Knowledge transfer for the management of dementia: a cluster randomised trial of blended learning in general practice

Policy options to address the effectiveness of health service management graduates in solving Iranian health system challenges: a mixed scoping review and policy Delphi approach

Background

Iran's healthcare system is grappling with multifaceted challenges, including financial constraints, staffing shortages, infrastructural deficiencies, legal hurdles, and cross-sectoral coordination issues. The integration of health service management graduates into the healthcare workforce is vital to tackle these obstacles effectively. However, the lack of skilled managers can exacerbate problems, leading to inflated costs, and wasted resources. This study aims to propose policy options to improve the effectiveness of healthcare management graduates in exposure to the challenges of Iran's health system.

Methods

The study used a mixed-methods design that combined a scoping review and interviews with academics specializing in healthcare management and hospital management, as well as key informants of the Ministry of Health and Medical Education (MoHME), the vice chancellor and deans of faculties of management and paramedicine (December 1, 2022 to February 30, 2023), and a policy Delphi technique (April 1, 2023 to Jun 30, 2023). In the scoping review, we searched PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC for articles published from the inception of each database until August 10, 2022, with an update on October 6, 2022. The search terms included "health services," "healthcare organizations," "healthcare management," "health management education," "Iran," "challenges," "issues," "policy," "interventions," "policy options," "solutions," "policy-making," "effectiveness," "efficacy," and similar terms. We incorporated scholarly articles that presented instances or resolutions demonstrating the impact of health service management graduates in addressing the issues encountered by Iran's healthcare system. Non-English research papers, except Persian, were excluded due to translation resource limitations. Articles from peer-reviewed journals were included based on their publication type, while conference abstracts, book reviews, commentaries, and editorial pieces were considered for review. In the present study, the first step of the modified Delphi methodology involved conducting interviews and qualitative content analysis. Then, through two rounds of online surveys, the policy Delphi technique engaged experts and stakeholders in reviewing and prioritising policy options.

Findings

In the scoping review, our initial search of the main databases retrieved 553 articles, with an additional 14 articles from gray literature and 5 studies from local databases, totaling 572 references. 426 studies remained after removing duplicates and reviewing them. We excluded 339 studies that did not align with our study's objectives, leaving us with 87 articles. We had access to the full text of 63 of these studies and ultimately selected 31 for review and thematic analysis. The study involved 21 participants, with a 100% response rate in the interview phase. In the Delphi phase, 64 experts were invited, with 41 participating in Round 1 (64% response rate) and 32 in Round 2 (78% response rate). The scoping review identified eleven policy options, followed by designing an interview guide and presenting nine more options based on expert insights from the interviews. We evaluated twenty policy options using a 5-point Likert scale and modified Delphi methodology to assess their effectiveness, feasibility, relevance, and acceptance cost. The study produced four policy options that were culturally and ethically appropriate, as well as compatible with the context and target population. These options were: 1) training and capacity building based on Iran's health system model; 2) development of the framework of Entrustable Professional Activities (EPAs) for healthcare management graduates; 3) determining the career pathways of healthcare management graduates and reviewing the job categories approved by the Ministry of Health and Medical Education (MoHME); and 4) providing effective collaboration between healthcare management graduates and professionals, policymakers, and stakeholders for integrated health system improvement.

Interpretation

The study provides evidence-based recommendations for improving the education, training, and professional deployment of healthcare management graduates in Iran.

Funding

This work was supported by the National Agency for Strategic Research in Medical Education (NASR) (Grant Number 4020159).

Exploring Outcomes and Mediating Factors Following Supercharged End-to-Side Anterior Interosseous Nerve to Ulnar Nerve Transfer: A Scoping Review With Expert Insight

Purpose

This scoping review with expert insight aims to map outcome measures following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer procedures, integrating clinical, patient-reported, and electrodiagnostic measures. It also explores surgical rationale and recovery trajectories, aiming to standardize methodologies and enhance patient care in nerve transfer surgeries.

Methods

Our search encompassed multiple online databases, including MEDLINE, Embase, PubMed, and Google Scholar, ensuring rigor and comprehensiveness in identifying relevant literature.

Results

Through scrutiny of 17 studies involving 300 patients from 300 articles, along with expert consultations on supercharged end-to-side nerve transfer for ulnar nerve entrapment, promising outcomes emerge, particularly in cubital tunnel syndrome. Primary measures such as Medical Research Council scale assessments and Disabilities of the Arm, Shoulder, and Hand scores demonstrate notable postsurgery improvements, with minor complications noted. Factors influencing recovery include preoperative dysfunction duration and surgical technique. Surgery indications prioritize high ulnar nerve injuries and severe cubital tunnel syndrome.

Conclusions

The review highlights the importance of standardized outcome measures, early intervention, and comprehensive rehabilitation for optimizing supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer outcomes.

Type of study/level of evidence

Therapeutic IIIa.

Effectiveness of a training program in improving knowledge and skills about selected common neurological disorders among primary healthcare doctors: The Karnataka Brain Health Initiative (KaBHI) in India

Introduction

Neurological disorders are the leading causes of death and disability globally. In low-middle-income countries such as India, there is a wide treatment gap for neurological disorders. To address this gap, an initiative known as the Karnataka Brain Health Initiative (KaBHI) was developed in collaboration with the public health system of the state of Karnataka in India.

Method

A structured hybrid training program was conducted for 120 medical doctors working in the Primary Health Centers (PHCs) in the public health system in three districts of Karnataka. Pre- and post-training evaluation was conducted to assess physicians' knowledge and skills for evaluating patients with common neurological conditions.

Results

Of 120 PHC doctors, 111 (92%) scored below the passing score of 50 points out of 100 before the training program. After the training, all trainees scored above this cut-off. The study found a significant improvement in knowledge and skills after the training (before training: 40.48 ± 7.92, after training: 66.28 ± 8.98 (P < 0.001) mean difference = 25.81), and was comparable among the PHC doctors in all three districts.

Conclusions

Our study shows the feasibility of training primary care doctors in the public health system to manage selected common neurological disorders. The training program can potentially help to reduce the treatment gap for neurological disorders in India.

Signs and symptoms of serious illness in infants aged up to 6 months: rapid review of clinical guidelines

BACKGROUND

There is a need to empower parents and carers of young infants to recognise signs of serious illness and to act on these appropriately. Compiling the signs and symptoms of serious illness in infants found in clinical guidelines will support the evidence-based update of the 30+-year-old content of the Baby Check App to empower parents and carers.

OBJECTIVE

To systematically review clinical guidelines for signs and symptoms related to serious illness in infants aged 6 months and below.

METHODS

A rapid review was carried out by searching PubMed, CINAHL, NICE, Cochrane and Embase for clinical guidelines reporting signs and symptoms of serious illness in young infants. The time period was restricted from 2018 to 2023. Only guidelines published in English were included.

RESULTS

Fourteen clinical guidelines from 2307 retrieved articles were reviewed. Sixty signs and symptoms indicative of serious illness in infants were identified from the clinical guidelines. The guidelines originated from the UK (n=9, 65%), Italy (n=1, 7%), South Africa (n=1, 7%), Switzerland (n=1, 7%), USA (n=1, 7%), UK and USA (n=1, 7%). The 10 most frequent signs and symptoms were decreased consciousness, tachypnoea, looks seriously unwell to a health professional, high fever, central cyanosis, apnoea, seizures, frequent vomiting, non-blanching rash and noisy breathing.

CONCLUSIONS

Knowledge of the most frequently occurring signs and symptoms that were found in the reviewed guidelines will contribute to the update of the content of the Baby Check App. This will ensure that guidance for parents and carers is consistent with the current evidence base.

Ethical issues raised by incorporating personalized language models into brain-computer interface communication technologies: a qualitative study of individuals with neurological disease

PURPOSE

To examine the views of individuals with neurodegenerative diseases about ethical issues related to incorporating personalized language models into brain-computer interface (BCI) communication technologies.

METHODS

Fifteen semi-structured interviews and 51 online free response surveys were completed with individuals diagnosed with neurodegenerative disease that could lead to loss of speech and motor skills. Each participant responded to questions after six hypothetical ethics vignettes were presented that address the possibility of building language models with personal words and phrases in BCI communication technologies. Data were analyzed with consensus coding, using modified grounded theory.

RESULTS

Four themes were identified. (1) The experience of a neurodegenerative disease shapes preferences for personalized language models. (2) An individual's identity will be affected by the ability to personalize the language model. (3) The motivation for personalization is tied to how relationships can be helped or harmed. (4) Privacy is important to people who may need BCI communication technologies. Responses suggest that the inclusion of personal lexica raises ethical issues. Stakeholders want their values to be considered during development of BCI communication technologies.

