Literature searching methods or guidance and their application to public health topics: A narrative review

Making Video Games More Inclusive for People Living With Motor Neuron Disease: Scoping Review

BACKGROUND

Evidence suggests that individuals with motor neuron disease (MND), a terminal illness, find enjoyment and social connection through video games. However, MND-related barriers can make gaming challenging, exacerbating feelings of boredom, stress, isolation, and loss of control over daily life.

OBJECTIVE

We scoped the evidence to describe relevant research and practice regarding what may help reduce difficulties for people with MND when playing video games.

METHODS

A scoping review was conducted using the Arksey and O'Malley framework, recent scoping review guidance, and engaging with people with lived experience of MND. Peer-reviewed studies were sourced from PubMed and the Swinburne University of Technology Library. Gray literature was identified from government, not-for-profit, commercial, and community websites. Data were extracted and summarized from the collected literature.

RESULTS

The evidence base, consisting of quantitative and qualitative research, lived experience stories, information resources, reviews, and guidelines, included 85 documents. Only 8 (9%) directly addressed video games and people with MND; however, these studies were limited in depth and quality. The primary technologies examined included customized information and communications technology for communication and control of computing systems (including desktop, laptop, smartphone, tablet, and console systems) and video game software and hardware (including hand controllers and accessibility features, such as difficulty level, speed, and remappable buttons and controls). Common factors in the evidence base highlight barriers and enablers to enjoying video games for people with MND. These include technological, physical, social, and economic challenges. Addressing these requires greater involvement of people with MND in game and technology research and development. Changes to information and communications technology, game software and hardware, policies, and guidelines are needed to better meet their needs.

CONCLUSIONS

There is a significant gap in understanding the lived experience of people with MND with video games and what makes playing them easier, including appropriate customization of technology and the social experience of games. This gap perpetuates exclusion from gaming communities and recreation, potentially worsening social isolation. Existing evidence suggesting viable options for future research and practice. Video game and information and communications technology research and development must prioritize qualitative and quantitative research with people with MND at an appropriate scale, with a focus on lived experience, use of improved participant engagement techniques, and user-focused design for more inclusive games. Practical work needs to increase awareness of what can help make games more inclusive, including incorporation of accessibility early in the game production process, early incorporation of accessibility in game production, and affordable options for customized interfaces and other devices to play games.

Interventions to improve pharmacists' competency in chronic disease management: a systematic review of randomized controlled trials

INTRODUCTION

Effective chronic disease management (CDM) is vital for addressing chronic disease challenges. Given the importance of ensuring pharmacists' competence in CDM, interventions targeting knowledge, skills, and attitudes are essential. Therefore, a comprehensive and up-to-date study is needed to analyze these interventions' effect and potential development. Categorizing the interventions based on the Effective Practice and Organization of Care (EPOC) taxonomy is essential for better informing policymakers. The objectives of this systematic review were to identify interventions to improve pharmacists' competency in chronic disease management based on the EPOC taxonomy and summarize their effectiveness.

METHODS

Following methods in the Cochrane Handbook, a systematic search was conducted up to April 2024 on MEDLINE and Scopus. The inclusion criteria were an intervention study with a randomized controlled trial (RCT) design published in English, targeting pharmacists, and measuring knowledge, skills, and attitudes in aspects of CDM. The risk of bias was assessed using Cochrane's RoB 2 tool for either randomized or cluster-randomized trials. Findings are reported narratively and align with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

We included 11 RCT studies that focused on various aspects of CDM among community and hospital pharmacists. Implementation strategies and combined implementation strategies-delivery arrangements interventions were identified. Six implementation strategies interventions consistently yielded effective results, with scores ranging from 0.99 to 9.17 (p < 0.05). However, the other two implementation strategies interventions reported mixed results, with no significant improvements in knowledge or skills. Two implementation strategies-delivery arrangements interventions showed improvements, with score differences ranging from 4.5% (95% CI: 1.6%-7.4%) to 30% (95% CI: 29%-40%). Conversely, one implementation strategies-delivery arrangements intervention showed no significant improvement. The risk of bias assessment revealed varying levels of bias across the studies.

