling processes, partnerships and potential outcomes for complex and comprehensive primary health care services.

The underrepresentation of racial/ethnic minorities in research on co-use of nicotine, alcohol, and/or cannabis via ecological momentary assessment methods: A narrative review

BACKGROUND

Co-use of nicotine, alcohol and/or cannabis is common among adults in the United States. Co-use may represent greater addiction severity than single substance use. Recent studies have examined the extent to which the frequency, order, simultaneity, motivations, and contextual factors associated with co-use differ from that of single use. Co-use has become prevalent among racial/ethnic minority individuals who exhibit distinct co-use patterns and related outcomes; however, most of these studies rely on cross-sectional or sparse longitudinal observations. Ecological momentary assessment (EMA) can illuminate such patterns and associations with time-varying contexts. This review summarizes EMA studies on co-use published from 2008 to 2023 involving racial/ethnic minority individuals and point to gaps. Our review addresses: 1) whether use of one substance leads to substitution or complementary use of another, 2) whether antecedents/contexts differ by co-use patterns and minority status, and 3) what consequences of co-use have been documented across co-use patterns or minority status.

METHODS

Search results yielded 465 articles, with 33 meeting inclusion criteria. We extracted study-level characteristics and synthesized the findings.

RESULTS

The findings largely focused on co-use patterns, categories of co-use, proximal antecedents and contexts, and consequences. Variations by minority status were rarely examined; few examined acute effects of unique experiences that may contribute to co-use among racial/ethnic minority adults.

CONCLUSIONS

The EMA literature on co-use is burgeoning in recent years and supports complementary hypothesis. More research to capture time-intensive data on experiences to contextualize the co-use among racial/ethnic minority groups with greater diversity in race/ethnicity is warranted.

Barriers and facilitators when implementing midwifery continuity of carer: a narrative analysis of the international literature

BACKGROUND

Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging.

METHODS

In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence.

RESULTS

Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced.

CONCLUSIONS

By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.

Narrative review on ethical and psychological issues raised by genetic and genomic testing in pediatric oncology care

In pediatric oncology, genetic and genomic tests are proposed throughout the care pathway for many reasons (e.g., cancer characterization, identification of the most appropriate treatment, patient selection for clinical trials, identification of tissue/organ donors, or risk of relapse prediction). Despite the many different approaches (somatic or germline testing, targeted gene or genome sequencing), the implicated individuals are confronted with situations that may intersect and that are interesting to compare. No study has identified and analyzed the available works on these new practices in pediatric oncology. The aim of this narrative literature review was to describe the ethical and psychological perspectives of children with cancer, parents, and healthcare professionals when genetic or genomic testing is proposed as part of the cancer management. Eighteen articles met the inclusion criteria and were comprehensively coded using MAXQDA. Their analysis showed that concerning the subjective implications of genetic and genomic testing, the areas of ambivalence (desire of treatment, desire for knowledge, uncertainty, and guilt) reported by patients and their parents seem to mirror the healthcare professionals' concerns. The ethical and psychological issues about predisposition testing, long discussed in the context of hereditary retinoblastoma and Li-Fraumeni syndrome, represent a useful starting point for a wider discussion of a genetic and genomic testing pathway in pediatric oncology more broadly.

Conceptualisation of health among young people: a protocol for systematic review and thematic synthesis of qualitative studies

BACKGROUND

Self-reported health is a widely used health indicator in surveys and questionnaires. The measure gained attention when research identified its association with mortality in the 1970s and 1980s. The measure is also associated with morbidity and other health outcomes such as the utilisation of health services. Self-reported health is a particularly useful measure for young people because this age group is generally clinically healthy. However, it is known that many chronic conditions have long latency periods that are initiated early in life. Because of its predictive nature, self-reported health can be used to estimate young people's current and future health. Despite its widespread use, however, self-reported health remains a poorly understood concept. This paper presents the protocol for a systematic review that will identify and synthesise qualitative studies that investigate the factors that are considered by young people when they assess their health, and when they talk about health overall.