CONCLUSIONS

With the rapid development of BCI communication technologies, it is critical to incorporate feedback from individuals regarding their ethical concerns about the storage and use of personalized language models. Stakeholder values and preferences about disability, privacy, identity and relationships should drive design, innovation and implementation.IMPLICATIONS FOR REHABILITATIONIndividuals with neurodegenerative diseases are important stakeholders to consider in development of natural language processing within brain-computer interface (BCI) communication technologies.The incorporation of personalized language models raises issues related to disability, identity, relationships, and privacy.People who may one day rely on BCI communication technologies care not just about usability of communication technology but about technology that supports their values and priorities.Qualitative ethics-focused research is a valuable tool for exploring stakeholder perspectives on new capabilities of BCI communication technologies, such as the storage and use of personalized language models.

Clinical course of adults with co-occurring hypertrophic cardiomyopathy and hypertension: A scoping review

Introduction

Hypertension affects approximately 50 % of patients with hypertrophic cardiomyopathy (HCM) but clinical course in adults with co-occurring HCM and hypertension is underexplored. Management may be challenging as routine anti-hypertensive medications may worsen obstructive HCM, the most common HCM phenotype. In this scoping review, we sought to synthesize the available literature related to clinical course and outcomes in adults with both conditions and to highlight knowledge gaps to inform future research directions.

Methods

We searched 5 electronic databases (PubMed, CINAHL, Scopus, Embase, Web of Science) to identify peer-reviewed articles, 2011-2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guideline.

Results

Eleven articles met eligibility. Adults with both conditions were older and had higher rates of obesity and diabetes than adults with HCM alone. Results related to functional class and arrhythmia were equivocal in cross-sectional studies. Only 1 article investigated changes in medical therapy among adults with both conditions. Hypertension was a predictor of worse functional class, but was not associated with all-cause mortality, heart failure-related mortality, or sudden-death. No data was found that related to common hypertension-related outcomes, including renal disease progression, nor patient-reported outcomes, including quality of life.

Conclusions

Our results highlight areas for future research to improve understanding of co-occurring HCM and hypertension. These include a need for tailored approaches to medical management to optimize outcomes, evaluation of symptom burden and quality of life, and investigation of hypertension-related outcomes, like renal disease and ischemic stroke, to inform cardiovascular risk mitigation strategies.

Examining the influence of organizational commitment on service quality through the lens of job involvement as a mediator and emotional labor and organizational climate as moderators

This study investigates the impact of organizational commitment and job engagement on service quality, while integrating the influences of organizational climate and emotional labor. Utilizing data from 427 participants, acquired via structured questionnaires, the research employed the Statistical Package for the Social Sciences (SPSS) for analysis. The findings reveal that heightened job engagement and organizational commitment significantly enhance service quality, primarily through reinforcing employees' trust in their organization. A favorable organizational climate is instrumental in strengthening employees' affiliation with their organization, consequently leading to superior service provision. Furthermore, the capability to effectively regulate emotions emerges as a critical factor in both job engagement and the quality of service. The study advocates for augmenting job engagement and organizational commitment, cultivating a supportive workplace atmosphere, and equipping employees with resources for efficient emotional management. These strategies are proposed to substantially improve service quality. The insights derived from this research provide essential directives for managers striving to achieve service excellence.

Characteristics and Outcome of ICU Unplanned Readmission in Trauma Patients During the Same Hospitalization

Objective

This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as the factors that predict this outcome.

Methods

This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center (Shiraz, Iran). It analyzed the ICU readmission rates among trauma patients over three years. The required data were extracted from the Iranian Intensive Care Registry (IICUR), which included patient demographics, injury severity, physiological parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 25.0. Descriptive statistics and different statistical tests, such as T-tests, Mann-Whitney tests, Chi-square tests, and logistic binary regression test were utilized.

Results

Among the 5273 patients discharged from the ICU during the study period, 195 (3.7%) were readmitted during the same hospitalization. Patients readmitted to the ICU had a significantly higher mean age (54.83±22.73 years) than those who were not readmitted (47.08 years, p<0.001). Lower Glasgow Coma Scale (GCS) scores at admission and discharge were associated with ICU readmission, implying that neurological status and readmission risk were correlated with each other. Furthermore, respiratory challenges were identified as the leading cause of unexpected readmission, including respiratory failure, hypoxic respiratory failure, respiratory distress, and respiratory infections such as pneumonia. Injury patterns analysis revealed a higher frequency of poly-trauma and head and neck injuries among patients readmitted to the ICU.

Conclusion

This study underscored the importance of ICU readmission among trauma patients, with a high readmission rate during the same hospitalization. By developing comprehensive guidelines and optimizing discharge processes, healthcare providers could potentially mitigate ICU readmissions and associated complications, ultimately enhancing patient outcomes and resource utilization in trauma ICU settings. This research provided valuable insights to inform evidence-based practices and improve the quality of care delivery for trauma patients in intensive care settings.

Meat consumption & positive mental health: A scoping review

The objective of this scoping review was to examine the breadth of the existing literature on the relation between meat consumption or meat abstention and positive psychological functioning. In April 2022, we conducted a systematic search of online databases (PubMed, PsycINFO, CINAHL Plus, Medline, Cochrane Library, and Web of Science) for primary research examining positive psychological functioning in meat consumers and those who abstain from meat. Thirteen studies met the inclusion/exclusion criteria, representing 89,138 participants (54,413 females and 33,863 males) with 78,562 meat consumers and 10,148 meat abstainers (13-102 years) from multiple geographic regions. The primary outcomes were life satisfaction, "positive mental health", self-esteem, and vigor. The secondary outcomes were "meaning in life", optimism, positive emotions, and psychological well-being. Eight of the 13 studies demonstrated no differences between the groups on positive psychological functioning, three studies showed mixed results, and two studies showed that compared to meat abstainers, meat consumers had greater self-esteem, "positive mental health", and "meaning in life". Studies varied substantially in methods and outcomes. Although a small minority of studies showed that meat consumers had more positive psychological functioning, no studies suggested that meat abstainers did. There was mixed evidence for temporal relations, but study designs precluded causal inferences. Our review demonstrates the need for future research given the equivocal nature of the extant literature on the relation between meat consumption and meat abstention and positive psychological functioning.

Proposing the "Value- and Evidence-Based decision making and Practice" (VEDMAP) framework for Priority-Setting and knowledge translation in low and Middle-Income Countries: A novel framework for Decision-Making in Low-and middle income countries like Malawi

The existence and availability of evidence on its own does not guarantee that the evidence will be demanded and used by decision and policy makers. Decision and policy-makers, especially in low-income settings, often confront ethical dilemmas about determining the best available evidence and its utilization. This dilemma can be in the form of conflict of evidence, scientific and ethical equipoise and competing evidence or interests. Consequently, decisions are made based on convenience, personal preference, donor requirements, and political and social considerations which can result in wastage of resources and inefficiency. To mitigate these challenges, the use of "Value- and Evidence-Based Decision Making and Practice" (VEDMAP) framework is proposed. This framework was developed by Joseph Mfutso-Bengo in 2017 through a desk review. It was pretested through a scoping study under the Thanzi la Onse (TLO) Project which assessed the feasibility and acceptability of using the VEDMAP as a priority setting tool for Health Technology Assessment (HTA) in Malawi. The study used mixed methods whereby it conducted a desk review to map out and benchmark normative values of different countries in Africa and HTA; focus group discussion and key informant interviews to map out the actual (practised) values in Malawi. The results of this review confirmed that the use of VEDMAP framework was feasible and acceptable and can bring efficiency, traceability, transparency and integrity in decision- policy making process and implementation.

Clinical reasoning training sessions for health educators-A scoping review

Objectives

Clinical reasoning (CR) is important in health professions, because it ensures patient safety and decreases morbidity. CR should be introduced early in medical school. Health educators play a major role in advocating for the use of CR among students; however, educators themselves can be a barrier to the incorporation of CR; consequently, CR training sessions for educators have been proposed as a potential solution. This scoping review was conducted to highlight studies on CR training among health educators.

Methods

A scoping review was performed to identify studies on CR training sessions for health educators. PubMed, SciVerse Scopus, Web of Science Core Collection, EBSCO Medline Complete and ERIC databases were searched with terms including clinical reasoning, diagnostic reasoning, teacher and trainer, to identify articles published between 1991 and 2021.

Results

The initial search yielded 6587 articles; after careful selection, n = 12 articles were included in this scoping review. Most CR training sessions were in the medical field, were conducted in North America, and involved clinical educators. The sessions focused on the fundamentals and steps of CR; biases and debiasing strategies; and learners' difficulties with various teaching formats, such as didactic presentations, facilitated small group sessions with case discussions, roleplay, and use of tools and a mobile application. Educators and students had positive perceptions regarding the conduct and effectiveness of the training sessions.

Conclusions

These training sessions were rated highly; however, longitudinal feedback regarding the application of learnt CR teaching strategies is necessary.