CONCLUSIONS

Implementation strategies and combined implementation strategies-delivery arrangements interventions improved pharmacists' competency in CDM. Most interventions consistently resulted in significant improvements in pharmacists' knowledge, skills, and attitudes. These findings underscore the potential of tailored, competency-based interventions to improve pharmacist competencies in CDM. Policymakers can use these insights to create guidelines and policies that promote ongoing professional development for pharmacists.

The optimal approach for retrieving systematic reviews was achieved when searching MEDLINE and Epistemonikos in addition to reference checking: a methodological validation study

BACKGROUND

Systematic reviews (SRs) are used to inform clinical practice guidelines and healthcare decision making by synthesising the results of primary studies. Efficiently retrieving as many relevant SRs as possible is challenging with a minimum number of databases, as there is currently no guidance on how to do this optimally. In a previous study, we determined which individual databases contain the most SRs, and which combination of databases retrieved the most SRs. In this study, we aimed to validate those previous results by using a different, larger, and more recent set of SRs.

METHODS

We obtained a set of 100 Overviews of Reviews that included a total of 2276 SRs. SR inclusion was assessed in MEDLINE, Embase, and Epistemonikos. The mean inclusion rates (% of included SRs) and corresponding 95% confidence intervals were calculated for each database individually, as well as for combinations of MEDLINE with each other database and reference checking. Features of SRs not identified by the best database combination were reviewed qualitatively.

RESULTS

Inclusion rates of SRs were similar in all three databases (mean inclusion rates in % with 95% confidence intervals: 94.3 [93.9-94.8] for MEDLINE, 94.4 [94.0-94.9] for Embase, and 94.4 [93.9-94.9] for Epistemonikos). Adding reference checking to MEDLINE increased the inclusion rate to 95.5 [95.1-96.0]. The best combination of two databases plus reference checking consisted of MEDLINE and Epistemonikos (98.1 [97.7-98.5]). Among the 44/2276 SRs not identified by this combination, 34 were published in journals from China, four were other journal publications, three were health agency reports, two were dissertations, and one was a preprint. When discounting the journal publications from China, the SR inclusion rate in the recommended combination (MEDLINE, Epistemonikos and reference checking) was even higher than in the previous study (99.6 vs. 99.2%).

CONCLUSIONS

A combination of databases and reference checking was the best approach to searching for biomedical SRs. MEDLINE and Epistemonikos, complemented by checking the references of the included studies, was the most efficient and produced the highest recall. However, our results point to the presence of geographical bias, because some publications in journals from China were not identified.

STUDY REGISTRATION

https://doi.org/10.17605/OSF.IO/R5EAS (Open Science Framework).

Estimating the impact on patient safety of enabling the digital transfer of patients' prescription information in the English NHS

OBJECTIVES

To estimate the number and burden of medication errors associated with prescription information transfer within the National Health Service (NHS) in England and the impact of implementing an interoperable prescription information system (a single digital prescribing record shared across NHS settings) in reducing these errors.

METHODS

We constructed a probabilistic mathematical model. We estimated the number of transition medication errors that would be undetected by standard medicines reconciliation, based on published literature, and scaled this up based on the annual number of hospital admissions. We used published literature to estimate the proportion of errors that lead to harm and applied this to the number of errors to estimate the associated burden (healthcare resource use and deaths). Finally, we used reported effect sizes for electronic prescription information sharing interventions to estimate the impact of implementing an interoperable prescription information system on number of errors and resulting harm.

RESULTS

Annually, around 1.8 million (95% credibility interval (CrI) 1.3 to 2.6 million) medication errors were estimated to occur at hospital transitions in England, affecting approximately 380 000 (95% CrI 260 397 to 539 876) patient episodes. Harm from these errors affects around 31 500 (95% CrI 22 407 to 42 906) patients, with 36 500 (95% CrI 25 093 to 52 019) additional bed days of inpatient care (costing around £17.8 million (95% CrI £12.4 to £24.9 million)) and >40 (95% CrI 9 to 146) deaths. Assuming the implementation of an interoperable prescription information system could reduce errors by 10% and 50%, there could be 180 000-913 000 fewer errors, 3000-15 800 fewer people who experience harm and 4-22 lives saved annually.

CONCLUSIONS

An interoperable prescription information system could provide major benefits for patient safety. Likely additional benefits include healthcare professional time saved, improved patient experience and care quality, quicker discharge and enhanced cross-organisational medicines optimisation. Our findings provide vital safety and economic evidence for the case to adopt interoperable prescription information systems.