METHODS

The population of the review is young people aged 10-24 years, with or without health conditions. We will search the databases of MEDLINE (Ovid®), PsycINFO (APA PsycNet), ProQuest Sociology Collection, and Web of Science Core Collection™. We will also utilise techniques of reference checking and forward citation searching, as this strategy has been shown to result in a higher number of high-quality studies in social science systematic reviews. Google Scholar and Google Search were used during preliminary searches; Google Scholar will be utilised for forward citation searching. We will include studies written in English, German, or Finnish; there will be no lower date limit. One reviewer will screen all citations. A second reviewer will independently screen a sample of 20% of the abstracts. Data will be extracted by one researcher, two other researchers will independently review all data extracted, and quality appraisal will be completed by the first reviewer. We will utilise the Quality Framework for the appraisal of included articles and thematic synthesis of qualitative studies.

DISCUSSION

The results of this systematic review will improve the understanding of the factors that are considered during the self-assessments of health; this will improve the interpretation of the results of quantitative research. Also, an improved understanding of the conceptualisation of health will inform the development of health policies and interventions that support young people's health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022367519.

The Interrelationship between Diabetes Mellitus and Emotional Well-Being: Current Concepts and Future Prospects

Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time.

Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review

BACKGROUND

Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences.

OBJECTIVE

This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health.

METHODS

Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation.

RESULTS

The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation.

CONCLUSIONS

Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation.

Teaching of reflection in higher education: a narrative review

Background

Healthcare professional students (HCPs) are encouraged to utilise reflection during and after their study programmes as a part of their life-long learning skill and professional competencies. However, the way in which the concept of reflection is taught and its' influence students' capacity to reflect have not been fully explored. This narrative review aimed to explore how the concept of reflection is taught in higher education and how the teaching of reflection influences HCP students' capacity to reflect.

Methods

Articles that were published during 2014-2024 within three databases, PubMed, CINAHL and ERIC were searched. 1929 articles were eligible for screening. 93 articles were further assessed for eligibility.

Results

18 articles were included. The included articles were geographically well-distributed in both the Global North and Global South countries, indicating universal interest in the topic. Eight articles had qualitative study designs; six had quantitative designs and four had mixed-method designs.Conceptually, the teaching of reflection could be categorised as a spectrum, ranging from: i) structured format (reflective templates or debriefing); ii) semi-structured format (physical/virtual small group discussions, video recordings, AI generative arts, in-verse reflection and concept mapping) and iii) flexible and creative (art-based pedagogy or narratives).All included articles indicated students actual and perceived better understanding of reflection. This claim is supported both quantitatively and qualitatively via either validated instruments or narratives and themes based on students' textual outputs.

Conclusions

This review identified several teaching methods that help facilitating students' capacity to reflect. Findings are unable to recommend the most efficient way to teach reflection since it depends on students' progress in their programmes. However, a more relational approach to teaching of reflection is recommended. Students might begin their reflective journey with a structured format of teaching of reflection then gradually move to less-rigid format of the teaching to empower students' autonomy.

Role of Nonalcoholic Fatty Liver Disease in Periodontitis: A Bidirectional Relationship