Examining Outcomes and Challenges of Telepsychiatry in Australian Elderly: A Scoping Review

Methods

To find relevant articles, we searched PubMed, Scopus, and Web of Science databases. We used a data extraction form to gather information from primary studies. Two researchers followed inclusion and exclusion criteria to select studies and extract data. Disagreements were resolved through discussion with all researchers. Studies needed to be in English, about telepsychiatry for Australian seniors, and use any technology type (synchronous, asynchronous, or both). We excluded nontelepsychiatry articles, books, book chapters, conference abstracts, and editor letters.

Results

Telepsychiatry was effectively employed to manage depression, anxiety, delirium, and cognitive impairments. Among these four disorders, telepsychiatry was mostly used for depression. Videoconference and telephone were mostly used to provide telepsychiatry services. Most telepsychiatry services for Australian seniors included "patient education on disorder control and management," "creating continuous interaction between the patient and the therapist," and "remote patients' assessment." "Reductions in symptoms of disorders," "improving patients' satisfaction with telepsychiatry," and "cost-effectiveness of telepsychiatry" were the most important positive outcomes of using telepsychiatry. We also identified four challenges in using telepsychiatry for elderly individuals in Australia.

Conclusions

This study is the first scoping review in Australia and provides valuable insight into telepsychiatry for elderly individuals.

Identifying dimensions and components of student support system in virtual learning: A scoping review

A student support system (SSS) has a crucial role in the absorption, retention, and success of students in virtual learning. The purpose of this scoping review was to identify and map the available evidence regarding the dimensions and components of the SSS in virtual learning. This study was conducted in accordance with the methodology of the Joanna Briggs Institute (JBI) for scoping reviews. Our search strategy was based on using search engines, such as MEDLINE, EMBASE, Scopus, WoS, CINAHL, ERIC, PsycINFO, ProQuest, and Google Scholar. The articles were published in renowned medical education journals, including Medical Education, Medical Teacher, and Academic Medicine, and the reference lists of identified and reviewed articles were searched manually. The search results were imported into EndNote X20, and after removing duplicates and screenings, 42 studies met the inclusion criteria and were included in the review. A descriptive- analytical approach was employed, including a numerical count of study characteristics (quantitative) and template analysis (qualitative). Five dimensions were identified in the SSS in virtual learning: types of support, domains of support, stages of support, instigating of support, levels of support, and their components and subcomponents. The findings of this study depict a comprehensive roadmap and have an important contribution to the knowledge body of SSS in virtual learning. We suggest system developers, planners, and higher education officials to improve the quality of virtual learning by applying these findings in their planning and decision-making.

Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review

INTRODUCTION

Interprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the evidence of impact is mixed. This has raised questions about whether team-based primary care models are being implemented to facilitate team collaboration and effectiveness. Thus, we present a protocol for a rapid scoping review to systematically map, synthesise and summarise the existing literature on the impact of provider remuneration mechanisms and extrinsic and intrinsic incentives in team-based primary care. This review will answer three research questions: (1) What is the impact of provider remuneration models on team, patient, provider and system outcomes in primary care?; (2) What extrinsic and intrinsic incentives have been used in interprofessional primary care teams?; and (3) What is the impact of extrinsic and intrinsic team-based incentives on team, patient, provider and system outcomes?

METHODS AND ANALYSIS

We will conduct a rapid scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. We will search electronic databases (Medline, Embase, CINAHL, PsycINFO, EconLit) and grey literature sources (Google Scholar, Google). This review will consider all empirical studies and full-text English-language articles published between 2000 and 2022. Reviewers will independently perform the literature search, data extraction and synthesis of included studies. The Mixed Methods Appraisal Tool will be used to appraise the quality of evidence. The literature will be synthesised, summarised and mapped to themes that answer the research question of this review.

ETHICS AND DISSEMINATION

Ethics approval is not required. Findings from this study will be written for publication in an open-access peer-review journal and presented at national and international conferences. Knowledge users are part of the research team and will assist with disseminating findings to the public, clinicians, funders and professional associations.

EMI and CLIL in Asian schools: A scoping review of empirical research between 2015 and 2022

As the role of English as a global language grows, many governments in the Asian region have been promoting the use of English as medium of instruction (EMI) in universities and schools. In recent years, the use of EMI has been promoted in the form of Content Language Integrated Learning (CLIL) in many pre-primary, primary and secondary school systems in Asia. Because this focus on the school sector is relatively new, there seems to be relatively limited empirical research on the implementation of EMI and CLIL in primary and secondary schools in Asia. Using scoping review methodology, this paper aims to 'map the terrain' by providing an overview of the contexts and focus areas of empirical research conducted in the last seven years (2015-2022). The findings highlight gaps in the existing body of literature, including a lack of research in primary school and early childhood contexts, limited research in some countries in the Asian region, and a relatively narrow range of research focus areas, stakeholder perspectives and methodological approaches. These findings highlight areas that future researchers may consider as they investigate EMI and CLIL in school contexts in Asia.

The effect of school-entry age on health is understudied in low- and middle-income countries: A scoping review and future directions for research

Background

Substantive literature has assessed the impact of starting school at younger ages relative to peers on health in high-income countries (HICs), but there is little evidence from low- and middle-income countries (LMICs). Conclusions drawn from HICs may not apply to different education contexts and health threats. This study maps the empirical evidence on the effect of school-entry age on health in LMICs and identifies directions for future research.

Methods

We conducted a scoping review between August and September 2022 by systematically searching the health sciences, education, economics, psychology, and general sciences literature and included quantitative and qualitative studies. The exposure of interest was relative age for grade defined as starting or progressing through school at a younger or older age compared to peers who are in the same grade. We extracted key characteristics of included studies and summarized their findings. We categorized results into broad health domains which emerged a posteriori from our analyses of included studies, including neurodevelopment and mental health, sexual and reproductive health, non-communicable diseases, and nutrition.

Findings

We identified 8 studies from middle-income countries published between 2017 and 2022. Among those studies, we identified 3 quasi-experimental studies using data from Brazil, Mexico, and Vietnam, and 5 observational studies primarily from Türkiye. Children starting school earlier had an increased risk of being diagnosed with attention deficit hyperactivity disorder, earlier sexual debut and cohabitation, adolescent pregnancy, adolescent marriage, and engaged more frequently in risky behavior compared to children who started school later. Pregnant women who started school younger also had fewer prenatal care visits and experienced more pregnancy complications. Although most studies identified negative health consequences from starting school earlier, the evidence for nutritional outcomes, such as overweight and stunting, was mixed. No studies were identified from low-income countries.

Conclusions

Little is known about the health consequences of school-entry age in low-resource settings. Additional research is needed to investigate the impact of relative age for grade, whether and how these effects persist into adulthood, and to inform strategies that can offset potential disadvantages stemming from school-entry cut-off dates.

The Variations in Catastrophic and Impoverishing Health Expenditures, and Its Determinants in Iran: A Scoping Review

Background

The high reliance on out-of-pocket (OOP) payments for health financing in Iran have been led to different inequity problems such as catastrophic health expenditure (CHE) and impoverishment. This scoping review has been conducted to understand the variations in CHE and impoverishment, the underlying determinants of CHE, and its inequality in the past 20 years.

Methods

This scoping review is guided by Arksey and O'Malley's scoping review framework. systematically PubMed, Scopus, Web of Science, ProQuest, Scientific Information Database, IranMedex, IranDoc, Magiran Science, Google Scholar, and grey literature were searched systematically from 1 January 2000 to August 2021. We included studies that reported the rate of CHE, impoverishment, inequality, and its influencing factors. Simple descriptive statistics and narrative synthesis were used to present the review findings.

Results

From 112 included articles, the average incidence of CHE was 3.19% at the 40% threshold, and about 3.21% of the households had impoverished. We found an unfavorable status of health inequality indices, including the average of fair financial contribution (0.833), concentration (-0.01), Gini coefficient (0.42), and Kakwani (-0.149). The most widely applied key drivers influencing the rate of CHE in these studies were household economic status, place of residence, health insurance status, household size, head of the household's gender, education level and employment status, having a household member under 5/ above 60 years old, with chronic diseases (in particular cancer and dialysis), disability, using inpatient and outpatient and dentistry services, medicines and equipment, and low insurance coverage.

Conclusion

The result of this review calls for intensifying health policies and financing structures in Iran to provide more equitable access to all populations, especially the poorest and vulnerable. Moreover, the government is expected to adopt effective measures in inpatient and outpatient care, dental services, medicines, and equipment.

Mobilizing registry data for quality improvement: A convergent mixed-methods analysis and application to spinal cord injury

Introduction

The rising prevalence of complex chronic conditions and growing intricacies of healthcare systems emphasizes the need for interdisciplinary partnerships to advance coordination and quality of rehabilitation care. Registry databases are increasingly used for clinical monitoring and quality improvement (QI) of health system change. Currently, it is unclear how interdisciplinary partnerships can best mobilize registry data to support QI across care settings for complex chronic conditions.