Landing error scoring system: A scoping review about variants, reference values and differences according to sex and sport

OBJECTIVE

The Landing Error Scoring System (LESS) is a movement analysis tool proposed to identify the risk of anterior cruciate ligament injuries, very useful for injury prevention. The aim of this study is to review the variants of the LESS, their normative scores and the differences according to sex and sport practiced.

METHODS

PubMed, Scopus and ScienceDirect databases were searched from inception to October 19, 2023. Studies were eligible if the objective was finding normative or reference scores for the LESS, analyze the differences between sexes or sports, or used some variant of the test. Results were limited to available full-text articles published in English in peer-reviewed journals.

RESULTS

Of the 360 articles identified, 20 were included for a full analysis (18,093 participants, age = 8-30 years, males = 70.6%). The military population was the most frequently analyzed (7 studies, n = 16,603). Results showed six variants of the LESS and average values ranged from 2.56 to 7.1. Males and females showed different pattern landing with errors in different planes.

CONCLUSIONS

Our findings highlight the need for more field studies on LESS reference scores, particularly for females and basketball or hockey players. Further research is required before conducting a systematic review and meta-analysis.

Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies

BACKGROUND

As healthcare systems rapidly become more complex, healthcare leaders are navigating expanding role scopes and increasingly varied tasks to ensure the provision of high-quality patient care. Despite a range of leadership theories, models, and training curricula to guide leadership development, the roles and competencies required by leaders in the context of emerging healthcare challenges (e.g., disruptive technologies, ageing populations, and burnt-out workforces) have not been sufficiently well conceptualized. This scoping review aimed to examine these roles and competencies through a deep dive into the contemporary academic and targeted gray literature on future trends in healthcare leadership roles and competencies.

METHODS

Three electronic databases (Business Source Premier, Medline, and Embase) were searched from January 2018 to February 2023 for peer-reviewed literature on key future trends in leadership roles and competencies. Websites of reputable healthcare- and leadership-focused organizations were also searched. Data were analyzed using descriptive statistics and thematic analysis to explore both the range and depth of literature and the key concepts underlying leadership roles and competencies.

RESULTS

From an initial 348 articles identified in the literature and screened for relevance, 39 articles were included in data synthesis. Future leadership roles and competencies were related to four key themes: innovation and adaptation (e.g., flexibility and vision setting), collaboration and communication (e.g., relationship and trust building), self-development and self-awareness (e.g., experiential learning and self-examination), and consumer and community focus (e.g., public health messaging). In each of these areas, a broad range of strategies and approaches contributed to effective leadership under conditions of growing complexity, and a diverse array of contexts and situations for which these roles and competencies are applicable.

CONCLUSIONS

This research highlights the inherent interdependence of leadership requirements and health system complexity. Rather than as sets of roles and competencies, effective healthcare leadership might be better conceptualized as a set of broad goals to pursue that include fostering collaboration amongst stakeholders, building cultures of capacity, and continuously innovating for improved quality of care.

Identification of retracted publications and completeness of retraction notices in public health

OBJECTIVES

Retraction is intended to be a mechanism to correct the published body of knowledge when necessary due to fraudulent, fatally flawed, or ethically unacceptable publications. However, the success of this mechanism requires that retracted publications be consistently identified as such and that retraction notices contain sufficient information to understand what is being retracted and why. Our study investigated how clearly and consistently retracted publications in public health are being presented to researchers.

STUDY DESIGN AND SETTING

This is a cross-sectional study, using 441 retracted research publications in the field of public health. Records were retrieved for each of these publications from 11 resources, while retraction notices were retrieved from publisher websites and full-text aggregators. The identification of the retracted status of the publication was assessed using criteria from the Committee on Publication Ethics and the National Library of Medicine. The completeness of the associated retraction notices was assessed using criteria from Committee on Publication Ethics and Retraction Watch.

RESULTS

Two thousand eight hundred forty-one records for retracted publications were retrieved, of which less than half indicated that the article had been retracted. Less than 5% of publications were identified as retracted through all resources through which they were available. Within single resources, if and how retracted publications were identified varied. Retraction notices were frequently incomplete, with no notices meeting all the criteria.

CONCLUSIONS

The observed inconsistencies and incomplete notices pose a threat to the integrity of scientific publishing and highlight the need to better align with existing best practices to ensure more effective and transparent dissemination of information on retractions.