Nonalcoholic fatty liver disease (NAFLD) and periodontitis share common risk factors such as obesity, insulin resistance (IR), and dyslipidemia, which contribute to systemic inflammation. It has been suggested that a bidirectional relationship exists between NAFLD and periodontitis, indicating that one condition may exacerbate the other. NAFLD is characterized by excessive fat deposition in the liver and is associated with low-grade chronic inflammation. There are several risk factors for the development of NAFLD, including gender, geriatric community, race, ethnicity, poor sleep quality and sleep deprivation, physical activity, nutritional status, dysbiosis gut microbiota, increased oxidative stress, overweight, obesity, higher body mass index (BMI), IR, type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), dyslipidemia (hypercholesterolemia), and sarcopenia (decreased skeletal muscle mass). This systemic inflammation can contribute to the progression of periodontitis by impairing immune responses and exacerbating the inflammatory processes in the periodontal tissues. Furthermore, individuals with NAFLD often exhibit altered lipid metabolism, which may affect oral microbiota composition, leading to dysbiosis and increased susceptibility to periodontal disease. Conversely, periodontitis has been linked to the progression of NAFLD through mechanisms involving systemic inflammation and oxidative stress. Chronic periodontal inflammation can release pro-inflammatory cytokines and bacterial toxins into the bloodstream, contributing to liver inflammation and exacerbating hepatic steatosis. Moreover, periodontitis-induced oxidative stress may promote hepatic lipid accumulation and IR, further aggravating NAFLD. The interplay between NAFLD and periodontitis underscores the importance of comprehensive management strategies targeting both conditions. Lifestyle modifications such as regular exercise, a healthy diet, and proper oral hygiene practices are crucial for preventing and managing these interconnected diseases. Additionally, interdisciplinary collaboration between hepatologists and periodontists is essential for optimizing patient care and improving outcomes in individuals with NAFLD and periodontitis.

Necessity and influencing factors for integrating oral health in cancer care for older people: a narrative review

PURPOSE

The number of older people with poor oral health diagnosed with cancer is increasing rapidly. However, integration of oral health in cancer care for older people to prevent or minimize oral health complications of cancer treatments is uncommon, except in head and neck oncology. The aim of this review is to describe the need, role of, and factors influencing the integration of oral health(care) into the treatment of older people with cancer.

METHODS

MEDLINE, CINAHL, PubMed, Scopus, and Web of Science databases were searched for papers published in the last 10 years that focus on oral health in older people diagnosed with cancer, the impact of oral health on cancer therapy, and integrated oral health in cancer treatment.

RESULTS

From 523 related papers, 68 publications were included and summarized as follows: (1) oral complications associated with cancer therapies, (2) the need for oral healthcare in older people with cancer, (3) the role of integration of oral health in cancer care, and (4) influencing factors such as ageism, interprofessional education and collaborations, oral healthcare workforce, oral health literacy, and financial considerations.

CONCLUSION

Integration of oral healthcare is highly recommended for the overall well-being of older people with cancer to prevent, minimize, and manage complications in cancer treatment. However, oral healthcare has not been integrated in cancer care yet, except for head and neck cancers. This review identified a notable gap in the literature, highlighting the need for research on integration of oral healthcare in geriatric oncology.

The Characteristics of Endurance Events with a Variable Pacing Profile-Time to Embrace the Concept of "Intermittent Endurance Events"?

A variable pacing profile is common in different endurance events. In these races, several factors, such as changes in elevation or race dynamics, lead participants to perform numerous surges in intensity. These surges are so frequent that certain events, such as cross-country (XC) skiing, mountain biking (MTB), triathlon, and road cycling, have been termed "intermittent endurance events". The characteristics of these surges vary depending on the sport: MTB and triathlon require athletes to perform numerous short (<10 s) bouts; XC skiing require periods of short- and moderate-(30 s to 2 min) duration efforts, while road cycling is comprised of a mix of short-, moderate-, and long-duration (>2 min) bouts. These bouts occur at intensities above the maximal metabolic steady state (MMSS), with many efforts performed at intensities above the athletes' maximal aerobic power or speed (MAP/MAS) (i.e., supramaximal intensities). Given the factors that influence the requirement to perform surges in these events, athletes must be prepared to always engage in a race with a highly stochastic pace. The aim of this review is to characterize the variable pacing profile seen in endurance events and to discuss how the performance of multiple maximal and supramaximal surges in intensity can affect how athletes fatigue during a race and influence training strategies that can lead to success in these races.

Masks and respirators for prevention of respiratory infections: a state of the science review

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): a mixed-methods systematic review

BACKGROUND

Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence.

METHODS

Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist.

RESULTS

A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden.

CONCLUSIONS

This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.