Purpose

We employed spinal cord injury (SCI) as a case study of a highly disruptive and debilitating complex chronic condition, with existing registry data that is underutilized for QI. We aimed to compare and converge evidence from previous reports and multi-disciplinary experts in order to outline the major elements of a strategy to effectively mobilize registry data for QI of care for complex chronic conditions.

Methods

This study used a convergent parallel-database variant mixed design, whereby findings from a systematic review and a qualitative exploration were analyzed independently and then simultaneously. The scoping review used a three-stage process to review 282 records, which resulted in 28 articles reviewed for analysis. Concurrent interviews were conducted with multidisciplinary-stakeholders, including leadership from condition-specific national registries, members of national SCI communities, leadership from SCI community organizations, and a person with lived experience of SCI. Descriptive analysis was used for the scoping review and qualitative description for stakeholder interviews.

Results

There were 28 articles included in the scoping review and 11 multidisciplinary-stakeholders in the semi-structured interviews. The integration of the results allowed the identification of three key learnings to enhance the successful design and use of registry data to inform the planning and development of a QI initiative: enhance utility and reliability of registry data; form a steering committee lead by clinical champions; and design effective, feasible, and sustainable QI initiatives.

Conclusion

This study highlights the importance of interdisciplinary partnerships to support QI of care for persons with complex conditions. It provides practical strategies to determine mutual priorities that promote implementation and sustained use of registry data to inform QI. Learnings from this work could enhance interdisciplinary collaboration to support QI of care for rehabilitation for persons with complex chronic conditions.

Effect of acupuncture on patients with major psychiatric disorder and related symptoms caused by earthquake exposure: Protocol for a scoping review of clinical studies

Earthquakes have the greatest destructive effect among all natural disasters. Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and anxiety disorder (AD) are major psychiatric disorders (MPD) that can be triggered by exposure to earthquakes. Conventional treatments such as pharmacological treatments have several limitations. Acupuncture therapy as a complementary integrative medicine may be an effective alternative treatment for these limitations. This study aimed to identify the status of the clinical evidence regarding acupuncture therapy for earthquake survivors with MPD. We will follow the scoping review process as previously described. The study question is as follows: "Which types of clinical research designs, study types, study durations, adverse events, and clinical outcomes have been reported regarding acupuncture therapy for MPD in earthquake survivors?" Medline, Excerpta Medica dataBASE, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycArticles databases, and Chinese, Korean, and Japanese databases will be comprehensively searched electronically from their inception to November 2022. Data from the included studies will be collected and descriptively analyzed in relation to our research question. We will collate, synthesize, and summarize the extracted data according to the analytical framework of a scoping review. The protocol will conform with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions of Scoping Reviews to ensure the clarity and completeness of our reporting in the whole phase of the scoping review (Protocol registration: https://osf.io/wfru7/). The findings of this scoping review will provide fundamental data that will help researchers identify appropriate research questions and design further studies on the use of acupuncture for MPD management in earthquake survivors. These results will be helpful for developing disaster site-specific research protocols for future clinical trials on this topic.

Evidence for 24-hour posture management: A scoping review

Introduction:

People with complex physical disabilities unable to change their position independently are at risk of developing postural deformities and secondary complications. 24-hour posture management is needed to protect body structure. With inconsistencies in current service provision, this research aimed to scope the evidence for a 24-hour posture management approach.

Method:

A scoping review was conducted using four health and social science databases. Inclusion and exclusion criteria were applied; further papers were included through citation chaining.

Results:

The evidence for 24-hour posture management was often low quality due to the complications of completing robust research studies in this complex specialty. However, many professionals in the field agree that a 24-hour approach to postural care is essential.

Conclusion:

There is a need for clear national policy and guidance relating to postural care and scope for development of dedicated posture management services. Current NHS service provision is variable and inconsistent. Lack of postural care is a safeguarding and human rights issue. Specialist training and research in postural care within the Occupational Therapy profession is required to raise awareness of the role Occupational Therapists can play in preventing postural deformities and other secondary complications through providing good postural care.

Impact of enhancing GP access to diagnostic imaging: A scoping review

BACKGROUND

Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care.

METHODS

A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR).

RESULTS

Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process.

CONCLUSION

Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.

Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review

INTRODUCTION

A well-functioning health system delivers quality services to all people when and where they need them. To help navigate the complex realm of patient care, it is essential that health care professions have a thorough understanding of their scope of practice. However, a lack of uniformity regarding scope of practice across the regulated health professions in Australia currently exists. This has led to ambiguity about what comprises scope of practice in some health care professions in the region.

OBJECTIVE

The objective of this review was to explore the literature on the factors that influence scope of practice of the five largest health care professions in Australia.

METHODS

This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the five largest health care professions in Australia. The search was conducted using the following databases: AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE (Excerpta Medica Database), MANTIS (Manual, Alternative and Natural Therapy Index System), MEDLINE, PubMed, and SCOPUS. Additional data sources were searched from Google and ProQuest.

RESULTS

A total of 12 771 publications were identified from the literature search. Twenty-three documents fulfilled the inclusion criteria and were included in the final analysis. Eight factors were identified across three professions (nursing & midwifery, pharmacy and physiotherapy) that influenced scope of practice: education, competency, professional identity, role confusion, legislation and regulatory policies, organisational structures, financial factors, and professional and personal factors.

CONCLUSION

The results of this study will inform a range of stakeholders including the private and public arms of the healthcare system, educators, employers, funding bodies, policymakers and practitioners about the factors that influence scope of practice of health professions in Australia.

The Effect of a Multidisciplinary Blended Learning Program on Palliative Care Knowledge for Health Care Professionals Involved in the Care for People with Parkinson's Disease

BACKGROUND

Parkinson's disease (PD) is an increasingly prevalent and progressive degenerative disease. Palliative care for PD should be integrated into the routine care for people with PD. However, PD health care professionals typically lack knowledge of palliative care, highlighting the necessity of educational programs in this field.

OBJECTIVE

To determine the effectiveness of a multidisciplinary blended learning program for health care professionals specialized in PD in the Netherlands.

METHODS

We used a pre-posttest intervention design. The intervention consisted of an e-learning in combination with an online network meeting in which the participating health care professionals discussed palliative care for PD with specialists from the field of palliative care. Outcome variables included self-rated level of knowledge (scale 1-10), familiarity with specialized palliative care services (5-point Likert scale) and the validated End-of-Life Professional Caregiver Survey (EPCS).

RESULTS

A total of 1029 participants from sixteen different disciplines, all active in the care for people with PD, with a mean age of 45 years and 13 years of working experience, followed the blended learning program. Self-rated level of knowledge improved from 4.75 to 5.72 (0.96; p < 0.001; 95% CI change = [0.85 . . . 1.08]. Familiarity with palliative care services also increased by 1.06 (from 1.85 to 2.90; p=<0.001; 95% CI change = [1.00 . . . 1.12]).

CONCLUSION

A blended learning program can improve self-rated knowledge about palliative care and its services. Such programs might be a first step towards optimal integration of palliative care expertise and services within PD-care.

Disruptions to the procurement of medical abortion medicines during COVID-19: a scoping review

OBJECTIVES

This scoping review aimed to systematically search, retrieve and map the extent and characteristics of available literature on the evidenced disruptions to medical abortion (MA) medicine procurement caused by the COVID-19 outbreak.

DESIGN

Scoping review using Arksey and O'Malley's methodology and Levac et al's methodological enhancement with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

DATA SOURCES

PubMed, Embase, PMC, Science Direct, the Cochrane Library and Google Scholar were searched from January 2020 to April 2022.

ELIGIBILITY CRITERIA

We included articles in English that: (1) contained information on MA medicines; (2) included descriptions of procurement disruptions, including those with examples, characteristics and/or statistics; (3) documented events during the COVID-19 pandemic; and (4) presented primary data.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened search results, performed a full-text review of preliminarily included articles and completed data extraction in a standard Excel spreadsheet. Extracted data from was compared for validation and synthesised qualitatively.

RESULTS

The two articles included are unpublished grey literature demonstrating evidence of short-lived disruptions in sexual and reproductive health commodity procurement, including MA medicines, in sub-Saharan Africa during the early months of the pandemic. Findings from the two included grey literature articles show that in sub-Saharan contexts, emergency preparedness, stockpiling, adaptations and flexibility of key actors, including donors, alleviated COVID-19 disruptions allowing for resumption of services within weeks.

CONCLUSION

There is a need for increased empirical evidence of MA procurement challenges to understand which barriers to MA procurement may persist and impact continuity of supply while others can fuel resilience and preparedness efforts at the country and subregional levels. The lack of evidence from social marketing organisations and their networks is a significant gap as these actors constitute a vital artery in the distribution of MA commodities in low-income and middle-income countries.

Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review

BACKGROUND

We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits.

METHODS

We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed.

RESULTS

We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI.

DISCUSSION AND CONCLUSION

Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.