How do people in prison access palliative care? A scoping review of models of palliative care delivery for people in prison in high-income countries

BACKGROUND

An ageing prison population with complex health needs combined with punitive sentencing practices means palliative care for incarcerated individuals is increasingly important. However, there is limited evidence regarding the models of care delivery in high-income countries, and their associated challenges and benefits.

AIM

To develop a typology of models of palliative care provision for incarcerated individuals, synthesise evidence of their outcomes and describe facilitators of and challenges in delivering different models of palliative and end-of-life care in prisons.

DESIGN

Scoping review following Arksey and O'Malley, with narrative synthesis. The protocol was registered prospectively (reviewregistry1260).

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, the Social Sciences Citation Index and grey literature were searched on 15th March 2023. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.

RESULTS

A total of 16,865 records were screened; 22 peer-reviewed articles and 18 grey literature sources met the inclusion criteria. Three models were identified: Embedded Hospice, Outsourcing Care and Community Collaboration. The Embedded Hospice model shows potential benefits for patients and prisons. Outsourcing Care may miss opportunities for comprehensive care. Collaborative Care relies on proactive prison-community relationships that could be formalised for improvement. Psychosocial and bereavement needs of those dying in prison and their caregivers lack sufficient documentation.

CONCLUSION

Further research is needed to evaluate prison hospice costs and examine how prison hospices impact compassionate release usage. Beyond the USA, policies might formalise care pathways and recognise best practices. Further investigation to address psychosocial needs of people in prison with life-limiting illnesses and post-death bereavement support is required.

The Birth of the Contextual Health Education Readability Score in an Examination of Online Influenza Patient Education Materials

Introduction Influenza is a major global health concern, with its rapid spread and mutation rate posing significant challenges in public health education and communication. Effective patient education materials (PEMs) are crucial for informed decision-making and improved health outcomes. This study evaluates the efficacy of online influenza PEMs using traditional readability tools and introduces the Contextual Health Education Readability Score (CHERS) to address the limitations of existing methods that do not capture the diverse array of visual and thematic means displayed. Materials and methods A comprehensive search was conducted to select relevant online influenza PEMs. This involved looking through Google's first two pages of results sorted by relevance, for a total of 20 results. These materials were evaluated using established readability tools (e.g., Flesch Reading Ease, Flesch-Kincaid Grade Level) and the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability. The study also involved the creation of CHERS, integrating factors such as semantic complexity, cultural relevance, and visual aid effectiveness. The development of CHERS included weighting each component based on its impact on readability and comprehension. Results The traditional readability tools demonstrated significant variability in the readability of the selected materials. The PEMAT analysis revealed general trends toward clarity in purpose and use of everyday language but indicated a need for improvement in summaries and visual aids. The CHERS formula was calculated as follows: CHERS = (0.4 × Average Sentence Length) + (0.3 × Average Syllables per Word) + (0.15 × Semantic Complexity Score) + (0.1 × Cultural Relevance Score) + (0.05 × Visual Aid Effectiveness Score), integrating multiple dimensions beyond traditional readability metrics. Discussion The study highlighted the limitations of traditional readability tools in assessing the complexity and cultural relevance of health information. The introduction of CHERS addressed these gaps by incorporating additional dimensions crucial for understanding in a healthcare context. The recommendations provided for creating effective influenza PEMs focused on language simplicity, cultural sensitivity, and actionability. This may enable further research into evaluating current PEMs and clarifying means of creating more effective content in the future. Conclusions The study underscores the need for comprehensive readability assessments in PEMs. The creation of CHERS marks a significant advancement in this field, providing a more holistic approach to evaluating health literacy materials. Its application could lead to the development of more inclusive and effective educational content, thereby improving public health outcomes and reducing the global burden of influenza. Future research should focus on further validating CHERS and exploring its applicability to other health conditions.

Characteristics of the sources, evaluation, and grading of the certainty of evidence in systematic reviews in public health: A methodological study

Objectives

To systematically explore how the sources of evidence, types of primary studies, and tools used to assess the quality of the primary studies vary across systematic reviews (SRs) in public health.

Methods

We conducted a methodological survey of SRs in public health by searching the of literature in selected journals from electronic bibliographic databases. We selected a 10% random sample of the SRs that met the explicit inclusion criteria. Two researchers independently extracted data for analysis.

