Mapping structure, process and outcomes in the removal of low-value care practices in Canadian intensive care units: protocol for a mixed-methods exploratory study

Assessment of the quality of services of reception with risk classification in obstetrics: a scoping review protocol

INTRODUCTION

Quality assessment in the context of maternal health services in Brazil has been the object of study due to maternal mortality rates that remain high in the country, in addition to the high costs of healthcare and the increased level of complexity in care. To change this situation, several strategies have been proposed to improve care for women. One of them is the improvement of women's access to maternal and child services through the Reception with Obstetric Risk Classification (ACCRO).

OBJECTIVE

To map and synthesise scientific evidence in the literature of studies that assess the quality of ACCRO services from the perspective of users, professionals and managers, as well as map tools that assess the quality of these services and their results.

METHOD AND ANALYSIS

It is a scoping protocol that follows the method recommended by the Joanna Briggs Institute, other authors and guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The Population, Concept and Context strategy will systematise the search in PubMed, Cochrane, Embase, LILACS, SCOPUS and Web of Science and PsycINFO databases. For the grey literature search: Google Scholar, Theses and Dissertations Bank of the Brazilian Institute of Information in Science and Technology, Federated Network of Institutional Repositories of Scientific Publications, Online Theses Electronic Service, Open Access Scientific Repository of Portugal, Academic Archive Online. Searches and application of selection criteria will be performed according to the PRISMA-ScR flow approach. The articles will be selected from the Web Rayyan platform, the results will be analysed and presented in a narrative and thematically organised way. This scoping review is expected to contribute to the feasibility of assessing the quality of ACCRO services.

ETHICS AND DISSEMINATION

Ethics approval is not required. Results will be disseminated through professional networks, conference presentations and publication in a scientific journal. This protocol has been registered with OSF (https://osf.io/sp5df).

American Academy of Ophthalmology Recommendations on Screening for Endogenous Candida Endophthalmitis

The American Academy of Ophthalmology evaluated the practice of routine screening for intraocular infection from Candida septicemia. In the United States, ophthalmologists are consulted in the hospital to screen for intraocular infection routinely for patients with Candida bloodstream infections. This practice was established in the era before the use of systemic antifungal medication and the establishment of definitions of ocular disease with candidemia. A recent systematic review found a rate of less than 1% of routinely screened patients with endophthalmitis from Candida septicemia. Other studies found higher rates of endophthalmitis but had limitations in terms of inaccuracies in ocular disease classification, lack of vitreous biopsies, selection biases, and lack of longer-term visual outcomes. Some studies attributed ocular findings to Candida infections, rather than other comorbidities. Studies also have not demonstrated differences in medical management that are modified for eye disease treatment; therefore, therapy should be dictated by the underlying Candida infection, rather than be tailored on the basis of ocular findings. In summary, the Academy does not recommend a routine ophthalmologic consultation after laboratory findings of systemic Candida septicemia, which appears to be a low-value practice. An ophthalmologic consultation is a reasonable practice for a patient with signs or symptoms suggestive of ocular infection regardless of Candida septicemia.