A scoping review of frameworks in empirical studies and a review of dissemination frameworks

BACKGROUND

The field of dissemination and implementation (D&I) research has grown immensely in recent years. However, the field of dissemination research has not coalesced to the same degree as the field of implementation research. To advance the field of dissemination research, this review aimed to (1) identify the extent to which dissemination frameworks are used in dissemination empirical studies, (2) examine how scholars define dissemination, and (3) identify key constructs from dissemination frameworks.

METHODS

To achieve aims 1 and 2, we conducted a scoping review of dissemination studies published in D&I science journals. The search strategy included manuscripts published from 1985 to 2020. Articles were included if they were empirical quantitative or mixed methods studies about the dissemination of information to a professional audience. Studies were excluded if they were systematic reviews, commentaries or conceptual papers, scale-up or scale-out studies, qualitative or case studies, or descriptions of programs. To achieve aim 1, we compiled the frameworks identified in the empirical studies. To achieve aim 2, we compiled the definitions from dissemination from frameworks identified in aim 1 and from dissemination frameworks identified in a 2021 review (Tabak RG, Am J Prev Med 43:337-350, 2012). To achieve aim 3, we compile the constructs and their definitions from the frameworks.

FINDINGS

Out of 6017 studies, 89 studies were included for full-text extraction. Of these, 45 (51%) used a framework to guide the study. Across the 45 studies, 34 distinct frameworks were identified, out of which 13 (38%) defined dissemination. There is a lack of consensus on the definition of dissemination. Altogether, we identified 48 constructs, divided into 4 categories: process, determinants, strategies, and outcomes. Constructs in the frameworks are not well defined.

IMPLICATION FOR D&I RESEARCH

This study provides a critical step in the dissemination research literature by offering suggestions on how to define dissemination research and by cataloging and defining dissemination constructs. Strengthening these definitions and distinctions between D&I research could enhance scientific reproducibility and advance the field of dissemination research.

Mapping mad maps and recovery tools developed by mental health service users and survivors of psychiatry: a scoping review

BACKGROUND

Since 1997, several tools based on the experiences of users and survivors of psychiatry have been developed with the goal of promoting self-determination in recovery, empowerment and well-being.

OBJECTIVES

The aims of this study were to identify these tools and their distinctive features, and to know how they were created, implemented and evaluated.

METHOD

This work was conducted in accordance with a published Scoping Review protocol, following the Arksey and O'Malley approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Five search strategies were used, including contact with user and survivor networks, academic database searching (Cochrane, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycARTICLES, SCOPUS, PubMed and Web of Science), grey literature searching, Google Scholar searching and reference harvesting. We focused on tools, elaborated by users and survivors, and studies reporting the main applications of them. The searches were performed between 21 July and 22 September 2022. Two approaches were used to display the data: descriptive analysis and thematic analysis.

RESULTS

Six tools and 35 studies were identified, most of them originating in the USA and UK. Thematic analysis identified six goals of the tools: improving wellness, navigating crisis, promoting recovery, promoting empowerment, facilitating mutual support and coping with oppression. Of the 35 studies identified, 34 corresponded to applications of the Wellness Recovery Action Plan (WRAP). All of them, but one, evaluated group workshops implementations. The most common objective was to evaluate symptom improvement. Only eight studies included users and survivors as part of the research team.

CONCLUSIONS

Only the WRAP has been widely disseminated and investigated. Despite the tools were designed to be implemented by peers, it seems they have been usually implemented without them as trainers. Even when these tools are not aimed to promote clinical recovery, in practice the most disseminated recovery tool is being used in this way.

Knowledge and attitudes of Implementation Support Practitioners-Findings from a systematic integrative review

BACKGROUND

It requires thoughtful planning and work to successfully apply and sustain research-supported interventions like healthcare treatments, social support, or preventive programs in practice. Implementation support practitioners (ISPs) such as facilitators, technical assistance providers, knowledge brokers, coaches or consultants may be involved to actively support the implementation process. This article presents knowledge and attitudes ISPs bring to their work.

METHODS

Building on a previously developed program logic, a systematic integrative review was conducted. Literature was sourced by searching nine electronic data bases, organizational websites, and by launching a call for publications among selected experts and social media. Article screening was performed independently by two researchers, and data from included studies were extracted by members of the research team and quality-assured by the lead researcher. The quality of included RCTs was assessed based on a framework by Hodder and colleagues. Thematic Analysis was used to capture information on knowledge and attitudes of ISPs across the included studies. Euler diagrams and heatmaps were used to present the results.

RESULTS

Results are based on 79 included studies. ISPs reportedly displayed knowledge about the clinical practice they work with, implementation / improvement practice, the local context, supporting change processes, and facilitating evidence-based practice in general. In particular, knowledge about the intervention to be implemented and its target population, specific improvement / implementation methods and approaches, organizational structures and sensitivities, training, and characteristics of (good) research was described in the literature. Seven themes describing ISPs' attitudes were identified: 1) professional, 2) motivated / motivating / encouraging / empowering, 3) empathetic / respectful / sensitive, 4) collaborative / inclusive, 5) authentic, 6) creative / flexible / innovative / adaptive, and 7) frank / direct / honest. Pertaining to a professional attitude, being responsive and focused were the most prevalent indicators across included publications.

CONCLUSION

The wide range and complexity of knowledge and attitudes found in the literature calls for a comprehensive and systematic approach to collaboratively develop a professional role for ISPs across disciplines. Embedding the ISP role in different health and social welfare settings will enhance implementation capacities considerably.

Emerging professional practices focusing on reducing inequity in speech-language therapy and audiology: a scoping review protocol

BACKGROUND

Human communication is essential for socialising, learning and working. Disabilities and social disadvantage have serious negative consequences on communication which can impact development from early life into adulthood. While speech-language therapists and audiologists (SLT/As) have an important role to play in addressing communication disability and disadvantage, services continue to be inaccessible, unaffordable and unattainable for the majority population. In order to support this large population, it is necessary to reimagine SLT/A practices in line with equity and social inclusion. Recently in the literature, there have been increasing calls for professions to reduce inequities in practice as indicated by the sustainable development goals, human rights and social inclusion approaches increasing in prominence. For the scoping review, equity is understood using the colonial matrix of power to understand how intersections of race, gender, class, disability, geography, heteronormativity and language create the context for inequity. As such, the aim of the scoping review is to address the following question: what are the emerging professional practices in SLT/A focused on reducing inequities?

METHODS

Following the Joanna Briggs Institute guidelines, this scoping review will focus on systematically mapping the documented emerging clinical practices in SLT/A in the literature to identify how the professions are developing equitable practices. The search will include electronic databases and grey literature including PubMed, Scopus, EbscoHost, The Cochrane Library and Dissertation Abstracts International, Education Resource Information Centre from their inception onwards. Published and unpublished literature including all evidence sources will be considered. There should be a clear focus on clinical practice addressing equity in SLT/A. There will be no language limitations for the study. The authors will endeavour translate to have abstracts of articles translated. There will be no time restrictions on date of publication of the literature.

DISCUSSION

We aim to review the current literature on emerging professional practices in relation to equity in SLT/A to identify emerging trends in clinical practice. It is our goal to provide a synthesis of emerging directions for practice, particularly to inform future practices in the Global South.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework ( osf.io/3a29w ).

Emergency nurses' triage narrative data, their uses and structure: a scoping review protocol

INTRODUCTION

The first clinical interaction most patients have in the emergency department occurs during triage. An unstructured narrative is generated during triage and is the first source of in-hospital documentation. These narratives capture the patient's reported reason for the visit and the initial assessment and offer significantly more nuanced descriptions of the patient's complaints than fixed field data. Previous research demonstrated these data are useful for predicting important clinical outcomes. Previous reviews examined these narratives in combination or isolation with other free-text sources, but used restricted searches and are becoming outdated. Furthermore, there are no reviews focused solely on nurses' (the primary collectors of these data) narratives.

METHODS AND ANALYSIS

Using the Arksey and O'Malley scoping review framework and PRISMA-ScR reporting guidelines, we will perform structured searches of CINAHL, Ovid MEDLINE, ProQuest Central, Ovid Embase and Cochrane Library (via Wiley). Additionally, we will forward citation searches of all included studies. No geographical or study design exclusion criteria will be used. Studies examining disaster triage, published before 1990, and non-English language literature will be excluded. Data will be managed using online management tools; extracted data will be independently confirmed by a separate reviewer using prepiloted extraction forms. Cohen's kappa will be used to examine inter-rater agreement on pilot and final screening. Quantitative data will be expressed using measures of range and central tendency, counts, proportions and percentages, as appropriate. Qualitative data will be narrative summaries of the authors' primary findings.

PATIENT AND PUBLIC INVOLVEMENT

No patients involved.

ETHICS AND DISSEMINATION

No ethics approval is required. Findings will be submitted to peer-reviewed conferences and journals. Results will be disseminated using individual and institutional social media platforms.

Medical education interventions influencing physician distribution into underserved communities: a scoping review

BACKGROUND AND OBJECTIVE

Physician maldistribution is a global problem that hinders patients' abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities.