Results

We selected 301 SRs for analysis: 94 (31.2%) of these were pre-registered, and 211 (70.1%) declared to have followed published reporting standard. All SRs searched for evidence in electronic bibliographic databases, and more than half (n = 180, 60.0%) searched also the references of the included studies. The common types of primary studies included in the SRs were primarily cross-sectional studies (n = 132, 43.8%), cohort studies (n = 126, 41.9%), randomized controlled trials (RCTs, n = 89, 29.6%), quasi-experimental studies (n = 83, 27.6%), case-control studies (n = 58, 19.3%) qualitative studies (n = 38, 12.6%) and mixed-methods studies (n = 32, 10.6%). The most frequently used quality assessment tools were the Newcastle-Ottawa Scale (used for 50.0% of cohort studies and 55.6% of case-control studies), Cochrane Collaboration's Risk of Bias tool (50.7% of RCTs) and Critical Appraisal Skills Program (38.5% of qualitative studies). Only 20 (6.6%) of the SRs assessed the certainty of the body of evidence, of which 19 (95.0%) used the GRADE approach. More than 65% of the evidence in the SRs using GRADE was of low or very low certainty.

Conclusions

SRs should always assess the quality both at the individual study level and the body of evidence for outcomes, which will benefit patients, health care practitioners, and policymakers.

Efficient searching for NICE public health guidelines: Would using fewer sources still find the evidence?

Systematic searches are integral to identifying the evidence that is used in National Institute for Health and Care Excellence (NICE) public health guidelines (PHGs). This study analyses the sources, including bibliographic databases and other techniques, required for PHGs. The aims were to analyse the sources used to identify the publications included in NICE PHGs; and to assess whether fewer sources could have been searched to retrieve these publications. Data showing how the included publications had been identified was collated using search summary tables. Three scenarios were created to test various combinations of sources to determine whether fewer sources could have been used. The sample included 29 evidence reviews, compiled using 13 searches, to support 10 PHG topics. Across the PHGs, 23 databases and six other techniques retrieved included publications. A mean reduction in total results of 6.5% could have been made if the minimum set of sources plus Cochrane Library, Embase, and MEDLINE were searched. On average, Cochrane Library, Embase, and MEDLINE contributed 76.8% of the included publications, with other databases adding 11% and other techniques 12.2%. None of the searches had a minimum set that was comprised entirely of databases. There was not a core set of sources for PHGs. A range of databases and techniques, covering a multi-disciplinary evidence base, was required to identify all included publications. It would be possible to reduce the number of sources searched and make some gains in productivity. It is important to create a tailored set of sources to do an efficient search.

A Tailored Approach: A model for literature searching in complex systematic reviews

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it ‘the Conventional Approach’. The Conventional Approach appears to meet the needs of researchers undertaking literature searches for systematic reviews of clinical interventions. In this article, we report a new and alternate process model of literature searching called ‘A Tailored Approach’. A Tailored Approach is indicated as a search process for complex reviews which do not focus on the evaluation of clinical interventions. The aims of this article are to (1) explain the rationale for, and the theories behind, the design of A Tailored Approach; (2) report the current conceptual illustration of A Tailored Approach and to describe a user’s interaction with the process model; and (3) situate the elements novel to A Tailored Approach (when compared with the Conventional Approach) in the relevant literature. A Tailored Approach suggests investing time at the start of a review, to develop the information needs from the research objectives, and to tailor the search approach to studies or data. Tailored Approaches should be led by the information specialist (librarian) but developed by the research team. The aim is not necessarily to focus on comprehensive retrieval. Further research is indicated to evaluate the use of supplementary search methods, methods of team-working to define search approaches, and to evaluate the use of conceptual models of information retrieval for testing and evaluation.

Health Libraries Group at 75

Celebrating its 75th year in 2022, Lynsey Hawker and Imrana Ghumra, Co-Chairs of the Health Libraries Group (HLG) look back on its origins, celebrate key activities and achievements. From its humble beginnings as the Medical Section of the UK Library Associations' University and Research Section, becoming a Section in its own right, its evolution as the Medical, Health and Welfare Libraries Group. Celebrating its publications, awards, partnership working and advocacy work, they invite you to share your memories and reflections on the HLG and its previous incarnations.