METHODS

A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians' decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations.

RESULTS

There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness.

CONCLUSIONS

Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.

Human factors applications in the design of decision support systems for population health: a scoping review

INTRODUCTION

Public health professionals engage in complex cognitive tasks, often using evidence-based decision support tools to bolster their decision-making. Human factors methods take a user-centred approach to improve the design of systems, processes, and interfaces to better support planning and decision-making. While human factors methods have been applied to the design of clinical health tools, these methods are limited in the design of tools for population health. The objective of this scoping review is to develop a comprehensive understanding of how human factors techniques have been applied in the design of population health decision support tools.

METHODS AND ANALYSIS

The scoping review will follow the methodology and framework proposed by Arksey and O'Malley. We include English-language documents between January 1990 and August 2021 describing the development, validation or application of human factors principles to decision support tools in population health. The search will include Ovid MEDLINE: Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE 1946-present; EMBASE, Scopus, PsycINFO, Compendex, IEEE Xplore and Inspec. The results will be integrated into Covidence. First, the abstract of all identified articles will be screened independently by two reviewers with disagreements being resolved by a third reviewer. Next, the full text for articles identified as include or inconclusive will be reviewed by two independent reviewers, leading to a final decision regarding inclusion. Reference lists of included articles will be manually screened to identify additional studies. Data will be extracted by one reviewer, verified by a second, and presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

ETHICS AND DISSEMINATION

Ethics approval is not required for this work as human participants are not involved. The completed review will be published in a peer-reviewed, interdisciplinary journal.

Hidden Curriculum in Medical Residency Programs: A Scoping Review

INTRODUCTION

Hidden curriculum is important in medical education and has numerous, long-lasting effects on medical residency. The present scoping review seeks to investigate, identify, and plot the main concepts relating to hidden curriculum and its dimensions, domains, impacts and factors in medical residency courses based on the main references and evidence.

METHODS

Scoping review methodology was used to guide a search of electronic databases for relevant papers. Of the 394 abstracts initially identified, after screening of both abstracts and full-text papers, 43 studies were selected for inclusion in this review. Following abstraction of key information from each study, a content analysis was undertaken.

RESULTS

Eleven themes were identified from the content analysis: 1) Organizational Issues (13.77%), 2) Socio-cultural Issues (10.5%), 3) Professional Issues (13.41%), 4) Communicational Factors (8.7%), 5) Educational Issues (22.83%), 6) Resident Personal Characteristics (21.01%), and 7) Resident Educational Characteristics (9.78%). Among the extracted effective hidden curriculum factors, the role modeling had the highest frequency and was emphasized in the studies.

CONCLUSIONS

Although this study explained and identified the components, elements and also the preparation of the initial format of the hidden curriculum framework of the medical residency program, its results can reduce the negative effects of the hidden curriculum on it. More extensive and in-depth studies with different qualitative methods or mixed methods related to the hidden curriculum in different contexts and disciplines of medical residency are recommended to define characteristics of a constructive hidden curriculum of medical residency programs.

Interpreter-mediated interactions between people using a signed respective spoken language across distances in real time: a scoping review

Background

Communication between people who are deaf and sign and people who use a spoken language is possible by means of an interpreter. Interpreting in real time can be performed at a distance, which differs from interpreting face-to-face. Due to COVID-19, interpretation at a distance has increased.

Objective

The objective of this study was to map the existing literature to identify key characteristics by addressing the following question: What is known about interpreted mediated interactions between people using a signed respective spoken language across distances in real time?

Design

Eight online databases, complemented by a search in one nonindexed journal of relevance to the review, were used to identify original studies published in 2010–2020, and 17 publications met the inclusion criteria. Charting of the data revealed insight from 17 original studies that were extracted, summarized, and reported.

Results

Four key characteristics were identified: (1) advantages and challenges in remote interpreting; (2) the need for training in remote interpreting and video relay service (VRS); (3) regulations and organizational structures of VRS; and (4) the interpreter as an active party in VRS.

Conclusion

Remote interpreting has several challenges but also advantages. Knowledge of these kinds of interactions is limited, and further research must be initiated and realized, not least due to technological developments and the increased number of interpreting events.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07776-y.

Effective coping strategies utilised by medical students for mental health disorders during undergraduate medical education-a scoping review

BACKGROUND

Coping denotes cognitive, emotional and behavioural struggles to tackle a troubled person-environment association. Therefore, coping strategies (CSs) are vital for mental well-being. Widespread research studies have explored this domain, targeting caregivers, nurses, physicians and medical teachers, but limited research has been done to explore the common CSs utilised by medical students at the undergraduate medical education level. Therefore, we aimed to identify the frequently occurring CSs and their effects on mental health disorders (MHDs) through the evidence available in the existing literature.

METHODS

For this scoping review, we searched the available literature (articles published from January 1, 1986, to March 31, 2021) on CSs at Google Scholar, PubMed and Scopus using the terms coping, medical students and undergraduate medical education. We included in our search all peer-reviewed journal articles whose central topics were the CSs employed by undergraduate medical students of any age, nationality, race and gender.

RESULTS

From among the 2,134 articles that were found, 24 were ultimately included in the study. The articles were authored in 14 countries, allowing us to gather broader data to answer our research question. The first identified theme (MHDs) had four subthemes: stress (55% of the articles), depression (30%), anxiety (25%) and burnout (15%). The second theme (CSs), on the other hand, had eight subthemes: support seeking (60%), active coping (40%), acceptance (40%), avoidance/denial (40%), substance abuse (35%), faith/religion (25%), sports (25%) and miscellaneous (40%).

CONCLUSIONS

Themes and subthemes were identified about the most common CSs utilised by undergraduate medical students to tackle common MHDs in the context of medical education. Among the most used CSs was support (social and emotional) seeking. Teaching medical students how to cope with challenging times is essential.

The characteristics of effective technology-enabled dementia education: a systematic review and mixed research synthesis

BACKGROUND

Dementia education is required to address gaps in dementia-specific knowledge among health and social care practitioners amidst increasing dementia prevalence. Harnessing technology for dementia education may remove obstacles to traditional education and empower large communities of learners. This systematic review aimed to establish the technological and pedagogical characteristics associated with effective technology-enabled dementia education for health and social care practitioners.

METHODS

MEDLINE, PubMed, Web of Science, CINAHL, Scopus, PsycINFO, ERIC and OVID Nursing Database were searched from January 2005 until February 2020. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Study quality was assessed with the Mixed Methods Appraisal Tool. Quantitative evidence was categorised based on Kirkpatrick's Model. Qualitative data was synthesised thematically and integrated with quantitative findings before conclusions were drawn.

RESULTS

Twenty-one published papers were identified. Participants were acute, primary and long-term care practitioners, or were students in higher education. Most training was internet-based; CD-ROMs, simulations and tele-mentoring were also described. Technology-enabled dementia education was predominantly associated with positive effects on learning outcomes. Case-based instruction was the most frequently described instructional strategy and videos were common modes of information delivery. Qualitative themes emerged as existing strengths and experience; knowledge gaps and uncertainty; developing core competence and expertise; involving relevant others; and optimising feasibility.

DISCUSSION

Technology-enabled dementia education is likely to improve dementia knowledge, skills and attitudes among health and social care practitioners from multiple practice contexts. Confidence in the results from quantitative studies was undermined by multiple confounding factors that may be difficult to control in the educational research context. Convenience and flexibility are key benefits of technology-enabled instructive and simulated pedagogy that can support the application of theory into practice. More research is required to understand the role of online learning networks and provisions for equitable engagement. A future emphasis on organisational and environmental factors may elucidate the role of technology in ameliorating obstacles to traditional dementia education.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ( CRD42018115378 ).

The Impacts of Benefit Sanctions: A Scoping Review of the Quantitative Research Evidence

In recent decades, the use of conditionality backed by benefit sanctions for those claiming unemployment and related benefits has become widespread in the social security systems of high-income countries. Critics argue that sanctions may be ineffective in bringing people back to employment or indeed harmful in a range of ways. Existing reviews largely assess the labour market impacts of sanctions but our understanding of the wider impacts is more limited. We report results from a scoping review of the international quantitative research evidence on both labour market and wider impacts of benefit sanctions. Following systematic search and screening, we extract data for 94 studies reporting on 253 outcome measures. We provide a narrative summary, paying attention to the ability of the studies to support causal inference. Despite variation in the evidence base and study designs, we found that labour market studies, covering two thirds of our sample, consistently reported positive impacts for employment but negative impacts for job quality and stability in the longer term, along with increased transitions to non-employment or economic inactivity. Although largely relying on non-experimental designs, wider-outcome studies reported significant associations with increased material hardship and health problems. There was also some evidence that sanctions were associated with increased child maltreatment and poorer child well-being. Lastly, the review highlights the generally poor quality of the evidence base in this area, with few studies employing research methods designed to identify the causal impact of sanctions, especially in relation to wider impacts.

Communication education regarding patient safety for registered nurses in acute hospital settings: a scoping review protocol

INTRODUCTION

The importance of correct and timely communication continues to be emphasised in the area of patient safety. Nurses play a key role in communicating with a variety of healthcare personnel to deliver safe care for patients. Many attempts have been made to improve nursing professionals' communication competencies regarding patient safety. However, the scope, method and effectiveness of communication education regarding patient safety for registered nurses have not been sufficiently reviewed. In order to understand the overall status of this field, a scoping review with a systematic framework is necessary. The objective of this study is to map the extent, range and nature of literature on communication education regarding patient safety for registered nurses in acute hospital settings and identify gaps to guide future research, policy and practice.

METHODS AND ANALYSIS

This study will be conducted in accordance with the methodology for scoping reviews developed by Arksey and O'Malley. To strengthen its rigour, the scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The overall review process will involve an independent review by two reviewers to select and analyse literature. The databases to be explored are MEDLINE (Ovid), Embase, Education Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Korean Medical Database (KMBASE). In addition, we will endeavour to include the grey literature through manual searches on patient safety-related websites. This review will target literature on communication programmes for patient safety provided to registered nurses in acute hospital settings and will include peer-reviewed literature in English and Korean since 2000, when research in the field of patient safety started to increase rapidly.

ETHICS AND DISSEMINATION

Since this study is a review of previous studies, no ethics approval is required. The findings of the study will be disseminated in a peer-reviewed journal for publication.

Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury

INTRODUCTION

Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI.

OBJECTIVE

To systematically map the accessible research literature to answer the research question: Which non-surgical, non-pharmacological interventions are used in the treatment of dysphagia in patients with moderate and severe ABI in the acute and subacute phase? DESIGN: Scoping review based on the methodology of Arksey and O'Malley and methodological advancement by Levac et al. DATA SOURCES: MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021.

ELIGIBILITY CRITERIA

All studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included.

DATA EXTRACTION AND SYNTHESIS

Data was extracted by two independent reviewers and studies were categorised based on treatment modality.

RESULTS

A total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into cortical or non-cortical stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training.

CONCLUSION

This scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.

Implementation of the WHO's collaborative framework for the management of tuberculosis and diabetes: a scoping review

OBJECTIVE

To map evidence on the implementation of the WHO's collaborative framework for the management of tuberculosis (TB) and diabetes mellitus (DM) comorbidity, globally.

DESIGN

Scoping review.

METHODS

Guided by Arksey and O'Malley's scoping review framework, this review mapped literature on the global implementation of the framework for the management of TB and DM comorbidity, globally. An extensive literature search for peer-reviewed studies, theses, studies in the press and a list of references from the selected studies was conducted to source-eligible studies. PubMed, Google Scholar, Web of Science, Science Direct, the EBSCOhost platform (academic search complete, health source: nursing/academic edition, CINAHL with full text), Scopus and the WHO library were used to source the literature. We performed title screening of articles using keywords in the databases, after which two independent reviewers (RS and PV) screened abstracts and full articles. Studies from August 2011 to May 2021 were included in this review and the screening was guided by the inclusion and exclusion criteria. Findings were analysed using the thematic content analysis approach and results presented in the form of a narrative report. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension was used as a checklist and for explaining the scoping review process.

RESULTS

This review found evidence of the WHO TB-DM collaborative framework's implementation in 35 countries across the globe. TB-DM comorbidity was identified in patients through bidirectional screening of both patients with TB and patients with DM in rural and urban settings.

CONCLUSION

Due to the paucity of evidence on mechanisms of collaboration, we recommend further research in other implementing countries to identify techniques used for diagnosis and integration of TB and DM services, in order to ensure that effective and joint management of TB-DM comorbidity in populations is achieved.

Establishing the effectiveness of technology-enabled dementia education for health and social care practitioners: a systematic review

BACKGROUND

Dementia prevalence is increasing globally and yet evidence suggest that gaps exist in dementia-specific knowledge among health and social care practitioners. Technological modes of educational delivery may be as effective as traditional education and can provide practitioners with increased accessibility to dementia training. Benefits of digitally based dementia education have been established including pedagogical strategies that influence dementia knowledge and care attitudes. This review aimed to appraise and synthesise contemporary experimental evidence that evaluated technology-enabled dementia education for health and social care practitioners. Outcomes based on Kirkpatrick's Model were learner satisfaction; knowledge, skills, and attitudes; behaviours; and results.

METHODS

MEDLINE, CINAHL, and Web of Science were among 8 bibliographic databases searched from January 2005 until February 2020. Keywords included dementia and education (and terms for technological modes of education, learning, or training). We included experimental and quasi-experimental studies. Medical Education Research Study Quality Instrument established the overall quality of included studies and pragmatic application of Mixed Methods Appraisal Tool established individual study quality and highlighted methodological features of educational research. Narrative synthesis was conducted as heterogeneous outcome data precluded meta-analysis.

RESULTS

We identified 21 relevant studies: 16 evaluated online dementia education and 5 evaluated computer-based approaches. Most studies used before-after designs and study quality was moderate overall. Most studies reported knowledge-based outcomes with statistically significant findings favouring the training interventions. Positive effects were also observed in studies measuring skills and attitudinal change. Fewer studies reported significant findings for behavioural change and results due to training. Case-based instruction was a frequently described instructional strategy in online dementia education and videos were common information delivery modes. CD-ROM training and simulation activities were described in computer-based dementia education.

DISCUSSION

Future emphasis must be placed on teaching and learning methods within technology-enabled dementia education which should be role relevant and incorporate active and interactive learning strategies. Future evaluations will require contextually relevant research methodologies with capacity to address challenges presented by these complex educational programmes and multi-component characteristics.

SYSTEMATIC REVIEW REGISTRATION

This systematic review is based on a protocol registered with PROSPERO ( CRD42018115378 ).

Adult food choices in association with the local retail food environment and food access in resource-poor communities: a scoping review protocol

INTRODUCTION

The local retail food environment influences dietary patterns and food choices, as suggested in the literature. The lack of access to healthy food within this environment may result in unhealthy food choices which may lead to obesity and the development of non-communicable diseases. Evidence suggests that resource-poor communities may have unhealthy food environments, therefore, preventing residents from making healthy food choices. A systematic scoping review will be conducted to provide an overview of the evidence on adult food choices in association with the local retail food environment and food access in resource-poor communities.

METHODS AND ANALYSIS

This protocol for the scoping review was developed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the framework process by Arksey and O'Malley. Observational studies, published from July 2005 to January 2021, will be searched and screened. Keywords and medical subject headings (MeSH) terms will be used to search several multidisciplinary databases. Two independent reviewers will screen identified articles using the selection criteria and extract data using the PRISMA-ScR checklist. Descriptive numerical and thematic analysis will be performed to evaluate and categorise quantitative and qualitative data.

ETHICS AND DISSEMINATION

Ethical approval will not be required for the review, as data from published studies will be used. The results of this scoping review will form part of a PhD thesis that will be submitted to the University of the Western Cape, South Africa. The review findings will also be presented at conferences and published in a peer-reviewed journal. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER: https://osf.io/shf93.

Dissemination and implementation of national physical activity, sedentary behaviour, and/or sleep guidelines among community-dwelling adults aged 18 years and older: a systematic scoping review and suggestions for future reporting and research

Strategies for dissemination (purposive distribution of a guideline to specific audiences) and implementation (actions to support the general public in meeting guideline recommendations/behavioural benchmarks) of national movement guidelines (physical activity (PA), sedentary behaviour, and sleep) have yet to be synthesized. The purpose of this systematic scoping review was to identify strategies for dissemination and implementation of national PA, sedentary behaviour, and/or sleep guidelines among community-dwelling adults (aged >18 years) and/or stakeholders in Canada and analogous countries. Five search approaches (e.g., published literature, grey literature, targeted web-based, custom Google, and content expert consultation) identified records (e.g., empirical studies, organizational reports, website pages, or guideline messages) that discussed and/or evaluated dissemination or implementation strategies for a prespecified list of guidelines. A modified strategy classification system was developed to chart the data. Forty-seven reports met inclusion criteria. Dissemination strategies (n = 42) were more frequently reported than implementation strategies (n = 24). Implementation strategies were more frequently evaluated (n = 13 vs. 7 dissemination strategies) and associated with positive outcomes. The 13 studies that evaluated strategies were at high or serious risk of bias. We identified limited information about the dissemination and implementation of national movement guidelines and identified strategies were rarely evaluated. Greater efforts are required to increase the impact of guidelines among the general public and stakeholders and to build the evidence base in this field. (Open Science Framework registration: https://osf.io/4tyw3.) Novelty An adapted movement guideline dissemination and implementation strategy classification framework is provided. Knowledge translation efforts should be documented and evaluated to advance science and practice in the movement guideline field.

Tools for measuring technical skills during gynaecologic surgery: a scoping review

BACKGROUND

Standardised assessment is key to structured surgical training. Currently, there is no consensus on which surgical assessment tool to use in live gynaecologic surgery. The purpose of this review is to identify assessment tools measuring technical skills in gynaecologic surgery and evaluate the measurement characteristics of each tool.

METHOD

We utilized the scoping review methodology and searched PubMed, Medline, Embase and Cochrane. Inclusion criteria were studies that analysed assessment tools in live gynaecologic surgery. Kane's validity argument was applied to evaluate the assessment tools in the included studies.

RESULTS

Eight studies out of the 544 identified fulfilled the inclusion criteria. The assessment tools were categorised as global rating scales, global and procedure rating scales combined, procedure-specific rating scales or as a non-procedure-specific error assessment tool.

CONCLUSION

This scoping review presents the current different tools for observational assessment of technical skills in intraoperative, gynaecologic surgery. This scoping review can serve as a guide for surgical educators who want to apply a scale or a specific tool in surgical assessment.

Smart aging monitoring and early dementia recognition (SAMEDR): uncovering the hidden wellness parameter for preventive well-being monitoring to categorize cognitive impairment and dementia in community-dwelling elderly subjects through AI

Reasoning weakening because of dementia degrades the performance in activities of daily living (ADL). Present research work distinguishes care needs, dangers and monitors the effect of dementia on an individual. This research contrasts in ADL design execution between dementia-affected people and other healthy elderly with heterogeneous sensors. More than 300,000 sensors associated activation data were collected from the dementia patients and healthy controls with wellness sensors networks. Generated ADLs were envisioned and understood through the activity maps, diversity and other wellness parameters to categorize wellness healthy, and dementia affected the elderly. Diversity was significant between diseased and healthy subjects. Heterogeneous unobtrusive sensor data evaluate behavioral patterns associated with ADL, helpful to reveal the impact of cognitive degradation, to measure ADL variation throughout dementia. The primary focus of activity recognition in the current research is to transfer dementia subject occupied homes models to generalized age-matched healthy subject data models to utilize new services, label classified datasets and produce limited datasets due to less training. Current research proposes a novel Smart Aging Monitoring and Early Dementia Recognition system that provides the exchange of data models between dementia subject occupied homes (DSOH) to healthy subject occupied homes (HSOH) in a move to resolve the deficiency of training data. At that point, the key attributes are mapped onto each other utilizing a sensor data fusion that assures to retain the diversities between various HSOH & DSOH by diminishing the divergence between them. Moreover, additional tests have been conducted to quantify the excellence of the offered framework: primary, in contradiction of the precision of feature mapping techniques; next, computing the merit of categorizing data at DSOH; and, the last, the aptitude of the projected structure to function thriving due to noise data. The outcomes show encouraging pointers and highlight the boundaries of the projected approach.

Bringing narratives from physicians, patients and caregivers together: a scoping review of published research

Patients and family caregivers tell different stories about their illness and care experiences than their physicians do. Better understanding of the relationships among these narratives could offer insight into intersections and disconnections in patient, caregiver and physician perceptions of illness and care. Such understanding could support enhanced patient-centred care in medical education and practice. Narrative writing is increasingly common among physicians, patients and caregivers and uniquely positioned to reveal matters of concern to these groups. We conducted a scoping review to identify literature in which first-person narratives from more than one group (physicians, patients and/or caregivers) were considered as 'data'. A search strategy involving nine databases located 6337 citations. Two reviewers independently screened titles and abstracts. Full-text screening followed (n=82), along with handsearching of grey literature and bibliographies. Of these, 22 met inclusion criteria. Most pieces analysed narratives by patients and caregivers (n=13), followed by patients, caregivers and physicians (n=7) and patients and physicians (n=2). Only nine pieces compared perspectives among any of these groups. The rest combined narratives for analysis, largely patient and caregiver stories (n=12). Most of the 22 papers used descriptive content analysis to derive themes. Themes of humanity, identity, agency and communication intersect between groups but often manifest in unique ways. What is absent, however, is a more interpretive narrative analysis of structure, orientation and characterisation within these narratives, which may reveal even more than their content. This scoping review offers a cautionary tale of lost potential. Many narratives are gathered and analysed but usually only thematically and rarely comparatively. We call for researchers to explore the potential of comparative analysis and the power of narrative inquiry in the field. Comparative narrative analysis may enrich understanding of how differences between perspectives come to be and what they mean for the experience of illness and care.

Effectiveness of face-to-face, blended and e-learning in teaching the application of local anaesthesia: a randomised study

BACKGROUND

Local anaesthesia plays a key role in many aspects of a dentist's work. The required skills to perform anaesthesia successfully are acquired at university. To take advantage of the possibilities for new teaching formats, a blended learning concept for the local anaesthesia course was developed. The aim of the study was to compare the effectiveness of face-to-face, blended and e-learning in teaching in local anaesthesia by assessing students' knowledge gain, performance of practical skills and satisfaction with the course.

METHODS

All participants (n = 37) were randomly allocated into three groups. After acquiring the theoretical background in the blended learning, e-learning or lecture groups, a test to assess knowledge gain was performed. The performance of the practical skills was assessed in a small-group seminar. Student attitudes were evaluated with a questionnaire.

RESULTS

The blended group showed significantly better results (mean = 17, SD =1.5) in theoretical knowledge gain than the other two groups (e-learning group: mean = 14.7, SD = 2.2; lecture group: mean = 14.8, SD =2.3). When comparing the results of the clinical skills assessment, there was no significant difference among all three groups (p > 0.017). The participants confirmed a high overall satisfaction with the course, in particular with the blended learning approach.

CONCLUSION

This study indicates that blended learning improves the learning outcome for theoretical knowledge in teaching local anaesthesia more than either face-to-face learning or e-learning alone. Furthermore, the blended learning approach is highly appreciated by the students. For acquiring practical skills, this study shows that blended learning is as effective as other teaching methods.

Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting - a scoping review

BACKGROUND

As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting.

METHODS

A scoping review was performed based on the five-stage methodological framework developed by Arksey and O'Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data.

RESULTS

A total of 5731 articles were screened. Twenty-nine studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as "Knowledge", "Skills", and "Social/Professional Role and Identity"; issues with "Environmental Context and Resources"; and the impact of "Social Influences" and "Emotion" on prescribing behaviour.

CONCLUSION

The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model

Background

New technologies for clinical staff are typically introduced via an “in-service” that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption.

Methods

The new technology proposed for adoption was a telehealth cart that provided direct video communication with electronic intensive care unit (eICU) staff for a rural Emergency Department (ED). A novel 3-Act-3-Debrief in situ simulation structure was created to target predictive constructs from the CFIR and connect debriefing to specific workflows. The structure and content of the simulation in relation to the framework is described. Participants completed surveys pre-simulation/post-simulation to measure change in their readiness to adopt the new technology.

Results

The scenario was designed and pilot tested before implementation at two rural EDs. There were 60 interprofessional participants across the 2 sites, with 58 pre-simulation and 59 post-simulation surveys completed. The post-simulation mean ratings for each readiness measure (feasibility, quality, resource availability, role clarity, staff receptiveness, and tech usability) increased significantly as a result of the simulation experience.

Conclusions

A novel 3-stage simulation-debriefing structure positively targets factors influencing the adoption of new healthcare technologies.

Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low-income and middle-income settings: protocol for a scoping review

INTRODUCTION

The diabetes mellitus (DM) epidemic is a major public health concern globally, with the highest-burden in low-income and middle-income countries (LMICs). Diabetic retinopathy (DR) is a microvascular complication of diabetes, and if left untreated can lead to visual impairment and blindness. Epidemiological studies suggest that the incidence of sight-threatening DR is decreasing in high-income countries due to improved treatments and management of DM; however, these trends are not replicated in LMICs. In this paper, we outline a scoping review protocol that aims to identify which LMICs have included DR in their national DM, non-communicable disease or prevention of blindness plans. The scoping review also aims to assess gaps when implementing national DR screening programmes in LMICs.

METHODS AND ANALYSIS

This scoping review will follow the Arksey and O'Malley (2005) methodology and the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Review guidelines. A comprehensive search of peer-reviewed and grey literature will be conducted from October 1989 (St. Vincent Declaration) to February 2020. Studies will be identified from electronic databases; Medline, Embase and CENTRAL (Cochrane Library). To identify further relevant articles, a hand search will be conducted using the reference lists of included studies. Two reviewers will independently screen records for relevant data and disagreements about eligibility will be resolved through consensus or arbitration by a third reviewer. A quantitative analysis will be performed to highlight key findings and thematic analysis will be used to identify emerging themes and subthemes from included studies. The key themes will highlight countries progress in terms of national-level DR service planning and screening implementation.

ETHICS AND DISSEMINATION

No ethical approval is required because the scoping review methodology aims to synthesise information from publicly available resources. The results will be disseminated through conference presentations and peer-reviewed publication.